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Determinants of change in blood pressure during childhood
Insights
Childhood blood pressure changes are influenced by initial levels, parental factors, and body weight. Higher initial blood pressure did not predict greater increases, suggesting no "horse-racing" effect in pediatric hypertension development.
Area of Science:
- Pediatrics
- Cardiovascular Health
- Epidemiology
Background:
- Childhood blood pressure tracks into adulthood, making early determinants crucial.
- Understanding factors influencing blood pressure change in children is vital for long-term cardiovascular health.
- Previous studies have explored various factors, but comprehensive longitudinal data in pediatric populations remain important.
Purpose of the Study:
- To investigate the determinants of blood pressure change in a cohort of Dutch children.
- To identify factors associated with the rate of change in systolic and diastolic blood pressure.
- To examine whether initial blood pressure levels predict subsequent increases in blood pressure.
Main Methods:
- Longitudinal study of 462 Dutch children aged 5-19 years with 3-7 annual blood pressure measurements.
- Least-squares regression used to determine the rate of blood pressure change for each child.
- Analysis included initial blood pressure, parental blood pressure, body weight, serum uric acid, and vascular reactivity.
Main Results:
- Initial blood pressure levels were negatively associated with subsequent blood pressure change, even after accounting for regression toward the mean.
- Parental blood pressure and initial body weight showed weak positive associations with blood pressure change.
- Initial serum uric acid was positively associated with blood pressure change in girls only; vascular reactivity, pulse rate, and lifestyle factors were not related.
Conclusions:
- Children with higher initial blood pressure did not exhibit the largest subsequent increases, refuting a "horse-racing" phenomenon.
- Age may modify the relationship between initial blood pressure levels and subsequent changes.
- These findings contribute to understanding pediatric blood pressure trajectories and potential interventions.
Abstract:
The determinants of change in blood pressure during childhood were studied in 596 Dutch children, aged 5-19 years. The children were randomly selected from a general population in Zoetermeer, near the Hague, the Netherlands, and this report deals with 462 children (78%), who had three to seven annual measurements of blood pressure between 1975 and 1982. The rate of change in blood pressure was obtained by least-squares regression of blood pressure on time for each subject. Initial level of blood pressure was associated negatively with subsequent change in systolic and diastolic pressure, even after adjustment for regression toward the mean. Parental blood pressure and initial body weight were related positively, but weakly, to the rate of blood pressure change. Initial serum uric acid was associated positively with change in blood pressure in girls only. Vascular reactivity, as measured by the cold pressor test, was not related to the rate of change in blood pressure. The same applied to pulse rate and the use of tobacco, coffee, and oral contraceptives. The finding that children with the highest initial levels of blood pressure did not have the largest subsequent increase suggests that there is no "horse-racing" of blood pressure during childhood. There is some evidence that the relation between initial level and subsequent change in blood pressure is modified by age.