Adolescent Blood Pressure and the Risk for Early Kidney Damage in Young Adulthood

Tsur, Avishai M; Akavian, Inbal; Derazne, Estela; Tzur, Dorit; Vivante, Asaf; Grossman, Ehud; Rotem, Ran; Fishman, Boris; Afek, Arnon; Coresh, Josef; Chodick, Gabriel; Twig, Gilad

doi:10.1161/hypertensionaha.121.18748

Cited by 7 publications

(9 citation statements)

References 43 publications

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“…A sensitivity analysis limited to those with abnormally high BMI yielded similar results. These observations corroborate previous studies of this cohort that found associations of adolescent hypertension with other metabolic sequela such as early- 8 and end-stage kidney disease, 7 cardiovascular mortality, 9 and type 2 diabetes. 6 As our study is observational in nature, we cannot infer explicit causality.…”

Section: Discussionsupporting

confidence: 92%

“…24 Our study suggests neurological sequela of established late-adolescent hypertension, in the form of stroke in young adulthood. This observation adds to the cumulative evidence of the potentially harmful effects of adolescent hypertension, 3,6–8 even when controlling for such central risk factors as adolescent BMI and diabetes during adult life. While stroke is less common in younger than older adults, the effects are more deleterious in terms of recurrence, disability, and death rates; and the economic impact is greater.…”

Section: Discussionmentioning

confidence: 62%

“…In previous works based on a nationwide cohort of adolescents who underwent screening for blood pressure (BP), we demonstrated associations of adolescent hypertension with higher risks for future type 2 diabetes, 6 early-and end-stage renal disease, 7,8 and cardiovascular mortality. 9 Here we studied the association between adolescent hypertension and incident stroke in young adulthood.…”

mentioning

confidence: 93%

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Adolescent Hypertension Is Associated With Stroke in Young Adulthood: A Nationwide Cohort of 1.9 Million Adolescents

Fishman

Bardugo

Zloof

et al. 2023

Stroke

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 62%

mentioning

confidence: 93%

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Adolescent Hypertension Is Associated With Stroke in Young Adulthood: A Nationwide Cohort of 1.9 Million Adolescents

Fishman

Bardugo

Zloof

et al. 2023

Stroke

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“…As described in an earlier study, 22 we intentionally disregarded incidences of CKD that may be attributed to causes other than BMI. First, we focused on albuminuria, an early stage of CKD, as the outcome and excluded incidences in which the initial presentation included a pronounced reduction in eGFR.…”

Section: Discussionmentioning

confidence: 99%

Adolescent Body Mass Index and Early Chronic Kidney Disease in Young Adulthood

Tsur,

Akavian,

Landau

et al. 2024

JAMA Pediatr

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ImportanceDespite increasing obesity rates in adolescents, data regarding early kidney sequelae are lacking.ObjectiveTo assess the association between adolescent body mass index (BMI) and early chronic kidney disease (CKD) in young adulthood (&lt;45 years of age).Design, Setting, and ParticipantsThis cohort study linked screening data of mandatory medical assessments of Israeli adolescents to data from a CKD registry of a national health care system. Adolescents who were aged 16 to 20 years; born since January 1, 1975; medically evaluated for mandatory military service through December 31, 2019; and insured by Maccabi Healthcare Services were assessed. Individuals with kidney pathology, albuminuria, hypertension, dysglycemia, or missing blood pressure or BMI data were excluded. Body mass index was calculated as weight in kilograms divided by height in meters squared and categorized by age- and sex-matched percentiles according to the US Centers for Disease Control and Prevention. Follow-up started at the time of medical evaluation or January 1, 2000 (whichever came last), and ended at early CKD onset, death, the last day insured, or August 23, 2020 (whichever came first). Data analysis was performed from December 19, 2021, to September 11, 2023.Main Outcomes and MeasuresEarly CKD, defined as stage 1 to 2 CKD by moderately or severely increased albuminuria, with an estimated glomerular filtration rate of 60 mL/min/1.73 m2 or higher.ResultsOf 629 168 adolescents evaluated, 593 660 (mean [SD] age at study entry, 17.2 [0.5] years; 323 293 [54.5%] male, 270 367 [45.5%] female) were included in the analysis. During a mean (SD) follow-up of 13.4 (5.5) years for males and 13.4 (5.6) years for females, 1963 adolescents (0.3%) developed early CKD. Among males, the adjusted hazard ratios were 1.8 (95% CI, 1.5-2.2) for adolescents with high-normal BMI, 4.0 (95% CI, 3.3-5.0) for those with overweight, 6.7 (95% CI, 5.4-8.4) for those with mild obesity, and 9.4 (95% CI, 6.6-13.5) for those with severe obesity. Among females, the hazard ratios were 1.4 (95% CI, 1.2-1.6) for those with high-normal BMI, 2.3 (95% CI, 1.9-2.8) for those with overweight, 2.7 (95% CI, 2.1-3.6) for those with mild obesity, and 4.3 (95% CI, 2.8-6.5) for those with severe obesity. The results were similar when the cohort was limited to individuals who were seemingly healthy as adolescents, individuals surveyed up to 30 years of age, or those free of diabetes and hypertension at the end of the follow-up.Conclusions and RelevanceIn this cohort study, high BMI in late adolescence was associated with early CKD in young adulthood. The risk was also present in seemingly healthy individuals with high-normal BMI and before 30 years of age, and a greater risk was seen among those with severe obesity. These findings underscore the importance of mitigating adolescent obesity rates and managing risk factors for kidney disease in adolescents with high BMI.

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“…46 Effects of childhood BP on the microvasculature is less well described with no difference in microalbuminuria between normotensive and hypertensive adolescents found, 45,47 although 20% of children with primary hypertension (mean age, 16.5 years) had a random urine albumin to creatinine ratio of >3.2 mg/mmol creatinine in a retrospective chart review. 48 In a study of Israeli conscriptees (N=589 702; age, 16-20 years), 0.3% of adolescents with BP ≥130/80 mm Hg developed early kidney damage after 15.1 years, 49 and adolescent BP in this cohort has also been related to adult end-stage renal disease 50 and type 2 diabetes. 51 Danish studies of retinopathy in adolescents (16-17 years old) found a relationship between BP and retinal arteriolar wall-to-lumen ratio but only in girls.…”

Section: Relation Of Child Bp To Subclinical Cardiovascular Diseasementioning

confidence: 94%

Blood Pressure in Children in the 21st Century: What Do We Know and Where Do We Go From Here?

2023

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The association between hypertension in adulthood and cardiovascular morbidity and mortality is well known. Based on that association, a diagnosis of elevated blood pressure in children has been clinically interpreted as early cardiovascular disease. The objective of this review is to discuss historical data and new research on the relationship between elevated blood pressure and early preclinical and later adult cardiovascular disease. After summarizing the evidence, we will address the gaps in knowledge around Pediatric hypertension in an effort to stimulate research into the important role that control of blood pressure in youth may play in preventing adult cardiovascular disease.

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Adolescent Blood Pressure and the Risk for Early Kidney Damage in Young Adulthood

Cited by 7 publications

References 43 publications

Adolescent Hypertension Is Associated With Stroke in Young Adulthood: A Nationwide Cohort of 1.9 Million Adolescents

Adolescent Hypertension Is Associated With Stroke in Young Adulthood: A Nationwide Cohort of 1.9 Million Adolescents

Adolescent Body Mass Index and Early Chronic Kidney Disease in Young Adulthood

Blood Pressure in Children in the 21st Century: What Do We Know and Where Do We Go From Here?

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