Systolic Blood Pressure Trajectory Across Childhood To Adolescence Predicts Self-Reported Htn In Adults: I3c Cv Outcomes Study

Levels of systolic blood pressure (SBP) in youth tend to predict adult SBP levels, but whether the trajectory of SBP over time predicts adult HTN is not known. In the International Childhood CV Cohort (i3C) Consortium, we constructed SBP trajectories in 9515 participants who had ≥2 SBPs in youth, and who reported HTN status (by questionnaire) at mean age 47 years. We used measured SBP from age 3-19 years to form trajectories using a mixed model with spline for age and random intercept and slope. The intercept and slope form personal trajectories during age 3-19 after removing the overall curve (spline) common to all participants. Trajectory groupings were formed by stratifying the intercept and slope by tertiles, forming 9 nearly equal sized groups, each having a consistent intercept and slope combination, among either a low, mid or high intercept and low (declining), mid (flat) or high (increasing) slope. The average SBP for all measurements in 6 age categories characterized the trajectories (Figure left panel). This characterization is reiterated using ages 3-11 and 12-19 years in the right panel which displays the adult HTN prevalence across the trajectories. Logistic models evaluated whether SBP trajectory group predicted adult HTN after adjustment for age and year at first childhood SBP measurement, age and BMI at adult HTN, smoking, sex, cohort, and race. Overall adult HTN prevalence was 30.9% increasing across SBP trajectories. All SBP trajectories compared to the highest intercept/slope group remained significant predictors of adult HTN even after adjustments (odds ratios 0.24 for lowest intercept/slope trajectory and 0.75 for highest intercept/intermediate slope trajectory both compared to highest intercept/highest slope, all P<0.0001). We conclude that baseline (intercept) and slope of SBP changes from childhood to adolescence can assist providers in identifying potential for modifying the development of hypertension in adulthood.