Performance of 4 definitions of childhood elevated blood pressure in predicting subclinical cardiovascular outcomes in adulthood.
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ABSTRACT:
SUBMITTER: Fan H
PROVIDER: S-EPMC8030891 | biostudies-literature | 2018 Mar
REPOSITORIES: biostudies-literature
Publications
Performance of 4 definitions of childhood elevated blood pressure in predicting subclinical cardiovascular outcomes in adulthood.
Fan Hui H Hou Dongqing D Liu Junting J Yan Yinkun Y Mi Jie J
Journal of clinical hypertension (Greenwich, Conn.) 20180125 3
We aimed to compare the ability of the pediatric blood pressure (BP) standards issued by the US Fourth Report, the recently proposed US, Chinese, and international standards to predict adult hypertension and subclinical cardiovascular disease (CVD). 2296 children were randomly selected from Beijing at baseline. The follow-up survey was conducted among 1177 adults. Subclinical adult CVD was assessed using the carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (CIMT), and ...[more]
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Project description:BackgroundElevated blood pressure (BP) levels in childhood have been associated with subsequent atherosclerosis. However, it is uncertain whether this risk is attenuated in individuals who acquire normal BP by adulthood. The present study examined the effect of child and adult BP levels on carotid artery intima-media thickness (IMT) in adulthood.Methods and resultsThe cohort consisted of 4210 participants from 4 prospective studies (mean follow-up, 23 years). Childhood elevated BP was defined according to the tables from the National High Blood Pressure Education Program. In adulthood, BP was classified as elevated for individuals with systolic BP ≥120 mm Hg, diastolic BP ≥80 mm Hg or with self-reported use of antihypertensive medications. Carotid artery IMT was measured in the left common carotid artery. High IMT was defined as an IMT ≥90th percentile according to age-, sex-, race-, and cohort-specific levels. Individuals with persistently elevated BP and individuals with normal childhood BP, but elevated adult BP had increased risk of high carotid artery IMT (relative risk [95% confidence interval]) 1.82[1.47-2.38] and 1.57[1.22-2.02], respectively) in comparison with individuals with normal child and adult BP. In contrast, individuals with elevated BP as children but not as adults did not have significantly increased risk (1.24[0.92-1.67]). In addition, these individuals had a lower risk of increased carotid artery IMT (0.66[0.50-0.88]) in compared with those with persistently elevated BP. The results were consistent when controlling for age, sex, and adiposity and when different BP definitions were applied.ConclusionsIndividuals with persistently elevated BP from childhood to adulthood had increased risk of carotid atherosclerosis. This risk was reduced if elevated BP during childhood resolved by adulthood.
| S-EPMC3875837 | biostudies-literature
Project description:ImportanceSingle measures of blood pressure (BP) levels are associated with the development of atherosclerosis; however, long-term patterns in BP and their effect on cardiovascular disease risk are poorly characterized.ObjectivesTo identify common BP trajectories throughout early adulthood and to determine their association with presence of coronary artery calcification (CAC) during middle age.Design, setting, and participantsProspective cohort data from 4681 participants in the CARDIA study, who were black and white men and women aged 18 to 30 years at baseline in 1985-1986 at 4 urban US sites, collected through 25 years of follow-up (2010-2011). We examined systolic BP, diastolic BP, and mid-BP (calculated as [SBP+DBP]/2, an important marker of coronary heart disease risk among younger populations) at baseline and years 2, 5, 7, 10, 15, 20, and 25. Latent mixture modeling was used to identify trajectories in systolic, diastolic, and mid-BP over time.Main outcomes and measuresCoronary artery calcification greater than or equal to Agatston score of 100 Hounsfield units (HU) at year 25.ResultsWe identified 5 distinct mid-BP trajectories: low-stable (21.8%; 95% CI, 19.9%-23.7%; n=987), moderate-stable (42.3%; 40.3%-44.3%; n=2085), moderate-increasing (12.2%; 10.4%-14.0%; n=489), elevated-stable (19.0%; 17.1%-20.0%; n=903), and elevated-increasing (4.8%; 4.0%-5.5%; n=217). Compared with the low-stable group, trajectories with elevated BP levels had greater odds of having a CAC score of 100 HU or greater. Adjusted odds ratios were 1.44 (95% CI, 0.83-2.49) for moderate-stable, 1.86 (95% CI, 0.91-3.82) for moderate-increasing, 2.28 (95% CI, 1.24-4.18), for elevated-stable, and 3.70 (95% CI, 1.66-8.20) for elevated-increasing groups. The adjusted prevalence of a CAC score of 100 HU or higher was 5.8% in the low-stable group. These odds ratios represent an absolute increase of 2.7%, 5%, 6.3%, and 12.9% for the prevalence of a CAC score of 100 HU or higher for the moderate-stable, moderate-increasing, elevated-stable and elevated-increasing groups, respectively, compared with the low-stable group. Associations were not altered after adjustment for baseline and year 25 BP. Findings were similar for trajectories of isolated systolic BP trajectories but were attenuated for diastolic BP trajectories.Conclusions and relevanceBlood pressure trajectories throughout young adulthood vary, and higher BP trajectories were associated with an increased risk of CAC in middle age. Long-term trajectories in BP may assist in more accurate identification of individuals with subclinical atherosclerosis.
