Blood Pressure Levels in Young Adulthood and Midlife Stroke Incidence in a Diverse Cohort

Yariv Gerber, Jamal S. Rana, David R. Jacobs, Yuichiro Yano, Deborah A. Levine, Mai N. Nguyen-Huynh, Joao A.C. Lima, Jared P. Reis, Lihui Zhao, Kiang Liu, Cora E. Lewis, Stephen Sidney

Research output: Contribution to journalArticlepeer-review

11 Scopus citations
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We examined the longitudinal association between blood pressure (BP) and stroke incidence in young and middle-aged adults. BP measured during 9 examinations of the CARDIA study (Coronary Artery Risk Development in Young Adults) from 1985-1986 to 2015-2016 was used to classify participants (n=5079) according to the 2017 Hypertension Clinical Practice Guidelines. We used the highest BP obtained through the third examination (1990-1991) to define baseline BP categories; time-dependent categories (accounting for change in BP over time) were determined incorporating follow-up measurements. BP groups at ages 30 and 40 years were also defined. Stroke events were adjudicated until 2018. Mean age at baseline was 29.8 years. Stroke occurred in 100 participants. Stroke incidence (per 100 000 person-years) was higher (P<0.001) in Black (120 [95% CI, 95-149]) versus White (29 [95% CI, 18-46]) participants. After adjustment with Cox models for sociodemographic and cardiovascular risk factors, stage 2 hypertension was associated with a higher risk of stroke at baseline (hazard ratio, 3.72 [95% CI, 2.12-6.54]), as a time-dependent variable (hazard ratio, 5.84 [95% CI, 3.43-9.95]), at age 30 (hazard ratio, 4.14 [95% CI, 2.19-7.82]) and at age 40 (hazard ratio, 5.59 [95% CI, 3.35-9.31]), compared with normal BP. Elevated BP and stage 1 hypertension showed more modest increases in risk. As a continuous variable, systolic BP ≥90 mm Hg at age 40 was directly associated with stroke risk. These findings call for primordial prevention strategies to reduce population BP levels among young and middle-aged adults, particularly in Black young adults given ≈4-fold higher stroke incidence, including within values traditionally considered to be normal.

Original languageEnglish (US)
Pages (from-to)1683-1693
Number of pages11
Issue number5
StatePublished - May 1 2021

Bibliographical note

Funding Information:
The CARDIA study (Coronary Artery Risk Development in Young Adults) is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (HH-SN268201800005I and HHSN268201800007I), Northwestern University (HHSN268201800003I), University of Minnesota (HHSN268201800006I), and Kaiser Foundation Research Institute (HHSN268201800004I). This article has been reviewed by CARDIA for scientific content. The views expressed in this article are those of the authors and do not necessarily represent the views of the NHLBI, the National Institutes of Health, or the US Department of Health and Human Services.

Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.


  • blood pressure
  • cohort studies
  • primary prevention
  • risk factors
  • young adult

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural


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