Hypertension in adolescence associated with end-stage renal disease

1. In this retrospective cohort study from Israel, hypertension at the age of 16-19 years old was linked with later-life end stage renal disease (ESRD).

2. The association between adolescent hypertension and ESRD remained after accounting for co-morbid conditions such as obesity, and after excluding those with severe hypertension.

Evidence Rating Level: 3 (Average)       

Study Rundown: Hypertension is a common risk factors for the development of end-stage renal disease (ESRD). The effect of non-malignant hypertension among youth on later life ESRD is not known. This study was a retrospective cohort analysis of Israeli military recruits which evaluated the impact of hypertension noted between the ages of 16-19 years on the risk of developing ESRD. The study found that hypertension in this age group increased the risk of ESRD nearly two-fold, even after adjusting for known confounders including obesity, sex, and sociodemographic variables.

The main strengths of this study included the confirmation of hypertension based on repeated blood pressure measurements, and large population of young male and female participants. The main limitations of the study include the lack of blood pressure data between the initial evaluation time and diagnosis of ESRD, and lack of evaluation of chronic kidney disease that was not end stage.

Click to read the study in JAMA Internal Medicine

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In-Depth [retrospective cohort]: This study included adolescents aged 16 to 19 years who were evaluated by the Israel Defense Forces regional recruitment centers prior to military service between 1967 and 2013. The cohort was linked to the ESRD registry of the Israel Ministry of Health. Participants were excluded if they were deceased prior to the start of the ESRD registry (1990), had baseline kidney disease or disease known to affect kidney function (diabetes, SLE, vasculitis, etc), or had secondary hypertension. Hypertension was defined as mean blood pressure greater than 140/90 mmHg, based on 10 consecutive BP measurements.

Of the 2,658,238 participants included in the study, 7997 (0.3%) had a diagnosis of essential hypertension. After a median follow up of 19.6 years, 2189 individuals developed ESRD. Adolescent hypertension was associated with an increased risk of ESRD (HR 5.07; 95% CI, 3.73-6.88), After adjusting for known covariates including obesity and sociodemographic variables, the association remained (HR 1.98; 95% CI, 1.42-2.77).

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