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Adolescent Hypertension Is Associated With Stroke in Young Adulthood: A Nationwide Cohort of 1.9 Million Adolescents.
Fishman, Boris; Bardugo, Aya; Zloof, Yair; Bendor, Cole D; Libruder, Carmit; Zucker, Inbar; Lutski, Miri; Ram, Amit; Hershkovitz, Yael; Orr, Omri; Omer, Ma'ayan; Furer, Ariel; Goldman, Adam; Yaniv, Gal; Tanne, David; Derazne, Estela; Tzur, Dorit; Afek, Arnon; Grossman, Ehud; Twig, Gilad.
Affiliation
  • Fishman B; Faculty of Medicine (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.), Tel Aviv University, Israel.
  • Bardugo A; Division of Cardiology (B.F., A.F.), Sheba Medical Center, Ramat Gan, Israel.
  • Zloof Y; The Gertner Institute for Epidemiology and Health Policy Research (B.F., A.G., G.T.), Sheba Medical Center, Ramat Gan, Israel.
  • Bendor CD; Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel (A.B., Y.Z., C.D.B., O.O., M.O., A.F., D. Tzur).
  • Libruder C; Faculty of Medicine (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.), Tel Aviv University, Israel.
  • Zucker I; Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel (A.B., Y.Z., C.D.B., O.O., M.O., A.F., D. Tzur).
  • Lutski M; Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel (A.B., Y.Z., C.D.B., O.O., M.O., A.F., D. Tzur).
  • Ram A; Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (C.L., I.Z., M.L., A.R., Y.H.).
  • Hershkovitz Y; Faculty of Medicine (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.), Tel Aviv University, Israel.
  • Orr O; Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (C.L., I.Z., M.L., A.R., Y.H.).
  • Omer M; Faculty of Medicine (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.), Tel Aviv University, Israel.
  • Furer A; Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (C.L., I.Z., M.L., A.R., Y.H.).
  • Goldman A; Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (C.L., I.Z., M.L., A.R., Y.H.).
  • Yaniv G; Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (C.L., I.Z., M.L., A.R., Y.H.).
  • Tanne D; Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel (A.B., Y.Z., C.D.B., O.O., M.O., A.F., D. Tzur).
  • Derazne E; Orthopedic Surgery, Rambam Health Care Campus, Haifa, Israel (O.O.).
  • Tzur D; Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel (A.B., Y.Z., C.D.B., O.O., M.O., A.F., D. Tzur).
  • Afek A; Faculty of Medicine (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.), Tel Aviv University, Israel.
  • Grossman E; Division of Cardiology (B.F., A.F.), Sheba Medical Center, Ramat Gan, Israel.
  • Twig G; Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel (A.B., Y.Z., C.D.B., O.O., M.O., A.F., D. Tzur).
Stroke ; 54(6): 1531-1537, 2023 06.
Article in En | MEDLINE | ID: mdl-37139816
BACKGROUND: Adult hypertension is a well-established risk factor for stroke in young adults (aged <55 years), and the effects are even more deleterious than at an older age. However, data are limited regarding the association between adolescent hypertension and the risk of stroke in young adulthood. METHODS: A nationwide, retrospective cohort study of adolescents (aged 16-19 years) who were medically evaluated before compulsory military service in Israel during 1985 to 2013. For each candidate for service, hypertension was designated after constructed screening, and the diagnosis was confirmed through a comprehensive workup process. The primary outcome was ischemic and hemorrhagic stroke incidence as registered at the national stroke registry. Cox proportional-hazards models were used. We conducted sensitivity analyses by excluding people with a diabetes diagnosis at adolescence or a new diabetes diagnosis during the follow-up period, analysis of adolescents with overweight, and adolescents with baseline unimpaired health status. RESULTS: The final sample included 1 900 384 adolescents (58% men; median age, 17.3 years). In total, 1474 (0.08%) incidences of stroke (1236 [84%] ischemic) were recorded, at a median age of 43 (interquartile range, 38-47) years. Of these, 18 (0.35%) occurred among the 5221 people with a history of adolescent hypertension. The latter population had a hazard ratio of 2.4 (95% CI, 1.5-3.9) for incident stroke after adjustment for body mass index and baseline sociodemographic factors. Further adjustment for diabetes status yielded a hazard ratio of 2.1 (1.3-3.5). We found similar results when the outcome was ischemic stroke with a hazard ratio of 2.0 (1.2-3.5). Sensitivity analyses for overall stroke, and ischemic stroke only, yielded consistent findings. CONCLUSIONS: Adolescent hypertension is associated with an increased risk of stroke, particularly ischemic stroke, in young adulthood.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Stroke / Diabetes Mellitus / Ischemic Stroke / Hypertension Type of study: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspects: Patient_preference Limits: Adolescent / Adult / Female / Humans / Male / Middle aged Language: En Journal: Stroke Year: 2023 Document type: Article Affiliation country: Israel Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Stroke / Diabetes Mellitus / Ischemic Stroke / Hypertension Type of study: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspects: Patient_preference Limits: Adolescent / Adult / Female / Humans / Male / Middle aged Language: En Journal: Stroke Year: 2023 Document type: Article Affiliation country: Israel Country of publication: United States