| S-EPMC4122296 | biostudies-literature
Project description:ImportanceSevere forms of common chronic oral infections or inflammations are associated with increased cardiovascular risk in adults. To date, the role of childhood oral infections in cardiovascular risk is not known because no long-term studies have been conducted.ObjectiveTo investigate whether signs of oral infections in childhood are associated with cardiovascular risk factors and subclinical atherosclerosis in adulthood.Design, setting, and participantsThe cohort study (n = 755) was derived from the Cardiovascular Risk in Young Finns Study, an ongoing prospective cohort study in Finland initiated in 1980. Participants underwent clinical oral examinations during childhood, when they were aged 6, 9, or 12 years and a clinical cardiovascular follow-up in adulthood in 2001 at age 27, 30, or 33 years and/or in 2007 at age 33, 36, or 39 years. Cardiovascular risk factors were measured at baseline and during the follow-up until the end of 2007. Final statistical analyses were completed on February 19, 2019.Main outcomes and measuresFour signs of oral infections (bleeding on probing, periodontal probing pocket depth, caries, and dental fillings) were documented. Cumulative lifetime exposure to 6 cardiovascular risk factors was calculated from dichotomized variables obtained by using the area-under-the-curve method. Subclinical atherosclerosis (ie, carotid artery intima-media thickness [IMT]) was quantified in 2001 (n = 468) and 2007 (n = 489).ResultsThis study included 755 participants, of whom 371 (49.1%) were male; the mean (SD) age at baseline examination was 8.07 (2.00) years. In this cohort, 33 children (4.5%) had no sign of oral infections, whereas 41 (5.6%) had 1 sign, 127 (17.4%) had 2 signs, 278 (38.3%) had 3 signs, and 248 (34.1%) had 4 signs. The cumulative exposure to risk factors increased with the increasing number of oral infections both in childhood and adulthood. In multiple linear regression models, childhood oral infections, including signs of either periodontal disease (R2 = 0.018; P = .01), caries (R2 = 0.022; P = .008), or both (R2 = 0.024; P = .004), were associated with adulthood IMT. The presence of any sign of oral infection in childhood was associated with increased IMT (third tertile vs tertiles 1 and 2) with a relative risk of 1.87 (95% CI, 1.25-2.79), whereas the presence of all 4 signs produced a relative risk of 1.95 (95% CI, 1.28-3.00). The associations were more obvious in boys: if periodontal disease were present, the corresponding estimate was 1.69 (95% CI, 1.21-2.36); if caries, 1.46 (95% CI, 1.04-2.05); and if all 4 signs of oral infections, 2.25 (95% CI, 1.30-3.89). The associations were independent of cardiovascular risk factors.Conclusions and relevanceOral infections in childhood appear to be associated with the subclinical carotid atherosclerosis seen in adulthood.
| S-EPMC6487573 | biostudies-literature
Project description:Blood pressure (BP) tracking (maintaining a BP percentile) across life is not well defined but is important in predicting which children will become hypertensive adults. We computed BP tracking in subjects with BP measured in childhood and adulthood and performed logistic regression to determine the ability of childhood BP to predict adult hypertension (N=5035, 46.7 years, 74.2% white, 17.7% black; 39.6% male). Prevalence of hypertension was 29%. Correlations between systolic BP for child and adolescent were r=0.48; for adolescent and young adult were r=0.40, and for child and young adult were r=0.24 (all P<0.0001). Participants self-reporting adult hypertension were less likely to be white (38.7% black, 27.6% white, 20.9% other; P<0.0001) and female (26.4% females, 32.9% male, P<0.0001). Participants with adult hypertension were more likely to have higher BP and adiposity by age 10 years and abnormal lipids and glucose by age 16 years. There was a graded increase in the frequency of self-reported adult hypertension across the BP change groups, even within the persistently normotensive group (X2<0.0001) from 19% in children with a systolic BP% persistently below the median to 80% for individuals with elevated BP in both childhood and adolescence. Although our precision to predict which individual child is at risk of adult BP-related cardiovascular disease is weak, an increase in systolic BP and body mass index percentile from childhood to adolescence should signal a need for lifestyle intervention to prevent future sustained hypertension-related cardiovascular disease.
