Teenage hypertension tied to later ESRD

  • Leiba A & al.
  • JAMA Intern Med
  • 25 Feb 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Hypertension (HTN) in late adolescence is tied to a doubled risk for future end-stage renal disease (ESRD) regardless of overweight or HTN severity.

Why this matters

  • Teenage hypertension is a growing public health issue in developed countries.

Study design

  • Israeli cohort study of 2,658,238 healthy military candidates aged 16-19 years (mean, 17.4±0.5 years; 60.1% male) undergoing comprehensive medical evaluation.
  • 7997 (0.3%) had established HTN (repeated measurements).
  • Funding: None disclosed.

Key results

  • Nearly half of hypertensive teenagers were overweight (20.1%) or obese (28.9%); the majority (90.5%) were male.
    • Majority originated from North America/Europe (42.4%) or former U.S.S.R. (21.3%).
  • 2189 teenagers later developed ESRD over a median 19.6-year follow-up (incidence rate, 3.9 per 100,000 person-years).
    • Rate among those with HTN, 20.2 per 100,000 person-years.
  • In unadjusted analysis, teenage HTN was tied to an increased risk for later ESRD (crude HR=5.07; 95% CI, 3.73-6.88).
  • In multivariate analysis, HR for later ESRD was 1.98 (95% CI, 1.42-2.77) after adjustments for sex, age, education, BMI, and other sociodemographic variables.
    • HR remained significant after excluding teenagers with severe HTN (HR=1.93; 95% CI, 1.37-2.70).
    • ESRD risk remained doubled when analysis was restricted to nonoverweight teenagers with HTN (HR=2.11; 95% CI, 1.05-4.24).

Limitations

  • Retrospective design.