Blood Pressure Trajectories From Childhood to Young Adulthood Associated With Cardiovascular Risk

Abstract

To identify subgroups of individuals with similar trajectories in blood pressure (BP) from childhood to young adulthood, and to determine the relationship of BP trajectories with carotid intima-media thickness (IMT) and left ventricular mass index (LVMI). BP was measured up to 16 times over a 23-year period in 683 participants from childhood to young adulthood. IMT and LVMI were measured in 551 participants and 546 participants respectively. Using latent class models, three trajectory groups in BP from childhood to young adulthood were identified, including high-increasing (HI), moderate-increasing (MI) and low-increasing (LI) group. We found that trajectory of systolic blood pressure (SBP) was a significant predictor of both IMT and LVMI with increased rate of growth in SBP associated with higher levels of IMT and LVMI (P for trend <0.001). Similar to the BP trajectory groups from childhood to young adulthood, three trajectory groups in BP during childhood (≤18 years) were identified and participants in the HI group had thicker IMT (P <0.001) and increased LVMI (P =0.043) in comparison with those in the LI group. Results were similar for Mid-BP trajectories but not for diastolic BP trajectories. Our results suggested that different BP trajectories exist from childhood to young adulthood, and the trajectories were independently associated with IMT and LVMI. We for the first time reported the association between SBP trajectories derived from childhood with subclinical cardiovascular risk in young adulthood, indicating that monitoring trajectories of BP from childhood may help identify a high cardiovascular risk population in early life.

Systolic blood pressure trajectory and cardiovascular outcomes: An analysis using data in the Systolic Blood Pressure Intervention Trial

“…Despite the impressive risk reduction in the primary composite outcome in SPRINT (HR with intensive therapy 0.75 [95% CI 0.64‐0.89], P < .001), the mean SBP in the intensive treatment group was 121.4 mm Hg at 1 year and 121.5 mm Hg throughout the follow‐up period, suggesting that more than half of the patients failed to reach the SBP treatment target of <120 mm Hg. Furthermore, BP changes in response to medication intensification differ over time across individuals, and could affect their cardiovascular outcomes . Hence, we hypothesised that SBP trajectory in SPRINT is associated with the cardiovascular outcomes.…”

Short‐term blood pressure changes have a more strong impact on stroke and its subtypes than long‐term blood pressure changes

“…Bold values in Table 2 Western countries. 9,12,13,15,24,25 Another form of BP changes is the visit-to-visit blood pressure variability, and studies have found that higher variability of BP or SBP is a powerful predictor of cardiovascular events independently of mean SBP or DBP, which has been more common in previous studies. 7,11,14,[26][27][28] A large longitudinal study of U.S. veterans found that greater long-term visit-to-visit SBP variability was associated with higher risk of subsequent stroke, independent of mean SBP, which is consistent with our findings.…”

“…Previous studies have confirmed and reinforced the importance of BP change by different forms for stroke. Limited prospective studies in the form of longitudinal elevated or decreased BP trajectories at several time points have emphasized that increase in BP is a major risk factor for adverse outcomes of CVD (including stroke) in China or Western countries . Another form of BP changes is the visit‐to‐visit blood pressure variability, and studies have found that higher variability of BP or SBP is a powerful predictor of cardiovascular events independently of mean SBP or DBP, which has been more common in previous studies .…”

Assessing genetic risk of hypertension at an early age: future research directions

“…BP trajectories) are associated with increased risk of cardiovascular disease. We recently observed that different BP trajectories exist in childhood with participants in the rapidly increasing group showing more target organ damage in young adulthood, adding yet another important piece of evidence in supporting the arguments for routine BP screening in childhood [31]. The underlying genetic factors determining the degree of BP rise over time might be different from those that determine initial BP levels.…”