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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Hsu CY, McCulloch CE, Darbinian J, Go AS, Iribarren C. Elevated blood pressure and risk of end-stage renal disease in subjects without baseline kidney disease. Arch Intern Med. 2005;165:923–8.
Psaty BM, Furberg CD, Kuller LH, Cushman M, Savage PJ, Levine D, et al. Association between blood pressure level and the risk of myocardial infarction, stroke, and total mortality: the cardiovascular health study. Arch Intern Med. 2001;161:1183–92.
Tebar WR, Ritti-Dias RM, Farah BQ, Zanuto EF, Vanderlei LCM, Christofaro DGD. High blood pressure and its relationship to adiposity in a school-aged population: body mass index vs waist circumference. Hypertens Res. 2018;41:135–40.
Moyer VA. Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159:613–9.
Urbina EM, Khoury PR, McCoy C, Daniels SR, Kimball TR, Dolan LM. Cardiac and vascular consequences of pre-hypertension in youth. J Clin Hypertens. 2011;13:332–42.
Lauer RM, Clarke WR. Childhood risk factors for high adult blood pressure: the Muscatine Study. Pediatrics. 1989;84:633–41.
Bao W, Threefoot SA, Srinivasan SR, Berenson GS. Essential hypertension predicted by tracking of elevated blood pressure from childhood to adulthood: the Bogalusa Heart Study. Am J Hypertens. 1995;8:657–65.
Juhola J, Oikonen M, Magnussen CG, Mikkila V, Siitonen N, Jokinen E, et al. Childhood physical, environmental, and genetic predictors of adult hypertension: the cardiovascular risk in young Finns study. Circulation. 2012;126:402–9.
Juonala M, Magnussen CG, Venn A, Dwyer T, Burns TL, Davis PH, et al. Influence of age on associations between childhood risk factors and carotid intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study, the Childhood Determinants of Adult Health Study, the Bogalusa Heart Study, and the Muscatine Study for the International Childhood Cardiovascular Cohort (i3C) Consortium. Circulation. 2010;122:2514–20.
Ramaswamy P, Lytrivi ID, Paul C, Golden M, Kupferman JC. Regression of left ventricular hypertrophy in children with antihypertensive therapy. Pediatr Nephrol. 2007;22:141–3.
Seeman T, Gilik J, Vondrak K, Simkova E, Flogelova H, Hladikova M, et al. Regression of left-ventricular hypertrophy in children and adolescents with hypertension during ramipril monotherapy. Am J Hypertens. 2007;20:990–6.
Litwin M, Niemirska A, Sladowska-Kozlowska J, Wierzbicka A, Janas R, Wawer ZT, et al. Regression of target organ damage in children and adolescents with primary hypertension. Pediatr Nephrol. 2010;25:2489–99.
Assadi F. Effect of microalbuminuria lowering on regression of left ventricular hypertrophy in children and adolescents with essential hypertension. Pediatr Cardiol. 2007;28:27–33.
Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 2011;128 Suppl 5:S213–56.
Hayman LL, Meininger JC, Daniels SR, McCrindle BW, Helden L, Ross J, et al. Primary prevention of cardiovascular disease in nursing practice: focus on children and youth: a scientific statement from the American Heart Association Committee on Atherosclerosis, Hypertension, and Obesity in Youth of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007;116:344–57.
Kavey RE, Daniels SR, Lauer RM, Atkins DL, Hayman LL, Taubert K. American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation. 2003;107:1562–6.
Flynn JT. Childhood blood pressure matters. Hypertension. 2019;73:296–8.
Chu C, Dai Y, Mu J, Yang R, Wang M, Yang J, et al. Associations of risk factors in childhood with arterial stiffness 26 years later: the Hanzhong adolescent hypertension cohort. J Hypertens. 2017;35 Suppl 1:S10–5.
Portegies ML, Mirza SS, Verlinden VJ, Hofman A, Koudstaal PJ, Swanson SA, et al. Mid- to late-life trajectories of blood pressure and the risk of stroke: the Rotterdam study. Hypertension. 2016;67:1126–32.
Kagura J, Adair LS, Munthali RJ, Pettifor JM, Norris SA. Association between early life growth and blood pressure trajectories in Black South African children. Hypertension. 2016;68:1123–31.
Zhang L, Wang F, Wang L, Wang W, Liu B, Liu J, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet. 2012;379:815–22.
