¹Tulane National Center for Cardiovascular Health, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA

Correspondence: Gerald S. Berenson, MD, Tulane Center for Cardiovascular Health, Tulane School of Public Health and Tropical Medicine, 1501 Canal Street, 14th Floor, New Orleans, LA 70112-2824.

^*This study was supported by grant HL38844 from the National Heart, Lung, and Blood Institute of the U.S. Public Health Service.

Received 24 October 1994; Revised  0000; Accepted 14 February 1995.

Abstract

It is well known that blood pressure (BP) levels persist over time. The present investigation examines tracking of elevated BP from childhood to adulthood and its progression to essential hypertension.

In a community study of early natural history of arteriosclerosis and essential hypertension, a longitudinal cohort was constructed from two cross-sectional surveys >15 years apart: 1505 individuals (56% female subjects, 35% black), aged 5 to 14 years at initial study.

Persistence of BP was shown by significant correlations between childhood and adulthood levels (r = 0.36 to 0.50 for systolic BP and r = 0.20 to 0.42 for diastolic BP), varying by race, sex, and age. These correlations remained the same after controlling for body mass index (BMI). Twice the expected number of subjects (40% for systolic BP and 37% for diastolic BP), whose levels were in the highest quintile at childhood, remained there 15 years later. Furthermore, of the childhood characteristics, baseline BP level was most predictive of the follow-up level, followed by change in BMI.

Subsequently, even at ages 20 to 31 years, prevalence of clinically diagnosed hypertension was much higher in subjects whose childhood BP was in the top quintile: 3.6 times (18% v 5%) as high in systolic BP and 2.6 times (15% v 5.8%) as high in diastolic BP, compared to subjects in every other quintile. Of the 116 subjects who developed hypertension, 48% and 41% had elevated childhood systolic and diastolic BP, respectively. Hypertension that developed in early adulthood was more prevalent in blacks, in subjects who had higher BP or BMI in childhood, or had gained more BMI from childhood to adulthood. The prediction of hypertension by earlier BP level was enhanced by multiple examinations. Estimated from 419 subjects who participated in four other surveys, individuals showing elevated BP levels at multiple times were more likely to develop future hypertension.

Elevated BP levels persist over time and progress to adult hypertension. Repeated measurements of BP early in life improve the prediction of adult hypertension.