It is uncertain what blood pressure level in an adolescent should alarm us and whether we should be looking at systolic or diastolic blood pressure. Conscription in Sweden was compulsory and the initial enrollment included a medical examination. An extraordinary record linkage study followed just over 1.2 million Swedish army recruits, mean age 18.4 years, between 1969 and 1995 for a median of 24 years (range 0–37).2011 The authors linked the unique personal identification number of each Swedish citizen to national death and emigration registers to examine the relationship between blood pressure and mortality, due to any cause or due to cardiovascular disease (12.5% of the total).
The authors found that the risk of dying from cardiovascular disease correlated better with diastolic than with systolic blood pressure and that there seemed to be a threshold diastolic pressure of 90 mm Hg above, which the risk started to increase considerably. In contrast, for systolic pressure, the lowest risk was with systolic pressures of about 130 mm Hg, and mortality rose gently either side of this in a U-shaped curve (see Figure 1). These remarkable new data afford the basis to design studies on the effect of treating adolescents with raised blood pressure levels to see if interventions can reduce mortality.