BLOOD PRESSURE IN YOUNG ADULTHOOD AND MORTALITY RISK: 6C.04

Abstract

Background: Blood pressures in adolescents are rising. Relations of systolic and diastolic blood pressures in late adolescence to mortality risk are unknown. Methods: We investigated shapes and magnitudes of such relations among 1,207,141 Swedish men who underwent military conscription examinations at a mean age of 18.4 years, using multivariable-adjusted Cox proportional hazards models. Results: During up to 37.3 years of follow-up, 28,934 men died. A U-shaped relation of systolic blood pressure to mortality risk was observed, with the lowest risk observed at a systolic blood pressure of circa 130 mm Hg. The relation of diastolic blood pressure to mortality risk was monotonous, positive, and stronger than that of systolic blood pressure both in terms of relative risk and population-attributable fraction. An apparent risk threshold was observed at a diastolic blood pressure of circa 90 mm Hg, below which diastolic blood pressure and mortality risk were unrelated, and above which a steep risk increase with higher diastolic blood pressures was observed. Pulse pressure was inversely related to mortality risk. Conclusions: In adolescent men, the relation of systolic blood pressure to mortality risk was U-shaped, and the relation of diastolic blood pressure to mortality risk stronger than that of systolic blood pressure. Diagnostic systolic blood pressure thresholds for adults are hence not applicable in adolescents. Considering current efforts for earlier risk detection and prevention, these observations emphasize risk associated with high diastolic blood pressure in young adulthood.