| S-EPMC6510248 | biostudies-literature
Project description:IntroductionHigh blood pressure in midlife is an established risk factor for cognitive decline and dementia but less is known about the impact of raised blood pressure on cognition in childhood and early adulthood.MethodWe systematically reviewed and quantified the existing evidence base relating to blood pressure in early life and subsequent cognitive performance. Medline, Embase, PsycINFOo, Scopus, and Web of Science were searched from inception to July 2020. We included longitudinal cohort and case-control studies involving participants aged 0-40 years with a baseline and at least one follow-up blood pressure assessment alongside at least one measure of cognition, occurring at the same time as, or subsequent to blood pressure measures. Risk of bias was assessed independently by two reviewers. PROSPERO registration CRD42020214655.ResultsOf a total of 5638 records identified, three cohort and two case-control studies were included with ages ranging from 3 to early 30s. Repeated blood pressure measurements averaged over 25 years or cumulative blood pressure in the 25-30 years prior to assessment of cognitive function were associated with poorer cognitive performance in the two largest cohort studies. The smallest cohort study reported no evidence of an association and the results from the two case-control studies were contradictory. All studies were at risk of bias.ConclusionOverall, the evidence in this area is lacking and study quality is mixed. Our review highlights an urgent need for studies evaluating the potential for a relationship between raised blood pressure and poorer cognition in early life given the potential for possible risk reduction if such a relationship exists.
| S-EPMC8972933 | biostudies-literature
Project description:Background Blood pressure associates with arterial stiffness, but the contribution of blood pressure at different life stages is unclear. We examined the relative contribution of childhood, young- and mid-adulthood blood pressure to mid-adulthood large artery stiffness. Methods and Results The sample comprised 1869 participants from the Cardiovascular Risk in Young Finns Study who had blood pressure measured in childhood (6-18 years), young-adulthood (21-30 years), and mid-adulthood (33-45 years). Markers of large artery stiffness were pulse wave velocity and carotid distensibility recorded in mid-adulthood. Bayesian relevant life course exposure models were used. For each 10-mm Hg higher cumulative systolic blood pressure across the life stages, pulse wave velocity was 0.56 m/s higher (95% credible interval: 0.49 to 0.63) and carotid distensibility was 0.13%/10 mm Hg lower (95% credible interval: -0.16 to -0.10). Of these total contributions, the highest contribution was attributed to mid-adulthood systolic blood pressure (relative weights: pulse wave velocity, childhood: 2.6%, young-adulthood: 5.4%, mid-adulthood: 92.0%; carotid distensibility, childhood: 5.6%; young-adulthood: 10.1%; mid-adulthood: 84.3%), with the greatest individual contribution coming from systolic blood pressure at the time point when pulse wave velocity and carotid distensibility were measured. The results were consistent for diastolic blood pressure, mean arterial pressure, and pulse pressure. Conclusions Although mid-adulthood blood pressure contributed most to mid-adulthood large artery stiffness, we observed small contributions from childhood and young-adulthood blood pressure. These findings suggest that the burden posed by arterial stiffness might be reduced by maintaining normal blood pressure levels at each life stage, with mid-adulthood a critical period for controlling blood pressure.
| S-EPMC9238667 | biostudies-literature
Project description:Background and objectivesThis study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP).MethodsA nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg).ResultsDuring a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05-1.24) but not in those by the 2017 ACC/AHA definition. Elevated on-treatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18-1.70) and stroke (aHR, 1.19; 95% CI, 1.08-1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10; 95% CI, 1.04-1.16). Similar results were seen in the propensity-score-matched cohort.ConclusionElevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.
