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Time course study of blood pressure in children over a three-year period. Bogalusa Heart Study
Insights
Childhood blood pressure (BP) shows tracking, meaning measurements tend to remain relatively stable over time. This tracking is crucial for identifying children at risk of high BP early on.
Area of Science:
- Pediatrics
- Cardiovascular Health
- Public Health
Background:
- Childhood hypertension is a growing concern with long-term health implications.
- Understanding blood pressure (BP) tracking in children is essential for early detection and intervention.
- Previous studies have explored BP variability, but quantifying tracking with consideration for within-child variation is key.
Purpose of the Study:
- To assess the tracking of indirect blood pressure (BP) in a representative population of children aged 5-14 years.
- To quantify the degree of BP tracking and its implications for identifying children at risk of sustained high BP.
- To apply the Gardner-Heady model to adjust for regression to the mean due to within-child variation.
Main Methods:
- Indirect blood pressure (BP) was measured using a mercury sphygmomanometer in 3524 children (ages 5-14).
- Annual re-examinations were conducted for children aged 5, 8, 11, and 14 years.
- The Gardner-Heady model was used to quantify regression to the mean due to within-child variation.
Main Results:
- Year 1 to Year 4 correlations for systolic blood pressure (SBP) ranged from 0.52 to 0.63, and for diastolic blood pressure (DBP4) from 0.23 to 0.45.
- Approximately 55% of children in the upper BP decile remained in the top two deciles after 3 years.
- The mean year-to-year standard deviation (SD) within children was 5.5 mm Hg for SBP and 5.9 mm Hg for DBP4.
- After 3 years, the age-specific cross-sectional SD was 8.7-9.7 mm Hg for SBP and 7.6-8.0 mm Hg for DBP4.
- Adjusted for within-child variation, children's average BP differed by approximately 1 mm Hg SBP and DBP from the expected level.
Conclusions:
- Childhood blood pressure exhibits significant tracking, indicating relative stability over time.
- Quantifying BP tracking, especially when accounting for within-child variability, is vital for early diagnosis and intervention strategies.
- These findings support the importance of monitoring BP in children for long-term cardiovascular health.
Abstract:
Indirect blood pressure (BP) was measured by mercury sphygmomanometer on 3524 children, ages 5-14 years, representative of a defined geographic population. Year 1 to Year 4 correlations ranged from 0.52 to 0.63 systolic blood pressure (SBP) and from 0.23 to 0.45 diastolic 4th phase blood pressure (DBP4). Some 55% of those originally in the upper decile remained in the uppermost two deciles 3 years later. All children ages 5, 8, 11, and 14 years were reexamined annually, and the mean year-to-year standard deviation (SD) within the child was computed to be 5.5 mm Hg SBP and 5.9 mm Hg DBP. After 3 years, for all available children (n = 2601) the age-specific cross-sectional SD was found to be 8.7-9.7 mm Hg SBP and 7.6-8.0 mm Hg DBP. These data enabled us to quantify the regression to the mean due to within-child variation for the uppermost and the lowest decile BP, using the Gardner-Heady model. These children had an average BP at examination that differed from the expected level (adjusting for regression to the mean due to within-child variation) by 1 mm Hg SBP and DBP. Quantification of the degree to which children's BP "tracks" is important for early diagnosis and intervention in high BP.