Relation of Blood Pressure in Childhood to Self-Reported Hypertension in Adulthood

Abstract

Blood pressure (BP) tracking (maintaining a BP percentile) across life is not well defined but is important in predicting which children will become hypertensive adults. We computed BP tracking in subjects with BP measured in childhood and adulthood and performed logistic regression to determine the ability of childhood BP to predict adult hypertension (N=5035, 46.7 years, 74.2% white, 17.7% black; 39.6% male). Prevalence of hypertension was 29%. Correlations between systolic BP for child and adolescent were r=0.48; for adolescent and young adult were r=0.40, and for child and young adult were r=0.24 (all P<0.0001). Participants self-reporting adult hypertension were less likely to be white (38.7% black, 27.6% white, 20.9% other; P<0.0001) and female (26.4% females, 32.9% male, P<0.0001). Participants with adult hypertension were more likely to have higher BP and adiposity by age 10 years and abnormal lipids and glucose by age 16 years. There was a graded increase in the frequency of self-reported adult hypertension across the BP change groups, even within the persistently normotensive group (X²<0.0001) from 19% in children with a systolic BP% persistently below the median to 80% for individuals with elevated BP in both childhood and adolescence. Although our precision to predict which individual child is at risk of adult BP-related cardiovascular disease is weak, an increase in systolic BP and body mass index percentile from childhood to adolescence should signal a need for lifestyle intervention to prevent future sustained hypertension-related cardiovascular disease.

Keywords: adiposity; blood pressure; hypertension; obesity; risk factor.

Figure 1.

Spearman correlation coefficients for BP between age groups (p<0.0001).

Figure 2.

Prevalence of self-reported adult HTN by SBP category trajectory from childhood to adolescence. Nl-Nl = Normotensive (SBP% <90th%) and less than the median; Nh-Nl = Normotensive above the median to normotensive to below the median; Nl-Nh = Normotensive below the median to normotensive to above the median; Nh-Nh = Normotensive above the median; H-N = High BP (SBP% >=90^th%) during childhood and normotensive in adolescence; N-H = Normotensive then high; H-H = High BP at both time points. *P value for Chi square for group differences in frequencies and difference in OR from reference group < 0.0001.

Figure 3.

SBP measured at age 10, 16 and 30 years for subjects with normal BP in youth stratified by self-report of adult HTN. *p<0.02 for difference between adult normotensive and hypertensive groups.