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Hypertension in Late Adolescence Might Increase Risk for End-Stage Renal Disease

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This was interesting so wanted to share with our readers.

Authors: Leiba A et al. 

JAMA Intern Med 2019 Feb 25

In otherwise healthy adolescents with persistent hypertension at age 16 to 19 years, long-term risk for developing ESRD was doubled.

The long-term implications of adolescent hypertension for the later development of end-stage renal disease (ESRD) is an unresolved and important question. In the current retrospective review of over 2.6 million healthy men and women recruited for the Israeli military at ages 16–19 years, researchers compared the risk for future ESRD between nonhypertensive and persistently hypertensive adolescents.

In all, 7997 individuals (90% men and 49% obese or overweight) were identified with persistent hypertension (>140/90 mm/Hg), and 95 had severe hypertension (>160/100 mm/Hg). After a median follow-up of 20 years, 0.5% of the hypertensive adolescents (42 cases) and 0.1% of normotensive recruits developed ESRD (crude hazard ratio, 5.1). The unadjusted incidence rate of ESRD in hypertensive adolescents was 20.2 per 100,000 person-years. After adjusting for multiple factors including body-mass index, the hazard ratio for ESRD in the hypertensive cohort was 2.0. In additional multivariate analyses, severe hypertension did not confer added risk for ESRD, nor did obesity or overweight.

COMMENT

Although the incidence of kidney failure is low in this setting overall, the risk was doubled in this large group of hypertensive adolescents without other apparent risk factors. Healthy teenagers are often infrequent or unreliable seekers of primary care. These data should increase our concern upon finding elevated blood pressures in older teens and further motivate us to determine whether the hypertension is persistent, and if so, to address it.

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