Blood pressure in late adolescence and early incidence of coronary heart disease and stroke in the Swedish 1969 conscription cohort.
OBJECTIVE
The association between blood pressure measured in late adolescence and early incidence of coronary heart disease and stroke was investigated in Swedish men. We used measures of systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse pressure.


METHODS
Information on blood pressure at age 18-20 was obtained from a cohort of 49,321 men born in 1949-1951 examined at conscription in 1969/1970. Information on coronary heart disease, acute myocardial infarction, and stroke during 1971-2004 was obtained from national hospital discharge and cause of death registers. Associations between blood pressure and outcomes were estimated with Cox regression as hazard ratios per standard deviation in blood pressure increase in mmHg.


RESULTS
Blood pressure at age 18-20 was found to be associated with coronary heart disease and stroke before 55 years of age. Adjustment for childhood socio-economic position and adolescent smoking, body mass index, and cognitive ability attenuated the associations. Systolic blood pressure was associated with coronary heart disease [hazard ratio (95% confidence interval) 1.09 (1.04, 1.15)] and acute myocardial infarction [1.09 (1.02, 1.17)]. Diastolic blood pressure was associated with coronary heart disease [1.06 (1.00, 1.11)], acute myocardial infarction [1.08 (1.01, 1.15)], and stroke [1.12 (1.04, 1.21)]. Blood pressure measured as mean arterial pressure was significantly associated with coronary heart disease and almost significantly associated with stroke. Pulse pressure had the weakest associations with all outcomes.


CONCLUSIONS
Measures of blood pressure in late adolescence were found to be associated with early incidence of coronary heart disease and stroke. Prediction of outcomes differed between measures.
Falkstedt
Daniel
D
Division of Occupational and Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. daniel.falkstedt@ki.se
Koupil
Ilona
I
Hemmingsson
Tomas
T
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001794:Blood Pressure; D001795:Blood Pressure Determination; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology; D003971:Diastole; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D013548:Sweden; D013599:Systole