Summary
A recent study from JAMA Pediatrics,1 reported that elevated systolic blood pressure (SBP) in early life contributed, in equal measure as compared with young adulthood, to the development of carotid intima-media thickness (cIMT), a marker of vascular remodeling that has been linked to cardiovascular disease (CVD) in adulthood.2 Hypertension (HTN) is a known risk factor for the development of CVD and treatments for adults have a broad evidence base and guidelines.3 However, whereas prior observational studies have found a link between childhood HTN and CVD in adults,4 recommendations from national organizations vary regarding the value of screening and intervention for HTN during childhood.5,6
For the study, researchers in Finland followed children from the age of 5 months to 26 years.1 The children who had elevated SBP during childhood and into adulthood were found to have higher cIMT, with higher SBP correlating with higher cIMT. A cumulative impact of high SBP was seen, with each stage of development (infancy, preschool, childhood, adolescence, and young adulthood) contributing equally to vascular thickening.
Therefore waiting until young adulthood or adulthood to screen for and intervene in HTN may be insufficient to reduce cardiovascular risk.1
Sources
1Meng Y, Sharman JE, Koskinen JS, et al. Blood pressure at different life stages over the early life course and intima-media thickness. JAMA Pediatr. 2024;178(2):133-141. doi:10.1001/jamapediatrics.2023.5351.
2Lorenz MW, Markus HS, Bots ML, et al. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation. 2007;115(4):459-467. doi:10.1161/CIRCULATIONAHA.106.628875.
3Falkner B, Gidding SS, Baker-Smith CM, et al. Pediatric primary hypertension: an underrecognized condition: a scientific statement from the American Heart Association. Hypertension. 2023;80(6):e101-e111. doi:10.1161/HYP.0000000000000228.
4Yang L, Magnussen CG, Yang L, et al. Elevated blood pressure in childhood or adolescence and cardiovascular outcomes in adulthood: a systematic review. Hypertension. 2020;75(4):948-955. doi:10.1161/HYPERTENSIONAHA.119.14168.
5Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904. doi:10.1542/peds.2017-1904.
6US Preventive Services Task Force; Krist AH, Davidson KW, et al. Screening for high blood pressure in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2020;324(18):1878-1883. doi:10.1001/jama.2020.20122.