| S-EPMC9160643 | biostudies-literature
Project description:BackgroundThe purposes of this study were to assess the long-term effect of adverse childhood experiences (ACEs) on blood pressure (BP) trajectories from childhood to young adulthood and to examine whether this relation is explained by childhood socioeconomic status (SES) or risk behaviors that are associated with ACEs.Methods and resultsSystolic and diastolic BPs were measured up to 16 times (13 times on average) over a 23-year period in 213 African Americans and 181 European Americans 5 to 38 years of age. Retrospective data on traumatic experiences before 18 years of age were collected, including abuse, neglect, and household dysfunction. Individual growth curve modeling within a multilevel framework was used to examine the relation between exposure to ACEs and BP development. No main effect of ACEs on average BP levels was found. However, a significant interaction of ACE score with age(3) was observed (systolic BP, P=0.033; diastolic BP, P=0.017). Subjects who experienced multiple traumatic events during childhood showed a faster rise in BP levels after 30 years of age than those without ACEs. As expected, a graded association of ACEs with childhood socioeconomic status and negative health behaviors was observed (P<0.001). The ACE-systolic BP relation was not explained by these factors, whereas the ACE-diastolic BP relation was partially mediated by illicit drug use.ConclusionIn this novel longitudinal study, we observed that participants who were exposed to multiple ACEs displayed a greater increase in BP levels in young adulthood compared with their counterparts without ACEs.
| S-EPMC4430378 | biostudies-literature
Project description:Background How measures of long-term exposure to elevated blood pressure might add to the performance of "current" blood pressure in predicting future cardiovascular disease is unclear. We compared incident cardiovascular disease risk prediction using past, current, and usual systolic blood pressure alone or in combination. Methods and Results Using data from UK primary care linked electronic health records, we applied a landmark cohort study design and identified 80 964 people, aged 50 years (derivation cohort=64 772; validation cohort=16 192), who, at study entry, had recorded blood pressure, no prior cardiovascular disease, and no previous antihypertensive or lipid-lowering prescriptions. We used systolic blood pressure recorded up to 10 years before baseline to estimate past systolic blood pressure (mean, time-weighted mean, and variability) and usual systolic blood pressure (correcting current values for past time-dependent blood pressure fluctuations) and examined their prospective relation with incident cardiovascular disease (first hospitalization for or death from coronary heart disease or stroke/transient ischemic attack). We used Cox regression to estimate hazard ratios and applied Bayesian analysis within a machine learning framework in model development and validation. Predictive performance of models was assessed using discrimination (area under the receiver operating characteristic curve) and calibration metrics. We found that elevated past, current, and usual systolic blood pressure values were separately and independently associated with increased incident cardiovascular disease risk. When used alone, the hazard ratio (95% credible interval) per 20-mm Hg increase in current systolic blood pressure was 1.22 (1.18-1.30), but associations were stronger for past systolic blood pressure (mean and time-weighted mean) and usual systolic blood pressure (hazard ratio ranging from 1.39-1.45). The area under the receiver operating characteristic curve for a model that included current systolic blood pressure, sex, smoking, deprivation, diabetes mellitus, and lipid profile was 0.747 (95% credible interval, 0.722-0.811). The addition of past systolic blood pressure mean, time-weighted mean, or variability to this model increased the area under the receiver operating characteristic curve (95% credible interval) to 0.750 (0.727-0.811), 0.750 (0.726-0.811), and 0.748 (0.723-0.811), respectively, with all models showing good calibration. Similar small improvements in area under the receiver operating characteristic curve were observed when testing models on the validation cohort, in sex-stratified analyses, or by using different landmark ages (40 or 60 years). Conclusions Using multiple blood pressure recordings from patients' electronic health records showed stronger associations with incident cardiovascular disease than a single blood pressure measurement, but their addition to multivariate risk prediction models had negligible effects on model performance.
| S-EPMC6645648 | biostudies-literature
Project description:We investigated the relationship between the body mass index (BMI) trajectory across childhood and the subsequent occurrence of elevated blood pressure (BP) in the Chinese pediatric population. The study cohort from the China Health and Nutrition Survey comprised 1484 children, each of whom underwent three BP and BMI assessments during childhood and had a non-elevated BP during the first childhood assessment. A group-based trajectory model was used to identify four distinct BMI trajectories across childhood: lean-stable increase, medium-marked increase, heavy marked decrease, and heavy marked increase. Elevated BP in childhood was as defined in the China's national BP reference for children. Covariate-adjusted logistic regression models were used to assess the associations of BMI trajectories with elevated BP. Overall, 27.6% of all participants between 3 and 13 years of age during the first childhood assessment developed elevated BP during a mean 6.5-year follow-up. Compared with participants in the lean-stable increase group, those in the medium-marked increase and heavy marked increase groups were more likely to have elevated BP (odds ratio [95% confidence interval], OR [95% CI]: 1.46 [1.08, 1.96] and 5.29 [2.44, 11.48], respectively; Ps < .05). The OR for the heavy marked decrease group was not statistically significant (OR [95% CI]: 1.58 [0.80, 3.13]; P = .192). In summary, distinct BMI trajectories conferred significantly different odds of elevated BP upon children, thus underscoring the importance of weight management in early life.
| S-EPMC8029666 | biostudies-literature