Research shows high blood pressure (BP) in adolescence puts people at greater risk for developing coronary atherosclerosis — arterial plaque buildup — later in adulthood. Ángel Herraiz-Adillo, PhD, from Linköping University, Sweden, and colleagues, reported these results in a manuscript published online Wednesday in JAMA: Cardiology. The risk of cardiovascular disease mortality is higher in teens who have high BP. Some studies have also linked high BP in adolescence to surrogate markers of atherosclerosis, but more research is needed to determine the relationship between the complex spectrum of atherosclerotic disease and elevated BP in young people. No study has evaluated this association with coronary computed tomography angiography (CCTA). Investigators in this research study examined systolic and diastolic BP in adolescence (data from the Swedish Military Conscription Register, 1972-1987) compared with atherosclerosis outcomes in middle-aged adults (data from the Swedish Cardiopulmonary Bioimage Study, 2013-2018). Atherosclerosis was measured using CCTA. Data were analyzed in May 2025. Adolescent BP was defined using the 2025 American College of Cardiology/American Heart Association (ACC/AHA) and the 2024 European Society of Cardiology (ESC) guidelines. BP categories were as follows according to the ACC/AHA guidelines: normal BP (SBP<120 mm Hg and DBP<80 mm Hg), elevated BP (SBP = 120-129 mm Hg and DBP<80 mm Hg), hypertension stage 1 (SBP = 130-139 mm Hg or DBP = 80-89 mm Hg), and hypertension stage 2 (SBP ≥140 mm Hg or DBP ≥90 mm Hg). Elevated BP was defined as 120-129/<80 mmHg in the ACC/AHA guidelines and 120-139/70-89 mm Hg in the ESC guidelines. Coronary atherosclerosis, determined by CCTA stenosis, was the primary outcome in this population-based cohort trial. BP and atherosclerotic results A total of 10,222 men (mean age at baseline=18.3 years; median age at follow-up=57.8 years) were included in the analyses. Mean systolic/diastolic BP (SBP/DBP) were 127.6 mmHg and 68.3 mmHg. The median follow-up time was 39.5 years, and 45.7% of participants had 1%-49% coronary stenosis and 8.6% of participants had ≥50% coronary stenosis. Participants who had higher BP in adolescence had a dose-response association with coronary stenosis in adulthood. The association was stronger with SBP than DBP. Adolescents who had stage 2 hypertension were at greater risk for severe coronary stenosis (≥50%; odds ratio [OR]=1.84, 95% confidence interval [CI]=1.40-2.42) with an adjusted prevalence of 10.1% (95% CI=8.6%-11.5%) compared to participants who had normal BP measurements (adjusted prevalence=6.9%; 95% CI=5.7%-8.1%). The investigators in this study highlighted several important limitations of the data: no females were included in the analysis; BP was measured during conscription, which may be stressful and not representative of actual, consistent BP; the participants with elevated DBP were analyzed before the categorization of BP into SBP and DBP; plaque characterization was limited; and other confounding variables may have been at play. Overall, men who have higher BP in adolescence have a greater likelihood of developing atherosclerosis later in life. Is early intervention the key to prevention? Sadiya S. Khan, MD, MSc, and Clyde W. Yancy, MD, MSc, from the Northwestern University Feinberg School of Medicine, Chicago, wrote an editorial accompanying the study by Herraiz-Adillo and colleagues. The editorialists emphasized the importance of early cardiovascular disease prevention and wrote that this present study highlights the potential later-life results of high BP during the teenage years. “Routine assessment of risk factors (such as BP, cholesterol level, and dysglycemia) must be paired with health behavior interventions andconsideration ofdrug therapy, as needed, to optimize cardiovascular health,” Drs. Khan and Yancy wrote. “Otherwise, we will remain in a frame of too little, too late.” Sources: Herraiz-Adillo Á, Eriksson H, Ahlqvist VH, et al. Blood pressure in adolescence and atherosclerosis in middle age. JAMA Cardiol. 2025 November 19. doi:10.1001/jamacardio.2025.4271 Khan SS, Yancy CW. Detecting atherosclerosis–from autopsy to angiography with computed tomography. JAMA Cardiol. 2025 November 19. doi:10.1001/jamacardio.2025.4283 Image Credit: halfpoint – stock.adobe.com