Arterial hypertension in adolescents has been linked to heart attacks and strokes in adulthood
A population-based cohort study by Canadian scientists found that adolescents with arterial hypertension have a 2.1-fold increased risk of serious adverse cardiac events in adulthood over nearly 14 years of follow-up. As reported in JAMA Pediatrics, the risks of stroke, myocardial infarction, unstable angina and congestive heart failure were increased two to three times.
There is a clear relationship between the duration and severity of arterial hypertension and cardiovascular disease risk. Widespread screening programmes for arterial hypertension have revealed that the prevalence of high blood pressure among young people has increased fivefold over the past three decades, from 1.3 per cent in 1990-1999 to 6 per cent in 2010-2014.
However, there is currently no evidence that adolescents and young adults diagnosed with hypertension have a higher risk of cardiovascular disease throughout adulthood. There is also no consensus on the significance of arterial hypertension in children, due to which there are conflicting recommendations for arterial hypertension in children.
A team of scientists led by Rahul Chanchlani of McMaster University conducted a retrospective population-based cohort study to examine the association between arterial hypertension in adolescence and serious cardiovascular events in adulthood. To do this, they used information from long-term follow-up from population-level administrative health databases.
The final cohort included 25605 children with a mean age of 15 (11-17) years with an established diagnosis of arterial hypertension and 128025 children in the control group without arterial hypertension. Baseline characteristics were well balanced after matching.
The median follow-up was 13.6 years and the mean age at last follow-up was 27 years in both cohorts. During follow-up, serious cardiovascular events occurred in 1557 children (6.1 per cent) with arterial hypertension compared with 3901 children in the control group (3.1 per cent). The incidence of cardiovascular events was 4.6 events per 1,000 person-years among children with arterial hypertension compared with 2.2 events per 1,000 person-years in the control group. Thus, children with arterial hypertension had a higher risk of serious cardiovascular events throughout the follow-up period compared with controls (relative risk 2.1).
Children with arterial hypertension had a higher risk of stroke (relative risk 2.7), hospitalisation for myocardial infarction or unstable angina (relative risk 1.8), coronary intervention (relative risk 4.1) and congestive heart failure (relative risk 2.6). No differences were found in the risk of death from cardiovascular disease.
According to the researchers, optimising the care provided to young people with arterial hypertension may help prevent long-term cardiovascular disease in adults. Further studies should confirm these findings among children with arterial hypertension and evaluate strategies for prevention, including dietary and lifestyle changes and the use of antihypertensive medications.