The Relationship Between Adolescent Hypertension and Stroke Risk After Age 40 Years

Patients with history of adolescent hypertension are at increased risk for stroke.

Hypertension in adolescence is associated with increased risk for stroke during adulthood, according to results of a study published in Stroke.

Adolescent hypertension has been associated with adverse renal and cardiovascular outcomes. Among adults who have had a stroke, hypertension is the most common modifiable risk factor.

To evaluate whether adolescent hypertension is also related with long-term stroke risk, investigators from Tel Aviv University sourced data from the Israeli Defense Forces and linked Israeli National Stroke Registry. Between 1985 and 2013, adolescents (N=1,900,387) received a medical evaluation prior to their compulsory military service. Stroke risk was compared between individuals who had an average blood pressure (BP) of greater than 140/90 mm Hg with those who did not.

The adolescents with (n=5221) and without (n=1,895,166) hypertension had a mean age of 17.6 (SD, 0.6) and 17.3 (SD, 0.5) years (P <.001), 91.8% and 57.6% were boys or men (P <.001), 42.2% and 78.9% had a normal BMI (P <.001), 46.6% and 70.2% had unimpaired health (P <.001), and 5.7% and 1.3% had diabetes (P <.001), respectively.

These findings suggest a potential clinical benefit of hypertension screening among adolescents.

The average systolic BP was 143.3 and 116.2 mm Hg and diastolic BP was 82.5 and 71.4 mm Hg among the hypertensive and control cohorts (both P <.001), respectively.

A total of 1474 first-documented stroke events occurred during a cumulative follow-up of 11,386,187 person-years. The median age at stroke was 43.2 years and 84% of events were ischemic.

In the fully adjusted model, risk for stroke was elevated among individuals with adolescent hypertension compared with the general population (adjusted hazard ratio [aHR], 2.1; 95% CI, 1.3-3.5).

Stratified by age at stroke, the rates of stroke were similar between the groups with and without adolescent hypertension at younger than 40 years of age. However, at ages 40 to 42 (rate ratio [RR], 7.7; 95% CI, 2.9-21.1), 43 to 45 (RR, 4.9; 95% CI, 1.9-13.2), 46 to 48 (RR, 4.3; 95% CI, 1.8-10.4), and 49 to 52 (RR, 4.7; 95% CI, 1.7-12.8) years, rates of stroke were elevated among those who had hypertension during adolescence.

In subgroups, adolescent hypertension remained associated with all-cause stroke risk among patients with unimpaired health (HR, 3.0; 95% CI, 1.7-5.7; P <.001), who were overweight or obese (HR, 2.7; 95% CI, 1.6-4.7; P <.001), and without diabetes (HR, 2.1; 95% CI, 1.1-4.0; P =.02) compared with control patients. Similar trends were observed for ischemic stroke risk.

This study may have been limited by the small number of stroke cases among the adolescent hypertension cohort (n=18).

“…hypertension, even in otherwise healthy adolescents, was associated with overall and specifically ischemic stroke in young adulthood,” the study authors wrote. “These findings suggest a potential clinical benefit of hypertension screening among adolescents.”


Fishman B, Bardugo A, Zloof Y, et al. Adolescent hypertension is associated with stroke in young adulthood: a nationwide cohort of 1.9 million adolescents. Stroke. Published online May 4, 2023. doi:10.1161/STROKEAHA.122.042100