Race and Sex Differences of Long-Term Blood Pressure Profiles From Childhood and Adult Hypertension

Abstract

This study aims to characterize longitudinal blood pressure (BP) trajectories from childhood in black-white and gender groups and examine the association between childhood level-independent trajectories of BP and adult hypertension. The longitudinal cohort consisted of 2,732 adults who had body mass index and BP measured 4–15 times from childhood (4–19 years) to adulthood (20–51 years). Model-estimated levels and linear slopes of BP and BMI at childhood age points were calculated at one-year intervals using the growth curve parameters and their first derivatives, respectively. Linear and nonlinear curve parameters differed significantly between race-gender groups; BP levels showed race and gender differences from age 15 years onwards. Hypertensives had higher long-term BP levels than normotensives in race-gender groups. Although linear and nonlinear slope parameters of BP were race- and gender-specific, they differed consistently, significantly between hypertension and normotension groups. BP trajectories during young adulthood (20–35 years) were significantly greater in hypertensives than in normotensives; however, the trajectories during middle-aged adulthood (36–51 years) were significantly smaller in hypertensives than in normotensives. Level-independent linear slopes of systolic BP showed significantly negative associations (odds ratio=0.50~0.76, p<0.001) during pre-puberty period (4–11 years) but significantly positive associations (odd ratio=1.44~2.80, p<0.001) during the puberty period (13–19 years) with adult hypertension, adjusting for covariates. These associations were consistent across race-gender groups. These observations indicate that adult hypertension originates in childhood, with different longitudinal BP trajectory profiles during young and middle-aged adulthood in black-white and gender groups. Puberty is a crucial period for the development of hypertension in later life.

Acute‐phase blood pressure trajectories and clinical outcomes in ischemic stroke

“…Repeated measures data of BP have at least two types of variation, among‐individual and within‐individual variance . Longitudinal studies are necessary to examine within‐individual changes over time.…”

“…11,12 Repeated measures data of BP have at least two types of variation, among-individual and within-individual variance. 18,19,25 Longitudinal Our study has several short comings. First, the small sample size is associated with relatively limited statistical power for the association analysis, especially for the BP trajectory group analysis.…”

“…Growth curve parameters of SBP repeatedly measured during the first 7 days were estimated using a random‐effects mixed model by SAS Proc MIXED, as previously reported . The mixed model incorporates fixed and random effects and allows the intercept, linear, and nonlinear parameters to vary from individual to individual.…”

“…Growth curve parameters of SBP repeatedly measured during the first 7 days were estimated using a random-effects mixed model by SAS Proc MIXED, as previously reported. 18,19 The mixed model in- higher-order terms were included one by one for model building. The higher-order terms of day were not included in the model if they were not significant, or made lower-order terms not significant, or did not improve the goodness-of-fit of the model based on AIC values.…”

Identifying elevated blood pressure and hypertension in children and adolescents

“…Longitudinal BP patterns during childhood with growth and development taken into account are also very important. Evidence from the Bogalusa Heart Study shows that childhood BP trajectories are closely associated with risk of adult hypertension and left ventricular hypertrophy (T. Zhang, S. Li, L. Bazzano, J. He, P. K. Whelton, W. Chen, unpublished data), independently of absolute BP levels.…”