By Lucy Piper, medwireNews Reporter
medwireNews: High blood pressure (BP) or hypertension in childhood or adolescence appears to endure into adulthood, report researchers in findings that support early prevention.
The study, published in JAMA Pediatrics, showed that children and adolescents with elevated blood pressure or hypertension, according to the American Academy of Pediatrics thresholds, were around twice as likely as those with normal levels to have elevated BP or hypertension as young adults, as indicated by the 2017 American College of Cardiology/American Heart Association guidelines.
The probability of reverting from childhood or adolescent hypertension to normal BP in adulthood, ranged from 23–63% and 16–44%, respectively, depending on severity.
The data “underscore the importance of prevention to maintain normal BP starting in childhood, suggesting adolescence as a potential critical period”, say Costan Magnussen (Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia) and colleagues.
They add that normal BP in childhood was sustained into adolescence, indicating the potential for “a reevaluation of the current pediatric BP screening guidelines toward reduced screening frequency among children with normal BP.”
Data on 2918 individuals (53.2% females) from the longitudinal Cardiovascular Risk in Young Finns Study were assessed. The participants had BP measured nine times over a 38-year period (average follow-up 33.4 years), from childhood (aged 6–12 years) or adolescence (15–18 years) to young adulthood (21–27 years), late young adulthood (30–37 years), and mid-adulthood (39–56 years).
The odds of children and adolescents with an initial measurement of elevated BP/hypertension also having one later in life was a significant 2.16 times higher than that for their counterparts with normal BP.
This odds ratio increased with the severity of raised BP, starting at a nonsignificant 1.12 for elevated BP (systolic BP 120–129 mmHg; diastolic BP <80 mmHg), rising to a significant 1.58 for stage 1 hypertension (systolic BP 130 –139 mmHg; diastolic BP 80–89) and a significant 3.16 for stage 2 hypertension (systolic BP ≥140 mmHg; diastolic BP ≥90 mmHg), compared with normal BP (systolic BP <120 mmHg; diastolic BP <80 mmHg).
The researchers note that the “probability of transitioning from initial BP classifications to different BP classifications increased over time, whereas the probability of maintaining initial BP classifications diminished.”
Comparing this pattern in females and males, the researchers found that females were less likely to progress from normal BP to hypertension and were more likely to revert from hypertension to normal BP.
For instance, the probability of progressing from normal BP in childhood to stage 2 hypertension in mid-adulthood was 8% in females, compared with 20% in males, while the corresponding probabilities for transitioning from stage 2 hypertension to normal BP were 58% and 23%.
Magnussen et al also found that children with normal BP at baseline generally continued to have normal levels into adolescence, but by young adulthood the probability of maintaining this status decreased from 81% to 69% in females and from 64% to 41% in males.
“The probability of maintaining normal BP sharply decreased in the first 5 to 10 years, stabilizing thereafter”, say the investigators, who propose that “the period from adolescence to young adulthood may be crucial for hypertension prevention”.
They suggest “integrating BP screening into routine school entrance physical examinations”, and “initiating BP screening at an early age, around kindergarten/first grade entry,” with children found to have normal BP re-evaluated after about 5 years.
However, they note that “[t]he potential harms associated with BP screening in the pediatric setting, such as misclassification, unnecessary treatment, psychological impacts, measurement discomfort, and increased health care costs, also need to be considered.”
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JAMA Pediatr 2024; doi:10.1001/jamapediatrics.2024.4368