Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Research Article
  • Published:

Pediatric blood pressure category predicts longitudinal blood pressure change in adolescence and early adulthood

Pediatric Research volume 94, pages 1731–1737 (2023)Cite this article

Abstract

Background

Patterns of blood pressure (BP) change from early adolescence to young adulthood have not been well-described. The objective of this study was to examine the predictive value of pediatric BP classification on BP change and identify subpopulations with large BP increases during adolescence and early adulthood.

Methods

Baseline data were obtained from medical checkups of Japanese adolescents aged 12–13 years in 2009 or 2010 and subsequent BP values were followed for a 9-year period. Mixed-effects models were used to estimate the effects of baseline factors on subsequent BP changes.

Results

Hypertensive and elevated BP group consistently had higher BP values than normal BP group throughout the observation period. Multivariate mixed-effects model analyses revealed group-by-time interactions between systolic BP change and BP category in males and uric acid category in females, and between diastolic BP change and white blood cell count in males and obesity and high-density lipoprotein cholesterol in females; however, these factors had limited effects on the rate of BP increase, indicating that they are not suitable as clinical predictors of BP increase.

Conclusions

Pediatric BP category predicted BP values, but there was no factor that identified subpopulations with large BP increases in adolescence and early adulthood.

Impact

  • Blood pressure category in the American Academy of Pediatrics clinical practice guideline at age 12–13 years predicted subsequent blood pressure values during adolescence and early adulthood.

  • No baseline factor that identified a subpopulation with large increase in blood pressure during adolescence and early adulthood in clinical practice was found.

  • Our study contributes to the existing literature by demonstrating the usefulness of the American Academy of Pediatrics clinical practice guideline for blood pressure classification in a Japanese population.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Longitudinal blood pressure trends for the entire study population.
Fig. 2: Longitudinal blood pressure changes by American Academy of Pediatrics blood pressure category at baseline.

Similar content being viewed by others

Data availability

The data used to support the findings of the present study are included in the main text or supplementary materials. Any remaining information are available from the corresponding author upon reasonable request.

References

  1. Theodore, R. F. et al. Childhood to early-midlife systolic blood pressure trajectories: early-life predictors, effect modifiers, and adult cardiovascular outcomes. Hypertension 66, 1108–1115 (2015).

    Article  CAS  PubMed  Google Scholar 

  2. Azegami, T., Uchida, K., Tokumura, M. & Mori, M. Blood pressure tracking from childhood to adulthood. Front Pediatr. 9, 785356 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yano, Y. et al. Association of blood pressure classification in young adults using the 2017 American College of Cardiology/American Heart Association Blood Pressure guideline with cardiovascular events later in life. JAMA 320, 1774–1782 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Yang, L., Magnussen, C. G., Yang, L., Bovet, P. & Xi, B. Elevated blood pressure in childhood or adolescence and cardiovascular outcomes in adulthood: a systematic review. Hypertension 75, 948–955 (2020).

    Article  CAS  PubMed  Google Scholar 

  5. Azegami, T. et al. Association of childhood anthropometric measurements and laboratory parameters with high blood pressure in young adults. Hypertens. Res. 44, 711–719 (2021).

    Article  CAS  PubMed  Google Scholar 

  6. Vos, L. E. et al. Does a routinely measured blood pressure in young adolescence accurately predict hypertension and total cardiovascular risk in young adulthood? J. Hypertens. 21, 2027–2034 (2003).

    Article  CAS  PubMed  Google Scholar 

  7. Juhola, J. et al. Childhood physical, environmental, and genetic predictors of adult hypertension: the cardiovascular risk in young Finns study. Circulation 126, 402–409 (2012).

    Article  PubMed  Google Scholar 

  8. Urbina, E. M. et al. Relation of blood pressure in childhood to self-reported. Hypertension 73, 1224–1230 (2019).

    Article  CAS  PubMed  Google Scholar 

  9. Alper, A. B. Jr. et al. Childhood uric acid predicts adult blood pressure: the Bogalusa Heart Study. Hypertension 45, 34–38 (2005).

    Article  CAS  PubMed  Google Scholar 

  10. Chan, K. C., Au, C. T., Hui, L. L., Wing, Y. K. & Li, A. M. Childhood OSA is an independent determinant of blood pressure in adulthood: longitudinal follow-up study. Thorax 75, 422–431 (2020).

    Article  PubMed  Google Scholar 

  11. Benisty, K. et al. Kidney and blood pressure abnormalities 6 years after acute kidney injury in critically ill children: a prospective cohort study. Pediatr. Res. 88, 271–278 (2020).

    Article  CAS  PubMed  Google Scholar 

  12. Kagura, J., Adair, L. S., Munthali, R. J., Pettifor, J. M. & Norris, S. A. Association between early life growth and blood pressure trajectories in Black South African children. Hypertension 68, 1123–1131 (2016).

    Article  CAS  PubMed  Google Scholar 

  13. Hao, G. et al. Blood pressure trajectories from childhood to young adulthood associated with cardiovascular risk: results from the 23-year longitudinal Georgia Stress and Heart Study. Hypertension 69, 435–442 (2017).

