Genetic Determinants Of Arterial Hypertension And Atherosclerosis Development In Adolescence: A Review Of The Current State

Abstract

Arterial hypertension (HTN) and atherosclerosis (AS) are no longer regarded as exclusively adult-onset disorders. Pathological precursors of both diseases—including elevated blood pressure trajectories, endothelial dysfunction, and early arterial wall changes—are detectable as early as the first two decades of life, and longitudinal cohort data confirm that adolescent risk factor burden predicts adult cardiovascular disease with high fidelity. A substantial proportion of inter-individual variability in blood pressure and atherogenic lipid traits during adolescence is attributable to heritable genetic variation. This review summarizes current knowledge on the genetic determinants of HTN and AS relevant to the adolescent period, covering monogenic forms of hypertension, polygenic contributions identified through genome-wide association studies of blood pressure and coronary artery disease, key lipid-metabolism genes (APOE, LDLR, PCSK9, LPA, APOB) driving early dyslipidemia and subclinical atherosclerosis, and the expanding role of polygenic risk scores in pediatric and adolescent risk stratification. We further discuss gene-environment interactions—diet, physical activity, obesity, and smoking initiation—that modulate genetic susceptibility during this developmental window, along with emerging epigenetic and mitochondrial mechanisms. We conclude by outlining the translational potential and current limitations of incorporating genetic and polygenic information into adolescent cardiovascular risk assessment and prevention strategies.