Repeated Blood Pressure Measurements in Childhood in Prediction of Hypertension in Adulthood

Abstract

Hypertension may be predicted from childhood risk factors. Repeated observations of abnormal blood pressure in childhood may enhance prediction of hypertension and subclinical atherosclerosis in adulthood compared with a single observation. Participants (1927, 54% women) from the Cardiovascular Risk in Young Finns Study had systolic and diastolic blood pressure measurements performed when aged 3 to 24 years. Childhood/youth abnormal blood pressure was defined as above 90th or 95th percentile. After a 21- to 31-year follow-up, at the age of 30 to 45 years, hypertension (>140/90 mm Hg or antihypertensive medication) prevalence was found to be 19%. Carotid intima-media thickness was examined, and high-risk intima-media was defined as intima-media thickness >90th percentile or carotid plaques. Prediction of adulthood hypertension and high-risk intima-media was compared between one observation of abnormal blood pressure in childhood/youth and multiple observations by improved Pearson correlation coefficients and area under the receiver operating curve. When compared with a single measurement, 2 childhood/youth observations improved the correlation for adult systolic (r=0.44 versus 0.35, P <0.001) and diastolic (r=0.35 versus 0.17, P <0.001) blood pressure. In addition, 2 abnormal childhood/youth blood pressure observations increased the prediction of hypertension in adulthood (0.63 for 2 versus 0.60 for 1 observation, P =0.003). When compared with 2 measurements, third observation did not provide any significant improvement for correlation or prediction ( P always >0.05). A higher number of childhood/youth observations of abnormal blood pressure did not enhance prediction of adult high-risk intima-media thickness. Compared with a single measurement, the prediction of adult hypertension was enhanced by 2 observations of abnormal blood pressure in childhood/youth.

Association of Blood Pressure Trajectories in Early Life with Subclinical Renal Damage in Middle Age

“…8 Population-based cohorts support the view that high BP in later life originates in childhood. [9][10][11] However, available evidence on the association between BP and CKD mainly concerns adult or elderly subjects with or without hypertension. 12 Few take into account the potential effect of BP levels experienced earlier in life or changes in BP levels over time.…”

Assessment of vascular function in low socioeconomic status preschool children: a pilot study

“…6 However, there is mounting evidence that BP elevation in children, even on a single encounter, predicts the development of HTN and CVD in adulthood. 4–6,24,25 In the Cardiovascular Risk in Young Finns Study, SBP in childhood, adolescence, and early adulthood (3–24 years, N = 1927) was correlated with that in middle age (30–45 years, Pearson r = 0.35). 25 In the younger children (3–9 years) from that study, an elevated BP in childhood, even on a single occasion, predicted HTN in adulthood with no statistical improvement when additional BP measurements were included.…”

“…4–6,24,25 In the Cardiovascular Risk in Young Finns Study, SBP in childhood, adolescence, and early adulthood (3–24 years, N = 1927) was correlated with that in middle age (30–45 years, Pearson r = 0.35). 25 In the younger children (3–9 years) from that study, an elevated BP in childhood, even on a single occasion, predicted HTN in adulthood with no statistical improvement when additional BP measurements were included. 25 Although not diagnostic of HTN, an elevation of BP on a single encounter in childhood may have implications for vascular health later in life and offer a window on interventions at an earlier age, a time when lifestyle interventions may have the greatest impact (ie, primordial prevention).…”

“…25 Although not diagnostic of HTN, an elevation of BP on a single encounter in childhood may have implications for vascular health later in life and offer a window on interventions at an earlier age, a time when lifestyle interventions may have the greatest impact (ie, primordial prevention). 25,26 …”

Investing in our future: The importance of ambulatory visits to achieving blood pressure control in young adults

“…Focusing on identifying hypertension early, and getting blood pressure (BP) to goal preferably without the use of medication, is important for a multitude of reasons. First, elevated BP tracks over time, such that elevated BP in adolescence and young adulthood is strongly associated with elevated BP later in life . Second, there is evidence that early‐onset hypertension (before age 45 years) is associated with a higher risk of cardiovascular death compared with hypertension that develops later .…”