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The predictive value of repeated blood pressure measurements in childhood for cardiovascular risk in adults: the Hanzhong Adolescent Hypertension Study

Abstract

There is currently a lack of strong evidence linking childhood elevated blood pressure to long-term cardiovascular risk in adulthood. Repeated observations of abnormal blood pressure in childhood may enhance the prediction of cardiovascular risk in adulthood compared with a single observation. The study included 1738 individuals in rural areas of Hanzhong City, Shaanxi, who had been followed for 30 years since baseline (1987, at which time participants were aged 6–15 years). According to four independent measurements of blood pressure in 1987, 1989, 1992, and 1995, childhood elevated blood pressure was defined as 2 in-person examinations with blood pressure values above the 90th percentile. Arterial stiffness and left ventricular hypertrophy in adulthood were assessed by brachial-ankle pulse wave velocity and the Cornell product index, respectively. Childhood elevated blood pressure was associated with an increased risk of adult hypertension (OR, 2.01; 95% CI, 1.53–2.65), arterial stiffness (OR, 1.69; 95% CI, 1.32–2.16) and left ventricular hypertrophy (OR, 1.86; 95% CI, 1.13–3.05) (all P < 0.05). Cardiovascular risk in adults increased with increasing childhood blood pressure levels. In addition, two abnormal childhood blood pressure observations predicted an increased likelihood of hypertension in adulthood (0.77 for 2 versus 0.70 for 1 observation, P < 0.001). Our study provides strong evidence that elevated blood pressure in childhood predicts cardiovascular risk in adults. The prediction was enhanced by two observations of abnormal blood pressure in childhood compared with a single measurement. We emphasize the importance of childhood blood pressure monitoring and control in the prevention of cardiovascular diseases.

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Acknowledgements

The Hanzhong Adolescent Hypertension Study is a joint effort of many investigators and staff members whose contribution is gratefully acknowledged. We especially thank the children and adults who have participated in this study over many years.

Funding

The study has been financially supported by the National Natural Science Foundation of China, nos. 81870319, 81570381 (JJM), 81600327 (YW), and 81700368 (CC); National Key R&D Program of China (2016YFC1300100); Grant 2017YFC1307604 from the Major Chronic Noncommunicable Disease Prevention and Control Research Key Project of the Ministry of Science and Technology of the People’s Republic of China; and Grant 2017ZDXM-SF-107 from the Key Research Project of Shaanxi Province.

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Correspondence to Jian-Jun Mu.

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Liao, YY., Ma, Q., Chu, C. et al. The predictive value of repeated blood pressure measurements in childhood for cardiovascular risk in adults: the Hanzhong Adolescent Hypertension Study. Hypertens Res 43, 969–978 (2020). https://doi.org/10.1038/s41440-020-0480-7

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