Combined Effects of Child and Adult Elevated Blood Pressure on Subclinical Atherosclerosis

Abstract

Background Elevated blood pressure (BP) levels in childhood have been associated with subsequent atherosclerosis. However, it is uncertain whether this risk is attenuated in individuals who acquire normal BP by adulthood. The present study examined the effect of child and adult BP levels on carotid artery intima-media thickness (cIMT) in adulthood. Methods and Results The cohort consisted of 4,210 participants from four prospective studies (mean follow-up 23 years). Childhood elevated BP was defined according to the tables from the National High Blood Pressure Education Program. In adulthood BP was classified as elevated for individuals with systolic BP ≥120mmHg, diastolic BP ≥80mmHg or with self-reported use of antihypertensive medications. cIMT was measured in the left common carotid artery. High IMT was defined as an IMT ≥age-, sex-, race-, and cohort-specific 90th percentile. Individuals with persistently elevated BP and individuals with normal childhood BP, but elevated adult BP had increased risk of high cIMT (RR[95%CI]) 1.82[1.47-2.38] and 1.57[1.22-2.02], respectively) when compared to individuals with normal child and adult BP. In contrast, individuals with elevated BP as children but not as adults did not have significantly increased risk (1.24[0.92-1.67]). In addition, these individuals had lower risk of increased cIMT (0.66[0.50-0.88]) when compared to those with persistently elevated BP. The results were consistent when controlling for age, sex, adiposity and when different BP definitions were applied. Conclusions Individuals with persistently elevated BP from childhood to adulthood had increased risk of carotid atherosclerosis. This risk was reduced if elevated BP during childhood resolved by adulthood.

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

“…Prospective studies have shown that elevated BP in adolescence is associated with both subclinical dysfunction of the left ventricle in the fifth decade of life and increased arterial stiffness (26)(27)(28)(29). Similarly, young adults with greater pulse wave velocity (PWV) had steeper increases of BP and visceral obesity from the age of 13 years (30).…”

“…28 The effects of BP lowering treatment on renal function and disease in adults, especially in those with chronic renal disease, are still an area of dispute. A recent meta-analysis (177) has concluded for no significant effect on renal failure, but single studies have yielded discordant results, which may depend on the different nature of renal disease (e.g., diabetic or nondiabetic), presence or absence of proteinuria, and the type of BP-lowering agents (reninangiotensin system inhibitors vs other classes).…”

Pharmacologic Management of Pediatric Hypertension

“…The best evidence for rates of persistence of hypertension comes from the i3C cohort, a subgroup analysis of 1,602 children with elevated blood pressure from four prospective studies: the Bogalusa Heart Study, the Cardiovascular Risk in Young Finns Study, the Muscatine Study, and the CDAH study. Analysis showed that 60% (969/1602) of children with elevated blood pressure had continued blood pressure elevation as adults, and that improvement in blood pressure tracked most closely with decrease in BMI [31].…”

Epidemiology of elevated blood pressure in youth and its utility for predicting adulthood outcomes: A review

“…In addition, elevated pulse pressure in youth has been associated with adverse changes in left ventricular morphology in youth and increased atherosclerosis in adulthood [11,45] . Most importantly, a recent study indicated that levels of carotid intima-media thickness (CIMT), a preclinical marker of atherosclerosis, is similar among those that normalize their elevated blood pressure in the time between youth and adulthood to those who did not have elevated blood pressure in youth or adulthood [58,59] . This reversal has not been demonstrated to the same extent in those who normalize their blood pressure during adulthood and thus confirms the importance of identifying elevated blood pressure in youth [41] .…”

“…For adiposity, the most comprehensive data were from Juhola et al [59] that used data from four large prospective studies (the Muscatine, Bogalusa, Young Finns and CDAH studies). They examined change in BMI z-score between youth and adulthood in respect to the youth-consumption, hormonal contraceptive use and socioeconomic status.…”