Groups of people at risk for cardiovascular disease (CVD) by early to mid-adulthood likely had high blood pressure as children, according to new data from the Dunedin Study published in Hypertension.

“Previous studies examining blood pressure change over time have modeled an average population trajectory. Recent research among older adults suggests there may be subgroups with different blood pressure trajectories,” Reremoana F. Theodore, PhD, of Dunedin Multidisciplinary Health and Development Research Unit in the department of psychology at the University of Otago in Dunedin, New Zealand, and colleagues wrote.

“Identifying subgroups at risk of developing adult hypertension early in life can inform effective risk reduction efforts.”


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With the goal of identifying various systolic blood pressure trajectories from childhood and their relationship with risk factors and early to midlife CV outcomes, the researchers analyzed blood pressure data at ages 7, 11, 18, 26, 32, and 38 years in 975 participants from a longitudinal, representative birth cohort study.

They categorized participants based on trajectory beginning at age 7 years: normal (21.8%), high-normal (43.3%), prehypertensive (31.6%), and hypertensive (4.2%).

In adulthood, participants in the normal and high-normal groups had mean blood pressures within the normal systolic blood pressure range (90 mm Hg to 120 mm Hg), the results revealed.

Participants in the prehypertensive group, however, had mean systolic blood pressure in the hypertensive range (120 mm Hg to 139 mm Hg). Similarly, those in the hypertensive range at age 7 years experienced the steepest increase in blood pressure — with mean blood pressure in the hypertensive range (140 mm Hg or greater) — by age 38 years.

Further, those in the higher blood pressure groups were more likely to have other negative health-related conditions, including higher cholesterol levels, by age 38 years.

The researchers identified several factors in early life linked to increased odds for being categorized as hypertensive. These included family history of high blood pressure (odds ratio [OR]=43.23; 95% CI, 5.27-354.65), male sex (OR=109.48; 95% CI, 26.82-446.96), being first born, (OR=2.5; 95% CI, 1.00-8.69), and low birth weight (OR=2.79; 95% CI, 2.49-3.09).

“This new information is useful for screening purposes to help clinicians identify young people who may develop high blood pressure later in adulthood,” Dr Theodore said in a press release.

Additionally, higher BMI and cigarette smoking were associated with increasing blood pressure levels over time, particularly among those in the higher blood pressure groups.

“Our findings can be used to inform early detection, targeted prevention and/or intervention to help reduce the burden associated with this silent killer,” Dr Theodore said.

Richie Poulton, PhD, director of the Dunedin Study and co-director of the National Centre for Lifecourse Research at the University of Otago, added that “encouraging lifestyle changes beginning early in life that include the maintenance of a healthy body weight, weight reduction, and stopping smoking may help to lower blood pressure levels over time, particularly among those individuals on a trajectory to developing hypertension.”

Reference

  1. Theodore RF, Broadbent J, Nagin D, et al. Childhood to Early-Midlife Systolic Blood Pressure Trajectories: Early-Life Predictors, Effect Modifiers, and Adult Cardiovascular Outcomes. Hypertension. 2015;doi:10.1161/HYPERTENSIONAHA.115.05831.