In a Finnish cohort study, systolic blood pressure (SBP) at each early-life stage (from infancy to young adulthood) contributed roughly equally to carotid intima-media thickness in young adulthood.

This summary is based on the publication of Meng 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 Feb 1;178(2):133-141. doi: 10.1001/jamapediatrics.2023.5351

Introduction and methods

Background

Medical authorities in Europe and the USA disagree on the value of screening and treating high blood pressure (BP) in children to prevent CVD [1-4]. A better understanding of the association of BP throughout the early life course with CVD is therefore needed.

Aim of the study

The authors investigated the relative contribution of BP at 5 early-life stages (from infancy to young adulthood) to carotid intima-media thickness (cIMT)—as indicator of early vascular remodeling and predictor of future CVD—in young adulthood.

Methods

Data were extracted from the STRIP (Special Turku Coronary Risk Factor Intervention Project) study, a randomized clinical cohort that enrolled 1116 infants aged 5 months in Finland and randomized them to an intervention (individualized dietary and subsequently antismoking counseling from age 7 months to 20 years) or control group [5]. The current analysis included 534 participants with BP measurements in infancy (age 7–13 months), preschool childhood (2–5 years), childhood (6–12 years), adolescence (13–17 years), and young adulthood (18–26 years) and a cIMT measurement in young adulthood (26 years). To examine the association between BP measurements in childhood through mid-adulthood (age 6–45 years, at 3-year intervals) and cIMT in mid-adulthood (33–45 years), cIMT findings were replicated in 1865 participants from the independent population-based cohort CRYFS (Cardiovascular Risk in Young Finns Study) [6].

Outcome

The primary endpoint was cIMT in young adulthood (at age 26 years).

Main results

• Analysis using the Bayesian relevant life-course exposure model adjusted for multiple covariates (including study group status (intervention or control), sex, smoking, BMI, lipid parameters, physical activity, and birth weight for gestational age) showed SBP at each early-life stage contributed to cIMT in young adulthood.
• The relative weight of the association of SBP with cIMT was 25.3% (95% credible interval (CrI): 3.3%–48.0%) in infancy, 27.0% (95%CrI: 2.5%–57.1%) in preschool childhood, 18.0% (95%CrI: 0.8%–48.4%) in childhood, 13.5% (95%CrI: 0.5%–38.9%) in adolescence, and 16.2% (95%CrI: 0.9%–41.7%) in young adulthood.
• At each life stage, a 10-mmHg higher SBP accumulated across the life course was associated with a higher cIMT in young adulthood. The lifetime effect was 0.02 mm (95%CrI: 0.01–0.03).
• When age-specific BP classifications were used, elevated or hypertensive SBP from infancy to young adulthood was associated with a 0.05 mm (95%CrI: 0.03-0.07) higher cIMT in young adulthood, with exposure at each life stage contributing approximately equally.
• Diastolic BP (lifetime effect: 0.00003; 95%CrI: –0.01 to 0.01) and hypertensive diastolic BP (lifetime effect: 0.03; 95%CrI: –0.04 to 0.16) were not associated with young-adulthood cIMT.
• Refitting the Bayesian relevant life-course exposure model in the CRYFS cohort indicated the relative weights of SBP at each studied age point had approximately equal contribution to mid-adulthood cIMT as well.

Conclusion

In this analysis of the Finnish STRIP cohort, the relative contribution of SBP throughout the early life course to cIMT in young adulthood was consistent across all 5 studied life stages (from infancy to young adulthood). Additionally, replication in an independent cohort indicated SBP in childhood through mid-adulthood was associated with a higher cIMT in mid-adulthood. The authors conclude their “results support prevention efforts that achieve and maintain normal BP levels across the life course, starting in infancy.”

Find this article online at JAMA Pediatr.

References

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2. Lurbe E, Agabiti-Rosei E, Cruickshank JK, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34(10):1887-1920. doi:10.1097/HJH.0000000000001039

3. Weintraub WS, Daniels SR, Burke LE, et al; American Heart Association Advocacy Coordinating Committee; Council on Cardiovascular Disease in the Young; Council on the Kidney in Cardiovascular Disease; Council on Epidemiology and Prevention; Council on Cardiovascular Nursing; Council on Arteriosclerosis; Thrombosis and Vascular Biology; Council on Clinical Cardiology, and Stroke Council. Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association. Circulation. 2011;124(8):967-990. doi:10.1161/CIR.0b013e3182285a81

4. Krist AH, Davidson KW, Mangione CM, et al; US Preventive Services Task Force. Screening for high blood pressure in children and adolescents. JAMA. 2020;324(18):1878-1883. doi:10.1001/jama.2020.20122

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6. Raitakari OT, Juonala M, Kähönen M, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA. 2003;290(17):2277-2283. doi:10.1001/jama.290.17.2277