Long-Term Association Between Childhood Blood Pressure and Adult Hypertension: Insights from a Cohort Study

Adult Hypertension or adult blood pressure (BP) is a risk factor for various cardiovascular diseases. Hence it is necessary to identify and address these issues at the earliest. Pediatric blood pressure has been associated with adverse cardiovascular outcomes. BP tracking and its persistence across age, and the likelihood of an individual transitioning between different BP categories over time has been discussed for a long time but did not yield satisfactory results. There is ambiguity on the association between maintaining normal BP in early life and the prevention of cardiovascular diseases later in life. There is uncertainty about the effectiveness of screening blood pressure in children and teenagers. The US Preventive Services Task Force (USPSTF) has also highlighted the knowledge gap between the long-term natural history of hypertension in children and the spontaneous resolution of hypertension. Hence researchers conducted a trial to evaluate BP tracking from childhood to midadulthood using the American Academy of Pediatrics (AAP) thresholds and estimate transition probabilities among BP classifications over time considering multiple time points.

The analyses were carried out in 2023 by utilizing data gathered from the longitudinal Cardiovascular Risk in Young Finns Study. About 3,596 participants aged 3 to 18 years were recruited and all the participants had BP examined 9 times over 38 years, from childhood (aged 6-12 years) or adolescence (15-18 years) to young adulthood (21-27 years), late young adulthood (30-37 years), and mid-adulthood (39-56 years). Three BP recordings were made at each visit and mean BP was taken. For individuals less than 18 years old BP classifications (normal, elevated, hypertension) were based on AAP guidelines, and for those 18 years or older the 2017 American College of Cardiology/American Heart Association guidelines were taken. generalized estimated equations were used to track coefficients. Transition probabilities among BP classifications were estimated using multistate Markov models.

Findings:

• This study included 2918 participants (mean [SD] baseline age, 10.7 [5.0] years; 1553 female [53.2%]).
• Over 38 years, the tracking coefficient for maintaining elevated BP/hypertension was 2.16.
• Males had a higher probability than females of progressing to and maintaining hypertension and a lower probability of reverting to normal BP from childhood to mid-adulthood.
• For both sexes, the probability of transitioning from adolescent hypertension to normal BP in mid-adulthood was lower compared with childhood hypertension.
• The probability of maintaining normal BP sharply decreased in the first 5 to 10 years, stabilizing thereafter.
• Children with normal BP generally maintained this status into adolescence but decreased by young adulthood.

Thus, the key takeaway from this study is the long-lasting link between blood pressure (BP) levels in childhood and adolescence and BP levels in adulthood. The BP levels in children and adolescents are associated with BP levels later in life, from young adulthood to mid-adulthood suggesting an early life high blood pressure can persist into adulthood increasing the hypertension and cardiovascular risk. The researchers also suggest early screening can help in early intervention.

Further reading: Meng Y, Sharman JE, Iiskala F, et al. Tracking and Transition Probability of Blood Pressure From Childhood to Midadulthood. JAMA Pediatr. Published online November 04, 2024. doi:10.1001/jamapediatrics.2024.4368