Blood pressure trajectory from birth to preschool- and school-age: evidence from environage birth cohort

Abstract

Objective: Blood pressure (BP) is an essential modifiable risk factor and associated with cardiovascular disease in adulthood. The modifiable effect of BP might initiates from birth and operates across the whole life span. We aimed to explore Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved the BP trajectory in childhood and evaluate whether the cardiovascular risk later in life is related to early life BP. Design and method: The Environmental Influence on Aging in Early Life (EN-VIRONAGE) is a birth cohort, with BP and other phenotypes measured at birth, preschool-(4-6 years) and school-age (9-11 years). The participants with 2 or more BP measurements at different visits were analyzed, including 283 children in the preschool dataset, 272 in the school-age dataset, and 500 in the combined dataset. Tracker, horse-racer and non-tracker were defined by the change in mean arterial pressure (MAP) percentiles between 2 visits within 0-1 quartile, moving up for 2 or 3 quartiles, and moving down for 2 or 3 quartiles. Elevated BP and hyper-tension, standardized for age, sex, and height, were defined following the 2017 American Academy of Pediatrics guidelines. Multivariable adjusted linear, mixed and Cox proportional hazard regression models were applied to associate incident hypertension and BP in earlier childhood. Results: This study included 500 healthy children (53.2% girls). Mean systolic/ diastolic BP tracked from 67.3/40.5 at birth to 100.2/57.5 at preschool-age and to 107.7/65.1 mm Hg at school-age, and correspondingly mean MAP increased from 51.2 to 74.6 and to 82.1 mm Hg. In the combined dataset and accounting for confounders, with per 1-standard deviation increase in initial BP, BP in the last follow-up increased by 2.67/1.31 mm Hg (1.66 to 3.68/0.21 to 2.40 mm Hg) in systolic/diastolic BP, and 1.91 mm Hg (0.78 to 3.04 mm Hg) in MAP, respectively. The hazard ratios of elevated BP and hypertension were 2.84 (1.50 to 5.38) and 3.75 (1.79 to 7.86), confirming the findings in preschool-and school-age datasets. Conclusions: In this prospective study, BP tracked over time. Risk of elevated BP and hypertension was associated with the BP levels in earlier childhood, suggesting that BP links to cardiovascular risk later in life.