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Association of blood pressure in late adolescence with subsequent mortality: cohort study of Swedish male conscripts

BMJ 2011; 342 doi: (Published 22 February 2011) Cite this as: BMJ 2011;342:d643
  1. Johan Sundström, associate professor1,
  2. Martin Neovius, associate professor2,
  3. Per Tynelius, statistician3,
  4. Finn Rasmussen, professor3
  1. 1Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, SE-75185 Uppsala, Sweden
  2. 2Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, SE-17177 Stockholm, Sweden
  3. 3Child and Adolescent Public Health Epidemiology Unit, Department of Public Health Sciences, Karolinska Institutet
  1. Correspondence to: J Sundström johan.sundstrom{at}
  • Accepted 9 December 2010


Objective To investigate the nature and magnitude of relations of systolic and diastolic blood pressures in late adolescence to mortality.

Design Nationwide cohort study.

Setting General community in Sweden.

Participants Swedish men (n=1 207 141) who had military conscription examinations between 1969 and 1995 at a mean age of 18.4 years, followed up for a median of 24 (range 0-37) years.

Main outcome measures Total mortality, cardiovascular mortality, and non-cardiovascular mortality.

Results During follow-up, 28 934 (2.4%) men died. The relation of systolic blood pressure to total mortality was U shaped, with the lowest risk at a systolic blood pressure of about 130 mm Hg. This pattern was driven by the relation to non-cardiovascular mortality, whereas the relation to cardiovascular mortality was monotonically increasing (higher risk with higher blood pressure). The relation of diastolic blood pressure to mortality risk was monotonically increasing and stronger than that of systolic blood pressure, in terms of both relative risk and population attributable fraction (deaths that could be avoided if blood pressure was in the optimal range). Relations to cardiovascular and non-cardiovascular mortality were similar, with an apparent risk threshold at a diastolic blood pressure of about 90 mm Hg, below which diastolic blood pressure and mortality were unrelated, and above which risk increased steeply with higher diastolic blood pressures.

Conclusions In adolescent men, the relation of diastolic blood pressure to mortality was more consistent than that of systolic blood pressure. Considering current efforts for earlier detection and prevention of risk, these observations emphasise the risk associated with high diastolic blood pressure in young adulthood.


  • Contributors: JS conceived and designed the study, did all statistical analyses, analysed and interpreted the data, and drafted the article. PT, MN, and FR contributed to acquisition and interpretation of the data and critical revision of the manuscript for important intellectual content. All researchers had access to all of the data in the study. JS is the guarantor.

  • Funding: The study was funded by the Swedish Heart-Lung Foundation, the Swedish Research Council (grant 2007-5942), Uppsala University, and Arbetsmarknadens Forsakrings-och Aktiebolag. The funding sources had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. Researchers were independent from the funders and sponsors of the study.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare that (1) the authors have no support from any company for the submitted work; (2) the authors have no relationships with companies that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) the authors have no non-financial interests that may be relevant to the submitted work.

  • Ethical approval: The Regional Ethics Committee at Karolinska Institutet, Stockholm, Sweden, approved the study.

  • Data sharing: No additional data available.

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