Blood Pressure and Hypertension in Adolescents and Young Adults: Results From a Nationwide Screening Program

Abstract

Literature on blood pressure (BP) norms in the adolescent and young adult (AYA) population remains sparse compared to adults. This study aims to describe the BP norms, prevalence of undiagnosed hypertension, and associations with demographic and anthropometric data among asymptomatic Asian AYA males. We studied retrospective cross-sectional data from individuals attending a national centralized BP screening program for enlistment over 30 months. Each individual's initial office BP reading was used to determine the cohort's BP norms. Individuals with a high reading, defined as systolic ≥140 mmHg and/or diastolic ≥90 mmHg, repeated office BP at a separate office visit. Those demonstrating two high readings underwent 24-h ambulatory BP (ABP) measurement. 49 033 males of median age 18.1 years were studied. The median, 75th centile, and 95th centile initial visit office BP readings were 121/74, 130/81, and 139/89 mmHg. 302 (0.62%; 95% CI, 0.55-0.69) were diagnosed with hypertension by office BP criteria. 270 underwent ABP measurement-180 (0.37%; 95% CI, 0.31-0.42) and 239 (0.49%; 95% CI, 0.43-0.55) had hypertension by ESC/ESH and ACC/AHA criteria, respectively. Higher weight, body mass index (BMI), and body fat percentage were associated with hypertension. The prevalence of undiagnosed hypertension among Asian AYA males is <1%. Norm-based cut-offs for high BP yielded absolute-value cut-offs similar to those recommended by adult guidelines; the 95th centile corresponded closely to 140/90 mmHg. Given similar diagnostic cut-offs with both norm-based and absolute-value approaches, both methods may be adopted. Focused screening of subgroups at higher risk of hypertension, such as obese individuals, may be considered in resource-limited settings.

Keywords: Asian; ambulatory blood pressure; epidemiology; screening.

FIGURE 1

Study flow diagram.

FIGURE 2

Distribution of body mass index (BMI) in (A) study cohort, (B) individuals with elevated office blood pressure, (C) individuals diagnosed with hypertension via the ESC/ESH ambulatory blood pressure criteria, and (D) individuals diagnosed with hypertension via the ACC/AHA ambulatory blood pressure criteria. High BMI is associated with hypertension (p < 0.001).