Controlling children’s blood pressure pays vascular dividends
medwireNews: Children with hypertension have increased cardiovascular risk later in life, unless their blood pressure (BP) is brought under control by the time they reach adulthood, shows a long-term study.
"While it might be tempting to interpret these data by downplaying the importance of childhood elevated BP, it is necessary to consider that elevated child BP is the strongest predictor of adult hypertension and that once elevated BP is established it is difficult to reverse," say the researchers.
Indeed, just 40% of the children they studied who had elevated BP reverted to normotension by adulthood (aged 23-46 years).
Study author Markus Juonala (Turku University Hospital, Finland) and colleagues collated data from four cohorts in the International Childhood Cardiovascular Cohort (i3C) Consortium, giving them data on 4210 participants with an average follow up of 23 years. In all, 60% of the 1632 participants who had elevated BP as children were hypertensive as adults, as were 42% of the 2078 who had normal BP as children.
Participants whose childhood hypertension resolved had a nonsignificant 24% increase in the risk for elevated cardiovascular risk in adulthood (≥90th percentile of carotid intima-media thickness [cIMT]), relative to those who remained normotensive throughout.
By contrast, participants whose hypertension failed to resolve had a significant 82% increased risk and those who developed incident hypertension in adulthood had a significant 57% increased risk for elevated cIMT. These findings were independent of age, gender, length of follow up, cohort, race, and adult body mass index (BMI).
Notably, BMI tracked BP changes, such that it decreased in participants whose childhood hypertension resolved by adulthood and increased in those with persistent or incident hypertension, relative to participants who remained normotensive throughout.
In an editorial accompanying the study in Circulation, Justin Zachariah (Boston Children's Hospital, Massachusetts, USA) highlights the change in BMI as a potential contributor to adulthood cIMT. He describes the data as "compelling," but cautions that "we must not infer the effect of pharmacologic BP lowering from these data as mechanisms of improvement."
Zachariah also praises the i3C consortium, asking whether such a venture "can ever happen again in our current scientific funding milieu."
He says: "In the absence of an RCT [randomized controlled trial] testing BP lowering interventions over a 25 year frame, the present study offers specific evidence for the utility of improving BP in children."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Eleanor McDermid, Senior medwireNews Reporter