Adolescent Hypertension Is Associated With Stroke in Young Adulthood: A Nationwide Cohort of 1.9 Million Adolescents-Reference-Cited by-同舟云学术

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

Published:2023-06 Issue:6 Volume:54 Page:1531-1537
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Fishman Boris¹²³^ORCID,Bardugo Aya⁴,Zloof Yair¹⁴^ORCID,Bendor Cole D.⁴^ORCID,Libruder Carmit⁵^ORCID,Zucker Inbar¹⁵^ORCID,Lutski Miri¹⁵^ORCID,Ram Amit⁵^ORCID,Hershkovitz Yael⁵^ORCID,Orr Omri⁴⁶,Omer Ma’ayan⁴,Furer Ariel¹²⁴^ORCID,Goldman Adam¹⁷³⁸^ORCID,Yaniv Gal¹⁹,Tanne David¹⁰^ORCID,Derazne Estela¹^ORCID,Tzur Dorit⁴,Afek Arnon¹¹¹,Grossman Ehud¹¹²^ORCID,Twig Gilad¹⁷³¹³^ORCID

Affiliation:

1. Faculty of Medicine (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.), Tel Aviv University, Israel.

2. Division of Cardiology (B.F., A.F.), Sheba Medical Center, Ramat Gan, Israel.

3. The Gertner Institute for Epidemiology and Health Policy Research (B.F., A.G., G.T.), Sheba Medical Center, Ramat Gan, Israel.

4. Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel (A.B., Y.Z., C.D.B., O.O., M.O., A.F., D. Tzur).

5. Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (C.L., I.Z., M.L., A.R., Y.H.).

6. Orthopedic Surgery, Rambam Health Care Campus, Haifa, Israel (O.O.).

7. Department of Epidemiology and Preventive Medicine, School of Public Health (A.G., G.T.), Tel Aviv University, Israel.

8. Department of Medicine F (A.G.), Sheba Medical Center, Ramat Gan, Israel.

9. Department of Diagnostic Imaging (G.Y.), Sheba Medical Center, Ramat Gan, Israel.

10. Rambam Health Care Campus and Rappaport Faculty of Medicine, Haifa, Israel (D. Tanne).

11. Central Management (A.A.), Sheba Medical Center, Ramat Gan, Israel.

12. Hypertension Unit and the Internal Division (E.G.), Sheba Medical Center, Ramat Gan, Israel.

13. Institute of Endocrinology, Diabetes and Metabolism (G.T.), Sheba Medical Center, Ramat Gan, Israel.

Abstract

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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