    Article  CAS  PubMed  Google Scholar 

  14. Cnaan, A., Laird, N. M. & Slasor, P. Using the general linear mixed model to analyse unbalanced repeated measures and longitudinal data. Stat. Med. 16, 2349–2380 (1997).

    Article  CAS  PubMed  Google Scholar 

  15. Murphy, J. I., Weaver, N. E. & Hendricks, A. E. Accessible analysis of longitudinal data with linear mixed effects models. Dis. Model Mech. 15, dmm048025 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kuczmarski, R. J. et al. CDC Growth Charts for the United States: methods and development. Vital-. Health Stat. 11, 1–190 (2002).

    Google Scholar 

  17. Barlow, S. E. & Expert, C. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 120, S164–S192 (2007).

    Article  PubMed  Google Scholar 

  18. Kato, N., Sato, K., Takimoto, H. & Sudo, N. BMI for age references for Japanese children-based on the 2000 growth survey. Asia Pac. J. Public Health 20, 118–127 (2008).

    PubMed  Google Scholar 

  19. Kato, N., Takimoto, H. & Sudo, N. The cubic functions for spline smoothed L, S and M values for BMI reference data of Japanese children. Clin. Pediatr. Endocrinol. 20, 47–49 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  20. Umemura, S. et al. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res. 42, 1235–1481 (2019).

    Article  PubMed  Google Scholar 

  21. Flynn, J. T. et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140, e20171904 (2017).

    Article  PubMed  Google Scholar 

  22. Khoury, M. et al. Prevalence implications of the 2017 American Academy of Pediatrics Hypertension guideline and associations with adult hypertension. J. Pediatr. 241, 22–28.e4 (2022).

    Article  PubMed  Google Scholar 

  23. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114, 555–576 (2004).

    Article  Google Scholar 

  24. Urbina, E. M. et al. Association of blood pressure level with left ventricular mass in adolescents. Hypertension 74, 590–596 (2019).

    Article  CAS  PubMed  Google Scholar 

  25. Haley, J. E. et al. Association of blood pressure-related increase in vascular stiffness on other measures of target organ damage in youth. Hypertension 79, 2042–2050 (2022).

    Article  CAS  PubMed  Google Scholar 

  26. Jacobs, D. R. Jr. et al. Childhood cardiovascular risk factors and adult cardiovascular events. N. Engl. J. Med. 386, 1877–1888 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  27. Nelson, M. J., Ragland, D. R. & Syme, S. L. Longitudinal prediction of adult blood pressure from juvenile blood pressure levels. Am. J. Epidemiol. 136, 633–645 (1992).

    Article  CAS  PubMed  Google Scholar 

  28. De Livera, A. M., Zaloumis, S. & Simpson, J. A. Models for the analysis of repeated continuous outcome measures in clinical trials. Respirology 19, 155–161 (2014).

    Article  PubMed  Google Scholar 

  29. Murtaugh, M. A. et al. Relationship of sodium intake and blood pressure varies with energy intake: secondary analysis of the DASH (Dietary Approaches to Stop. Hypertension)-Sodium trial. Hypertension 71, 858–865 (2018).

  30. Mitsumata, K., Saitoh, S., Ohnishi, H., Akasaka, H. & Miura, T. Effects of parental hypertension on longitudinal trends in blood pressure and plasma metabolic profile: mixed-effects model analysis. Hypertension 60, 1124–1130 (2012).

    Article  CAS  PubMed  Google Scholar 

  31. Kotchen, J. M., McKean, H. E., Neill, M. & Kotchen, T. A. Blood pressure trends associated with changes in height and weight from early adolescence to young adulthood. J. Clin. Epidemiol. 42, 735–741 (1989).

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge all of the staff at Keio University Health Center who were involved in this research.

Funding

This work was supported by the Keio University Academic Development Funds for Joint Research (T.A.).

Author information

Authors and Affiliations

  1. Keio University Health Center, Yokohama-shi, Japan

    Tatsuhiko Azegami, Keiko Uchida, Ayano Murai-Takeda, Mikako Inokuchi & Masaaki Mori

  2. Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    Tatsuhiko Azegami & Hiroshi Itoh

  3. Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan

    Yasunori Sato

Authors
  1. Tatsuhiko Azegami
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keiko Uchida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasunori Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ayano Murai-Takeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mikako Inokuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroshi Itoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masaaki Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception: T.A. and K.U.; Design: T.A. and K.U.; Acquisition of data: T.A. and U.K.; Analysis: T.A.; Interpretation of Data: T.A., K.U., and Y.S.; Drafting the article: T.A.; Revising the article: K.U., Y.S., A.M.-T., M.I., H.I., and M.M. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tatsuhiko Azegami.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Azegami, T., Uchida, K., Sato, Y. et al. Pediatric blood pressure category predicts longitudinal blood pressure change in adolescence and early adulthood. Pediatr Res 94, 1731–1737 (2023). https://doi.org/10.1038/s41390-023-02675-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41390-023-02675-2

Search

Advanced search

Quick links