Adolescents with even minimally elevated blood pressure have an increased risk for cardiovascular disease as adults, according to an article in the July issue of the American Journal of Hypertension. The Dutch investigators of the Atherosclerosis Risk in Young Adults (ARYA) study concluded that the cascade of events associated with increased cardiovascular risk begins in adolescence, especially for youths with high systolic blood pressure.

"This study is further confirmation of the dangers of even minimal increases in blood pressure and the need for greater public awareness about this condition," said Michael A. Weber, MD, an editor of the journal. "Systolic blood pressure increases as people age and becomes a major risk factor for heart attacks and strokes.

"The study also points out the importance of parents having the blood pressure of their children and teenagers measured as part of an annual physical," he said.

"Early identification of youngsters whose pressures are higher than they ought to be enables physicians to begin intervention programs to stop the consequences of high blood pressure."

The study involved 750 adults (398 women and 352 men) ages 27 to 30 years from one city who voluntarily participated in the project. Investigators had access to a total of 15,592 health records. In addition to a physical examination including blood pressure and pulse pressure, participants underwent an ultrasound examination of both common carotid arteries to assess artery wall thickness.

The procedure, also known as carotid intima-media thickness, is an intermediate measure of vascular damage that is common in young adults. The investigators found that high blood pressure at adolescence continuing into young adulthood was associated with the largest carotid intima-media thickness.

During adolescence, blood pressure values were higher in men while body mass index and stage of sexual maturation were lower. There was a larger percentage of smokers among women, and women tended to have higher childhood socioeconomic status. In young adulthood, blood pressure, weight, height, waist-hip ratio, percentage of smokers and carotid artery thickness were all higher in men.

"In general, systolic blood pressure was found to be more strongly related
to common carotid intima-media thickness than diastolic blood pressure," the
investigators wrote, noting that adolescent pulse pressure was related to a thicker common carotid intima-media thickness at 28 years of age than adolescent systolic blood pressure.

"This increase was found to be independent of other variables at adolescence and young adulthood, including age, sex, body mass index, and adult blood pressure," the researchers concluded. "Our results strengthen the notion that the process of increasing cardiovascular risk is already initiated at adolescence."