Puberty Timing and Sex-Specific Trajectories of Systolic Blood Pressure: a Prospective Cohort Study

Abstract

Background: Sex differences in systolic blood pressure (SBP) emerge during adolescence but the role of puberty is not well understood. We examined sex-specific changes in SBP preceding and following puberty and examined the impact of puberty timing on SBP trajectories in females and males.

Methods: Trajectories of SBP before and after puberty and by timing of puberty in females and males in a contemporary birth cohort study were analyzed. Repeated measures of height from age 5 to 20 years were used to identify puberty timing (age at peak height velocity). SBP was measured on ten occasions from 3 to 24 years (N participants, 4062; repeated SBP measures, 29 172). Analyses were performed using linear spline multilevel models based on time before and after puberty and were adjusted for parental factors and early childhood factors.

Results: Mean age at peak height velocity was 11.7 years (SD, 0.8) for females and 13.6 years (SD, 0.9) for males. Males had faster rates of increase in SBP before puberty leading to 10.19 mm Hg (95% CI, 6.80-13.57) higher mean SBP at puberty which remained similar at 24 years (mean difference, 11.43 mm Hg [95% CI, 7.22-15.63]). Puberty timing was associated with small transient differences in SBP trajectories postpuberty in both sexes and small differences at 24 years in females only.

Conclusions: A large proportion of the higher SBP observed in males compared with females in early adulthood is accrued before puberty. Interventions targeting puberty timing are unlikely to influence SBP in early adulthood.

Keywords: blood pressure; cardiovascular diseases; puberty; risk factor.

Figure 1.

Mean adjusted trajectories of systolic blood pressure (SBP) in females and males before and after puberty from multilevel models based on pubertal age. Models are adjusted for birth weight, gestational age, maternal education, parity, maternal smoking during pregnancy, maternal age, maternal prepregnancy body mass index (BMI), household social class, marital status, partner education, breastfeeding, BMI residuals of offspring.

Figure 2.

Mean adjusted trajectories of systolic blood pressure (SBP) in females and males for the 10th, median and 90th sex-specific percentiles of age at peak height velocity from multilevel models based on pubertal age. Ages presented are rounded exact ages are 12.8 y, 11.7 y, and 10.7 y for females and 14.7 y, 13.6 y, and 12.4 y for males. Models are adjusted for birth weight, gestational age, maternal education, parity, maternal smoking during pregnancy, maternal age, maternal prepregnancy body mass index (BMI), household social class, marital status, partner education, breastfeeding, BMI residuals of offspring.