2025-11-19 リンショーピング大学
<関連情報>
- https://liu.se/en/news-item/high-blood-pressure-in-adolescence-a-silent-risk-of-atherosclerosis
- https://jamanetwork.com/journals/jamacardiology/fullarticle/2841358
青年期の血圧と中年期の動脈硬化 Blood Pressure in Adolescence and Atherosclerosis in Middle Age
Ángel Herraiz-Adillo, PhD; Hampus Eriksson, MSc; Viktor H. Ahlqvist, PhD;et al
JAMA Cardiology Published:November 19, 2025
DOI:10.1001/jamacardio.2025.4271
Key Points
Question What is the association between blood pressure (BP) in adolescence and computed tomography–detected atherosclerosis in middle age?
Findings In this population-based cohort study of 10 222 men enrolled in the Swedish Military Conscription Register followed up for a median (IQR) duration of 39.5 (35.2-42.8) years, higher BP levels in adolescence were associated with greater risk of coronary atherosclerosis in middle age. Elevated risk was observed at BP of 120/80 mm Hg or higher.
Meaning These findings suggest that BP in adolescence plays a significant role in the development of coronary atherosclerosis in middle age, highlighting the importance of early-life focus on BP prevention strategies.
Abstract
Importance Elevated blood pressure (BP) in adolescence has been linked to higher risk of cardiovascular disease mortality, as well as surrogate markers of atherosclerosis, such as carotid intima-media thickness and coronary artery calcification. However, these markers do not fully capture the complex spectrum of subclinical atherosclerotic cardiovascular disease.
Objective To examine the association between systolic and diastolic BP in adolescence and atherosclerosis in middle age, measured by coronary computed tomography angiography (CCTA).
Design, Setting, and Participants This population-based cohort study conducted in Sweden 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. Data analyses were performed in May 2025.
Exposure 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.
Main Outcomes and Measures The primary outcome was coronary atherosclerosis, evaluated via CCTA stenosis. The associations were analyzed using multinomial logistic regression, adjusted (marginal) prevalences, and restricted cubic splines.
Results A total of 10 222 men with mean (SD) age of 18.3 (0.5) years at baseline and median (IQR) age of 57.8 (53.4-61.2) years at follow-up were included. At baseline, mean (SD) systolic BP (SBP) and diastolic BP (DBP) were 127.6 (10.7) mm Hg and 68.3 (9.5) mm Hg, respectively. After a median (IQR) follow-up of 39.5 (35.2-42.8) years, 4159 participants (45.7%) had 1% to 49% coronary stenosis and 784 (8.6%) had 50% or greater coronary stenosis. Elevated BP in adolescence was associated with coronary stenosis in a dose-response fashion. Adolescents with stage 2 hypertension had a higher risk of severe coronary stenosis (≥50%), with an odds ratio of 1.84 (95% CI, 1.40-2.42) and an adjusted prevalence of 10.1% (95% CI, 8.6%-11.5%) compared to those with normal BP (adjusted prevalence, 6.9%; 95% CI, 5.7%-8.1%). Elevated BP categories according to the 2025 ACC/AHA (120-129/<80 mm Hg) and the 2024 ESC (120-139/70-89 mm Hg) were associated with severe coronary atherosclerosis in middle age. The association was stronger for SBP than for DBP.
Conclusions and Relevance In this population-based cohort study, higher BP levels in adolescence were associated with a dose-dependent higher risk for atherosclerosis in middle age, particularly for severe coronary atherosclerosis. Excess risks of atherosclerosis were even evident in the elevated BP range in adolescence as defined by the 2025 ACC/AHA and 2024 ESC BP guidelines.
