Abstract

Background: There is limited research on how adherence to 24 h movement guidelines from adolescence to adulthood affects long-term hypertension outcomes. This study examined the association between sustained adherence to these guidelines and hypertension risk. Methods: Analysis was done on data from adolescents 12- to 19-year-olds who took part in Waves I and V of the Add Health Study. Physical activity (PA), screen time, and sleep duration were assessed through self-report questionnaires. Blood pressure (BP) was assessed on the right arm following a 5 min seated rest, utilizing an oscillometric device, and hypertension was defined as systolic/diastolic BP ≥ 140/90 mmHg, physician-diagnosed hypertension, or current antihypertensive medication use. Results: This prospective study included a total of 3076 participants (60.3% female), and 802 were diagnosed with hypertension. Meeting sleep duration guidelines at Wave I was associated with reductions in systolic [− 0.568 mmHg, 95% bias-corrected and accelerated (BCa) confident interval (CI) − 2.128 to − 0.011, P = 0.044] and diastolic (− 0.331 mmHg, 95% BCa CI − 1.506 to − 0.071, P = 0.043) BP at Wave V. Adherence to PA and sleep duration guidelines at both waves further reduced BP, with the greatest decreases observed among participants meeting all three guidelines: systolic (− 6.184 mmHg, 95% BCa CI − 13.45 to − 0.915, P = 0.040) and diastolic BP (− 3.156 mmHg, 95% BCa CI − 6.413 to − 0.120, P = 0.047). The risk of hypertension was lower among those who met the PA guidelines individually [relative risk (RR) 0.710, 95% CI 0.516–0.976, P = 0.035] or adhered to all three recommendations (RR 0.699, 95% CI 0.311–0.899, P = 0.030) in both waves. Conclusions: Our findings highlight the cardiovascular benefits of consistently adhering to healthy movement behaviors from adolescence through adulthood. © The Author(s) 2025.