Teen Blood Pressure Predicts Future ESRD Risk

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Otherwise-healthy adolescents with hypertension are at double the risk of developing end stage renal disease (ESRD) as adults, reports a study in JAMA Internal Medicine.

The retrospective study included nearly 2.7 million healthy Israeli youth, aged 16 to 19, who underwent medical evaluation before military conscription from 1967 through 2013. Sixty percent of participants were male. The mean age was 17.4 years. The analysis excluded those with evidence of kidney damage or risk factors for kidney disease. Adolescent hypertension was evaluated for association with ESRD diagnosed from 1990 through 2014, based on national registry data.

At examination, 0.3% of adolescents had diagnosed hypertension (higher than 140/90 mm Hg). Approximately 29% of individuals with hypertension were obese and 20% were overweight, compared to 4% and 9% of nonhypertensive adolescents, respectively. About 42% of hypertensive youth were from the United States or Europe and 21% were from the former Soviet Union.

During a median follow-up of 19.6 years, ESRD was diagnosed in 0.5% of participants who had had hypertension as adolescents. This group had a crude ESRD incidence rate of 20.2 per 100,000 person-years, compared to 3.9 per 100,000 for the nonhypertensive group. In a fully adjusted multivariable model, adolescent hypertension was associated with a twofold increase in ESRD risk: odds ratio 1.98. The association remained significant on analysis excluding participants with severe hypertension (higher than 160/100 mm Hg) and on subanalysis of non-overweight adolescents.

The presence of established hypertension during late adolescence is associated with a twofold increase in the risk of developing ESRD later in life.

“This finding may suggest that nonmalignant hypertension, while being a close surrogate and strong promoter of chronic kidney disease progression, is a relatively modest initiator of the disease,” the researchers write [Leiba A, et al. Association of adolescent hypertension with future end-stage renal disease. JAMA Intern Med 2019; DOI: 10.1001/jamainternmed.2018.7632].