Elevated BP in adolescence a risk factor for atherosclerosis in middle age

Adolescents with high BP levels are at increased risk of atherosclerosis in middle age, with the risk increasing commensurate with BP levels, according to a population-based cohort study from Sweden.

Researchers used linked BP data from the Swedish Military Conscription Register (1972–1987) during adolescence to atherosclerosis data from the Swedish Cardiopulmonary Bioimage Study (2013–2018) during middle age.

Adolescent BP was categorized according to the 2025 American College of Cardiology/American Heart Association (ACC/AHA) and the 2024 European Society of Cardiology (ESC) guidelines. Coronary atherosclerosis was the primary outcome and evaluated using coronary computed tomography angiography stenosis.

The analysis included 10,222 men, with a mean age of 18.3 years at baseline and median age of 57.8 years at follow-up. Mean systolic and diastolic BP were 127.6 and 68.3 mm Hg at baseline. After a median follow-up of 39.5 years, coronary stenosis was between 1 percent and 49 percent in 45.7 percent of participants and ≥50 percent in 8.6 percent.

BP in adolescence showed a dose-response association with coronary stenosis. Compared with normal BP, stage 2 hypertension in adolescence was associated with 84-percent greater odds of severe coronary stenosis (≥50 percent) (adjusted prevalence, 10.1 percent vs 6.9 percent; odds ratio, 1.84, 95 percent confidence interval, 1.40–2.42).

Elevated BP categories based on the 2025 ACC/AHA (120–129/<80 mm Hg) and the 2024 ESC (120–139/70–89 mm Hg) definitions were also associated with severe coronary atherosclerosis in middle age. The association was more pronounced for systolic than for diastolic BP.