Ishikawa J, Ishikawa S, Kabutoya T, Gotoh T, Kayaba K, Schwartz JE, et al. Cornell product left ventricular hypertrophy in electrocardiogram and the risk of stroke in a general population. Hypertension. 2009;53:28–34.
Wachtell K, Olsen MH, Dahlof B, Devereux RB, Kjeldsen SE, Nieminen MS, et al. Microalbuminuria in hypertensive patients with electrocardiographic left ventricular hypertrophy: the LIFE study. J Hypertens. 2002;20:405–12.
Li XX, Zhao Y, Huang LX, Xu HX, Liu XY, Yang JJ, et al. Effects of smoking and alcohol consumption on lipid profile in male adults in northwest rural China. Public Health. 2018;157:7–13.
China Hypertension Prevention Guidelines Revision Committee, Hypertension Alliance (China), Chinese Medical Association Cardiovascular Branch, Chinese Medical Doctor Association Hypertension Professional Committee, Hypertension Branch of China Association for the Promotion of International Exchange of Healthcare, Hypertension Branch of Chinese Geriatrics Society. Guidelines for the prevention and treatment of hypertension in China (2018 revision). Chinese Journal of Cardiology. 2019;24:24–56.
Pan J, Ren Z, Li W, Wei Z, Rao H, Ren H, et al. Prevalence of hyperlipidemia in Shanxi Province, China and application of Bayesian networks to analyse its related factors. Sci Rep. 2018;8:3750.
Tanaka A, Tomiyama H, Maruhashi T, Matsuzawa Y, Miyoshi T, Kabutoya T, et al. Physiological diagnostic criteria for vascular failure. Hypertension. 2018;72:1060–71.
Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.
Mule G, Calcaterra I, Costanzo M, Geraci G, Guarino L, Foraci AC, et al. Relationship between short-term blood pressure variability and subclinical renal damage in essential hypertensive patients. J Clin Hypertens. 2015;17:473–80.
Leoncini G, Viazzi F, Conti N, Baratto E, Tomolillo C, Bezante GP, et al. Renal and cardiac abnormalities in primary hypertension. J Hypertens. 2009;27:1064–73.
Urbina EM, de Ferranti S, Steinberger J. Observational studies may be more important than randomized clinical trials: weaknesses in US Preventive Services Task Force recommendation on blood pressure screening in youth. Hypertension. 2014;63:638–40.
Lai CC, Sun D, Cen R, Wang J, Li S, Fernandez-Alonso C, et al. Impact of long-term burden of excessive adiposity and elevated blood pressure from childhood on adulthood left ventricular remodeling patterns: the Bogalusa Heart Study. J Am Coll Cardiol. 2014;64:1580–7.
Raitakari OT, Juonala M, Kahonen M, Taittonen L, Laitinen T, Maki-Torkko N, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. Jama. 2003;290:2277–83.
Zheng W, Mu J, Chu C, Hu J, Yan Y, Ma Q, et al. Association of blood pressure trajectories in early life with subclinical renal damage in middle age. J Am Soc Nephrol. 2018;29:2835–46.
Du T, Fernandez C, Barshop R, Chen W, Urbina EM, Bazzano LA. 2017 pediatric hypertension guidelines improve prediction of adult cardiovascular outcomes. Hypertension. 2019;73:1217–23.
Kawabe H, Azegami T, Takeda A, Kanda T, Saito I, Saruta T, et al. Features of and preventive measures against hypertension in the young. Hypertens Res. 2019;42:935–48.
Oikonen M, Nuotio J, Magnussen CG, Viikari JS, Taittonen L, Laitinen T, et al. Repeated blood pressure measurements in childhood in prediction of hypertension in adulthood. Hypertension. 2016;67:41–7.
van den Elzen AP, de Ridder MA, Grobbee DE, Hofman A, Witteman JC, Uiterwaal CS. Families and the natural history of blood pressure. A 27-year follow-up study. Am J Hypertens. 2004;17:936–40.
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
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
About this article
Cite this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41440-020-0480-7
Keywords
This article is cited by
-
Childhood modifiable risk factors and later life chronic kidney disease: a systematic review
BMC Nephrology (2023)
-
Child-to-adult body mass index trajectories and the risk of subclinical renal damage in middle age
International Journal of Obesity (2021)