Blood Pressure Trajectories in Childhood Predict CVD Risk

New findings show that blood pressure (BP) trajectories from childhood to young adulthood predict the risk of cardiovascular disease (CVD) in young adulthood.¹

CVD risk associated with high BP is not only limited to hypertension but also applies to BP trajectories, according to previous findings. Research published in 2014, for example, found that young adults with more rapid increases in BP over time (higher BP trajectories) had an elevated risk of coronary artery calcification in middle age compared with young adults with slower trajectories.²

In the present study, researchers at the Medical College of Georgia at Augusta University and the Medical University of South Carolina in Charleston explored BP trajectories from childhood to young adulthood and their association with subclinical CVD risk. The sample consisted of 683 participants from the longitudinal Georgia Stress and Heart Study of CV risk factors in children and young adults.

During a period of 23 years, participants’ BP was measured up to 16 times. The current analysis included participants who had at least 3 BP measurements; 75% of these participants had more than 8 BP measurements.  

The analysis revealed 3 distinct trajectory groups:

• The high-increasing BP group (HI; 12.2%) had a high baseline level and a rapid increase in systolic BP (SBP; 22.0 mm Hg) from childhood to young adulthood. Participants in this group were more likely to be male, black, have higher BMIs, and have fathers with lower levels of education (P <.05).
• The moderate-increasing BP group (MI; 39%) had a moderate baseline level and a moderate SBP increase (13.9 mm Hg) over time.
• The low-increasing BP group (LI; 48.9%) had a low baseline level and maintained a small SBP increase (9.1 mm Hg) across the study period.

Approximately 42% of participants in the HI group had hypertension or were taking antihypertensive agents compared with 6% in the MI group and 1.8% in the LI group. The results further showed that SBP trajectory significantly predicted carotid intima-media thickness (IMT) and left ventricular mass index (LVMI), and increased SBP growth was linked with higher levels of both (P_{for trend} <.001).

In addition, 3 distinct trajectories of BP during childhood were identified, and individuals in the HI group had thicker IMT (P <.001) and increased LVMI (P =.043) vs participants in the LI group. Similar results were observed for mid-BP trajectories.

According to the researchers, this is the first study to “report significant associations between SBP trajectories derived from childhood and subclinical cardiovascular indices in young adulthood.”

“Monitoring trajectories of BP from childhood may provide an important approach to identify the population with higher risk for developing hypertension and CVD,” the investigators noted, which could prompt early prevention and intervention efforts.

References

1. Hao G, Wang X, Treiber FA, Harshfield G, Kapuku G, Su S. Blood pressure trajectories from childhood to young adulthood associated with cardiovascular risk: results from the 23-year longitudinal Georgia Stress and Heart Study [published online January 16, 2017]. Hypertension.  doi:10.1161/HYPERTENSIONAHA.116.08312
2. Allen NB, Siddique J, Wilkins JT, et al. Blood pressure trajectories in early adulthood and subclinical atherosclerosis in middle age. JAMA. 2014;311(5):490-497. doi:10.1001/jama.2013.285122