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Summary of  JAMA Cardiology https://doi.org/10.1001/jamacardio.2025.4271 
Dr. Ángel Herraiz-Adillo  et al.

Points

Researchers analyzed data from over ten thousand Swedish men to track the progression from adolescent blood pressure levels to coronary health nearly forty years later.
The study employed coronary computed tomography angiography to detect atherosclerosis and found a dose-dependent link between early systolic pressure and subsequent vessel stenosis.
Results indicated that adolescents with stage 2 hypertension had an odds ratio of 1.84 for developing severe coronary stenosis compared to those with normal pressure.
Elevated risk for arterial disease was observed even in participants who presented with blood pressure readings as low as 120 over 80 during their youth.
The findings suggest that atherosclerosis pathogenesis begins in adolescence and supports lowering the threshold for early cardiovascular monitoring and intervention in young male populations.

Summary

This population-based cohort study investigated the long-term association between adolescent blood pressure (BP) and the prevalence of coronary atherosclerosis in middle age. Utilizing data from the Swedish Military Conscription Register linked to the Swedish Cardiopulmonary Bioimage Study (SCAPIS), researchers analyzed 10,222 men with a mean baseline age of 18.3 years and a median follow-up of 39.5 years. The primary outcome was coronary atherosclerosis evaluated via coronary computed tomography angiography (CCTA). The analysis revealed that elevated BP in adolescence followed a dose-response relationship with coronary stenosis, with the association being stronger for systolic than diastolic pressure.

Results indicated that 45.7% of participants exhibited 1% to 49% coronary stenosis, while 8.6% presented with severe stenosis of 50% or greater at follow-up. Adolescents classified with stage 2 hypertension demonstrated a significantly higher risk of severe coronary stenosis, with an odds ratio of 1.84 (95% CI, 1.40–2.42) compared to normotensive individuals. Furthermore, the adjusted prevalence of severe stenosis was 10.1% (95% CI, 8.6%–11.5%) in the hypertensive group versus 6.9% (95% CI, 5.7%–8.1%) in the normal BP group. Notably, excess risk was evident even at lower thresholds defined by 2025 ACC/AHA guidelines (120–129/<80 mm Hg).

These findings suggest that the pathogenesis of atherosclerosis begins significantly earlier than typically addressed in clinical practice, with subclinical disease markers detectable in middle age based on adolescent physiology. The data supports the validity of recent, lower guideline thresholds for defining elevated blood pressure. Consequently, the study advocates for earlier cardiovascular monitoring and intervention strategies in young populations to mitigate the long-term trajectory of coronary artery disease.

Link to the article: https://jamanetwork.com/journals/jamacardiology/fullarticle/2841358

References

Herraiz-Adillo, Á., Eriksson, H., Ahlqvist, V. H., Ballin, M., Wennberg, P., Daka, B., Lenander, C., Berglind, D., Östgren, C. J., Lundgren, O., Rådholm, K., & Henriksson, P. (2025). Blood pressure in adolescence and atherosclerosis in middle age. JAMA Cardiology. https://doi.org/10.1001/jamacardio.2025.4271