Participant-level meta-analyses assessed the age-specific relevance of office blood pressure to cardiovascular complications, but this information is lacking for out-of-office blood pressure. At baseline, daytime ambulatory (n=12 624) or home (n=5297) blood pressure were measured in 17 921 participants (51.3% women; mean age, 54.2 years) from 17 population cohorts. Subsequently, mortality and cardiovascular events were recorded. Using multivariable Cox regression, floating absolute risk was computed across 4 age bands (≤60, 61-70, 71-80, and >80 years). Over 236 491 person-years, 3855 people died and 2942 cardiovascular events occurred. From levels as low as 110/65 mm Hg, risk log-linearly increased with higher out-of-office systolic/diastolic blood pressure. From the youngest to the oldest age group, rates expressed per 1000 person-years increased (P<0.001) from 4.4 (95% CI, 4.0-4.7) to 86.3 (76.1-96.5) for all-cause mortality and from 4.1 (3.9-4.6) to 59.8 (51.0-68.7) for cardiovascular events, whereas hazard ratios per 20-mm Hg increment in systolic out-of-office blood pressure decreased (P≤0.0033) from 1.42 (1.19-1.69) to 1.09 (1.05-1.12) and from 1.70 (1.51-1.92) to 1.12 (1.07-1.17), respectively. These age-related trends were similar for out-of-office diastolic pressure and were generally consistent in both sexes and across ethnicities. In conclusion, adverse outcomes were directly associated with out-of-office blood pressure in adults. At young age, the absolute risk associated with out-of-office blood pressure was low, but relative risk high, whereas with advancing age relative risk decreased and absolute risk increased. These observations highlight the need of a lifecourse approach for the management of hypertension.
Purpose: Adolescent involvement in cyberbullying is common and involves several roles (witness, perpetrator, or victim). Whether different cyberbullying roles are differentially associated with substance use is unknown. The present study examined the associations of adolescent cyberbullying involvement with use and polyuse of various substances.
Methods: A longitudinal cohort of students in Los Angeles, California (N = 2,768) completed surveys at baseline (10th grade, 2014, mean age = 15.5 years) and 12-month follow-up (11th grade, 2015). Five mutually exclusive cyberbullying roles were identified at baseline-no involvement; witness only; witness and victim; witness and perpetrator; and witness, victim, and perpetrator. Past 6-month use of nine substances and poly-use of multiple substances were assessed at baseline and follow-up.
Results: Most students (52.2%) were involved in >1 cyberbullying roles. Relative to no involvement, all cyberbullying roles, including witnessing only, were associated with increased odds of using most substances and polysubstance use at follow-up, after adjusting for sociodemographics and baseline substance use (odds ratios: 1.44 [95% confidence interval: 1.18-1.76] to 5.24 [2.73-10.05]). Relative to the witness-only role, students involved in all three roles were at greater odds of using several substances at follow-up (odds ratios: 1.47 [95% confidence interval: 1.05-2.05] to 2.96 [1.60-5.50]).
Conclusions: Cyberbullying involvement, even witnessing, may be associated with future substance use in adolescence. All cyberbullying roles warrant consideration in understanding and preventing youth substance use.