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Kenneth H. Cooper MD, MPH

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Does Blood Pressure Earlier in Life Predict Hypertension Later in Life?

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Live well

Thursday, May 11, 2017

In adults, a normal resting blood pressure is considered to be <120/80 mmHg.  Prehypertension is defined as a resting systolic blood pressure between 120-139 mmHg and/or a diastolic blood pressure between 80-89 mmHg. Hypertension is defined as a consistent resting blood pressure >140/90 mmHg. It is well-known that hypertension is present in ~33% of U.S. adults, and is a major risk factor for heart attack, stroke (May is national stroke month), and heart failure. As you may know, most people with hypertension have no symptoms; this has led to hypertension having the nickname of ‘the silent killer.’ Resting systolic blood pressure is lowest during childhood, and typically rises throughout the aging process. In fact, about 75% of adults over the age of 75 have a systolic blood pressure indicative of hypertension! In a recently published paper, the authors presented data strongly suggesting that monitoring blood pressure during childhood, adolescence, and early adulthood can be used to predict future prehypertension and hypertension, as well as future risk of cardiovascular disease. The study tracked 975 individuals who were born in the early 1970’s in New Zealand. Blood pressure was carefully measured under standardized conditions at ages 7, 11, 18, 26, 32, and 38.  While systolic blood pressure increased with age in all subjects, four different patterns of blood pressure increase were identified from this data. The blood pressure patterns and the percentage of the participants with each pattern are shown in the Figure below:

The prehypertension and hypertension pattern groups had worse cardiovascular outcomes by early midlife. Thus, individuals who developed hypertension in early to mid-adulthood had elevated blood pressure during childhood and adolescence and were more likely to have cardiovascular disease by the age of 38. Dr. Reremoana Theodore, lead author of the study, reported that certain factors significantly increased the likelihood of being in the hypertension group. These factors included family history of hypertension, male gender, being first born and having a low birth weight. Having a higher body mass index, as well as cigarette smoking also resulted in a steeper increase in blood pressure during the period of time studied.  

The authors concluded that blood pressure should be monitored during childhood and adolescence.  They also emphasized that children and adolescents with elevated blood pressure should be targeted for preventive behavior change strategies to help prevent future hypertension and cardiovascular disease. Among these strategies are attaining a normal body weight, avoiding tobacco, obtaining regular physical activity, and consuming a heart-healthy diet such as the DASH Eating Plan. With the current dual epidemics of obesity and sedentary lifestyle among children and adolescents, the alarm has sounded. Unless early behavior intervention occurs, many of these children and teens are doomed for a future of hypertension and associated cardiovascular risks.

Reference

Theodore, R.F., Broadbent, J., Nagin, D., Ambler, A., Hogan, S. Ramrakha, S.,…Poulton, R. (2015). Childhood to early-midlife systolic blood pressure trajectories: early-life predictors, effect modifiers, and adult cardiovascular outcomes. Hypertension, 66(6), 1108-1115.

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