High BP during infancy tied to adult atherosclerosis: JAMA

The researchers revealed that lowering the risk of arterial thickening and by inference cardiovascular diseases (CVDs), potentially could be optimized by maintaining lower BP levels since infancy, and each life stage was equally important.

In the cohort study, systolic BP from infancy and accumulated across the early life course was linked to higher carotid intima-media thickness in young adulthood with almost equal contribution from BP in young adulthood, adolescence, childhood, preschool childhood, and infancy.

Higher BP is a key risk factor for CVD, making it a primary target for intervention in adulthood. However, the value of treating and screening BP in the pediatric setting is controversial. Observational studies have shown a link between childhood BP and preclinical CVD in adults, as well as fatal and nonfatal cardiovascular events, there is no clarity on whether the timing of exposure to heightened BP matters in shaping this association.

Carotid intima-media thickness (cIMT) suggests early vascular remodelling and can predict future CVD. To gain insight into the BP's role in early arterial injury, and therefore CVD, Yaxing Meng, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia, and colleagues aimed to determine the relative contribution of BP at different life stages across the early-life course from infancy to young adulthood with carotid IMT. They also aimed to replicate the findings in a separate child-to-mid-adulthood cohort study.

For this purpose, analyses were performed in 2022 using data gathered from 1989 through 2018 within the Special Turku Coronary Risk Factor Intervention Project, an infancy-onset, randomized cohort of 534 participants coupled with annual blood pressure (from age 7 months to 20 years), biennial IMT measurements (from ages 13 to 19 years). They were followed up with again at age 26 years.

BP was measured from infancy (7 to 13 months age), preschool (2 to 5 years age), childhood (6 to 12 years), adolescence (13 to 17 years), and young adulthood (18 to 26 years).

Primary outcomes were cIMT measured in young adulthood at 26 years of age. Bayesian-relevant life-course exposure models evaluated the relative contribution of blood pressure at each life stage.

The study led to the following findings:

• Systolic BP at each life stage contributed to the association with young adulthood carotid IMT (infancy: relative weight, 25.3%; preschool childhood: relative weight, 27.0%; childhood: relative weight, 18.0%; adolescence: relative weight, 13.5%; and young adulthood: relative weight, 16.2%).
• A 1-SD (at single life stage) higher systolic BP accumulated across the life course was associated with a higher carotid IMT (0.02 mm).
• The findings for carotid IMT were replicated in the Cardiovascular Risk in Young Finns Study that assessed systolic BP from childhood and carotid IMT in adulthood (33 to 45 years).

The study showed that a life course approach suggested that accumulation of risk exposure to BP levels contributed to adulthood carotid IMT at all life stages. Of those, the contribution attributed to each observed life stage was approximately equal.

"These findings support prevention efforts that maintain and achieve normal BP levels across the life course, starting in infancy," the researchers concluded.

Reference:

Meng Y, Sharman JE, Koskinen JS, et al. Blood Pressure at Different Life Stages Over the Early Life Course and Intima-Media Thickness. JAMA Pediatr. Published online December 04, 2023. doi:10.1001/jamapediatrics.2023.5351