ESSENTIAL-HYPERTENSION PREDICTED BY TRACKING OF ELEVATED BLOOD-PRESSURE FROM CHILDHOOD TO ADULTHOOD - THE BOGALUSA HEART-STUDY

It is well known that blood pressure (BP) levels persist over time. Th e present investigation examines tracking of elevated BP from childhoo d to adulthood and its progression to essential hypertension. In a com munity study of early natural history of arteriosclerosis and essentia l hypertension, a longitudinal cohort was constructed from two cross-s ectional surveys >15 years apart: 1505 individuals (56% female subject s, 35% black), aged 5 to 14 years at initial study. Persistence of BP was shown by significant correlations between childhood and adulthood levels (r = 0.36 to 0.50 for systolic BP and r = 0.20 to 0.42 for dias tolic BP), varying by race, sex, and age. These correlations remained the same after controlling for body mass index (BMI). Twice the expect ed number of subjects (40% for systolic BP and 37% for diastolic BP), whose levels were in the highest quintile at childhood, remained there 15 years later. Furthermore, of the childhood characteristics, baseli ne BP level was most predictive of the follow-up level, followed by ch ange in BMI. Subsequently, even at ages 20 to 31 years, prevalence of clinically diagnosed hypertension was much higher in subjects whose ch ildhood BP was in the top quintile: 3.6 times (18% v 5%) as high in sy stolic BP and 2.6 times (15% v 5.8%) as high in diastolic BP, compared to subjects in every other quintile. Of the 116 subjects who develope d hypertension, 48% and 41% had elevated childhood systolic and diasto lic BP, respectively. Hypertension that developed in early adulthood w as more prevalent in blacks, in subjects who had higher BP or BMI in c hildhood, or had gained more BMI from childhood to adulthood. The pred iction of hypertension by earlier BP level was enhanced by multiple ex aminations. Estimated from 419 subjects who participated in four other surveys, individuals showing elevated BP levels at multiple times wer e more likely to develop future hypertension. Elevated BP levels persi st over time and progress to adult hypertension. Repeated measurements of BP early in life improve the prediction of adult hypertension.