Childhood Blood Pressure Predicts Longitudinal Decline in Vascular Function: The ExAMIN Youth SA Study

Elevated childhood blood pressure (BP) is a known predictor of future adult cardiovascular risk. We explored whether baseline BP predicted vascular health decline over time.

We included 715 children with baseline (mean age, 7 years) and 4-year follow-up data. Measures of central hemodynamics included pulse wave velocity, cardiac output, cardiac index, stroke volume, augmentation index corrected for heart rate of 75 bpm, and total vascular resistance. Kaplan-Meier survival analyses were used to compare the event rate of follow-up vascular measures greater than or equal to the highest population quartile for each measure between BP groups at baseline. In the total population, we determined the relative risk of baseline BP predicting poorer vascular health at follow-up using Cox proportional hazard models.

At baseline, pulse wave velocity, stroke volume, cardiac output, and augmentation index corrected for heart rate of 75 bpm were higher in children in the elevated BP compared with the normotensive group (all P≤0.014). In the total population, baseline systolic BP increased the relative risk for higher pulse wave velocity (hazard ratio [HR]=1.98; P<0.001), cardiac output (HR=1.23; P=0.005), and stroke volume (HR=1.21; P=0.008) at follow-up, while diastolic BP increased the relative risk for higher follow-up pulse wave velocity (HR=1.57; P=0.038), augmentation index corrected for heart rate of 75 bpm (HR=1.24; P=0.003), and total vascular resistance (HR=1.17; P=0.019).

Elevated BP in prepubescent children may contribute to early functional changes in central hemodynamics preceding hypertension in adolescence. These findings suggest a high-volume load in at-risk children, which may contribute to the onset of early vascular aging and hypertension in early life.