TY - JOUR
T1 - Adolescent Hypertension Is Associated With Stroke in Young Adulthood
T2 - A Nationwide Cohort of 1.9 Million Adolescents
AU - Fishman, Boris
AU - Bardugo, Aya
AU - Zloof, Yair
AU - Bendor, Cole D.
AU - Libruder, Carmit
AU - Zucker, Inbar
AU - Lutski, Miri
AU - Ram, Amit
AU - Hershkovitz, Yael
AU - Orr, Omri
AU - Omer, Ma'ayan
AU - Furer, Ariel
AU - Goldman, Adam
AU - Yaniv, Gal
AU - Tanne, David
AU - Derazne, Estela
AU - Tzur, Dorit
AU - Afek, Arnon
AU - Grossman, Ehud
AU - Twig, Gilad
N1 - Publisher Copyright:
© 2023 American Heart Association, Inc.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Background: Adult hypertension is a well-established risk factor for stroke in young adults (aged <55 years), and the effects are even more deleterious than at an older age. However, data are limited regarding the association between adolescent hypertension and the risk of stroke in young adulthood. Methods: A nationwide, retrospective cohort study of adolescents (aged 16-19 years) who were medically evaluated before compulsory military service in Israel during 1985 to 2013. For each candidate for service, hypertension was designated after constructed screening, and the diagnosis was confirmed through a comprehensive workup process. The primary outcome was ischemic and hemorrhagic stroke incidence as registered at the national stroke registry. Cox proportional-hazards models were used. We conducted sensitivity analyses by excluding people with a diabetes diagnosis at adolescence or a new diabetes diagnosis during the follow-up period, analysis of adolescents with overweight, and adolescents with baseline unimpaired health status. Results: The final sample included 1 900 384 adolescents (58% men; median age, 17.3 years). In total, 1474 (0.08%) incidences of stroke (1236 [84%] ischemic) were recorded, at a median age of 43 (interquartile range, 38-47) years. Of these, 18 (0.35%) occurred among the 5221 people with a history of adolescent hypertension. The latter population had a hazard ratio of 2.4 (95% CI, 1.5-3.9) for incident stroke after adjustment for body mass index and baseline sociodemographic factors. Further adjustment for diabetes status yielded a hazard ratio of 2.1 (1.3-3.5). We found similar results when the outcome was ischemic stroke with a hazard ratio of 2.0 (1.2-3.5). Sensitivity analyses for overall stroke, and ischemic stroke only, yielded consistent findings. Conclusions: Adolescent hypertension is associated with an increased risk of stroke, particularly ischemic stroke, in young adulthood.
AB - Background: Adult hypertension is a well-established risk factor for stroke in young adults (aged <55 years), and the effects are even more deleterious than at an older age. However, data are limited regarding the association between adolescent hypertension and the risk of stroke in young adulthood. Methods: A nationwide, retrospective cohort study of adolescents (aged 16-19 years) who were medically evaluated before compulsory military service in Israel during 1985 to 2013. For each candidate for service, hypertension was designated after constructed screening, and the diagnosis was confirmed through a comprehensive workup process. The primary outcome was ischemic and hemorrhagic stroke incidence as registered at the national stroke registry. Cox proportional-hazards models were used. We conducted sensitivity analyses by excluding people with a diabetes diagnosis at adolescence or a new diabetes diagnosis during the follow-up period, analysis of adolescents with overweight, and adolescents with baseline unimpaired health status. Results: The final sample included 1 900 384 adolescents (58% men; median age, 17.3 years). In total, 1474 (0.08%) incidences of stroke (1236 [84%] ischemic) were recorded, at a median age of 43 (interquartile range, 38-47) years. Of these, 18 (0.35%) occurred among the 5221 people with a history of adolescent hypertension. The latter population had a hazard ratio of 2.4 (95% CI, 1.5-3.9) for incident stroke after adjustment for body mass index and baseline sociodemographic factors. Further adjustment for diabetes status yielded a hazard ratio of 2.1 (1.3-3.5). We found similar results when the outcome was ischemic stroke with a hazard ratio of 2.0 (1.2-3.5). Sensitivity analyses for overall stroke, and ischemic stroke only, yielded consistent findings. Conclusions: Adolescent hypertension is associated with an increased risk of stroke, particularly ischemic stroke, in young adulthood.
KW - adolescents
KW - diabetes
KW - hypertension
KW - stroke
KW - young adults
UR - http://www.scopus.com/inward/record.url?scp=85159779028&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.122.042100
DO - 10.1161/STROKEAHA.122.042100
M3 - Article
C2 - 37139816
AN - SCOPUS:85159779028
SN - 0039-2499
VL - 54
SP - 1531
EP - 1537
JO - Stroke
JF - Stroke
IS - 6
ER -
