Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK.
J Hypertens. 2022 Feb 1;40(2):389-397. doi: 10.1097/HJH.0000000000003025.
Globally, 80% of cardiovascular disease (CVD) occur in low-income /middle-income countries. High blood pressure (BP), a major risk factor for CVD, has its origins in early-life. We investigated how age trajectories of BP (childhood to late-adolescence) have changed recently in China and the mediating roles of physical growth.
Using the longitudinal data on 3785 children from the China Health and Nutrition Survey 1991-2015, we estimated mean BP trajectories (7-18 years) for cohorts born in 1981-1985, 1986-1990, 1991-1995 and 1996-2000 using random effect models. Models were adjusted for BMI and/or height growth to assess their impact on BP trends.
BP trajectories shifted upwards across cohorts. Compared with the earliest cohort, mean BP was higher in the latest cohort throughout childhood to late adolescence. For example, the increment in SBP was 4.4 mmHg (95% confidence interval: 2.9-5.8) in boys and 4.0 mmHg (2.6-5.5) in girls at 9 years, narrowed slightly during adolescence, and was 3.0 mmHg (0.7-5.4) and 2.6 mmHg (0.4-4.8) respectively at 17 years. BMI and height trajectories also shifted upwards. The overall increment was greater for height than BMI. When adjusting for physical growth, the increment in BP trajectories reduced (more for height than BMI), but remained in childhood (P < 0.05).
The upward shift of BP trajectories among Chinese youths was largely explained by trends in physical growth, especially increasing height. Other early-life factors might have also contributed to the BP trends. Substantial increases in mean BP in children within a short time frame is a public health concern and will affect future CVD, especially in the developing world.
全球 80%的心血管疾病（CVD）发生在低收入/中等收入国家。高血压（BP）是 CVD 的主要危险因素，其起源于生命早期。我们研究了中国最近儿童期至青春期后期血压（BP）的年龄轨迹是如何变化的，以及身体生长在其中的中介作用。
利用 1991-2015 年中国健康与营养调查的 3785 名儿童的纵向数据，我们使用随机效应模型估计了 1981-1985 年、1986-1990 年、1991-1995 年和 1996-2000 年出生的队列的平均 BP 轨迹（7-18 岁）。模型调整了 BMI 和/或身高生长情况，以评估其对 BP 趋势的影响。
BP 轨迹在各队列中均呈上升趋势。与最早的队列相比，最新的队列在儿童期至青春期后期的平均 BP 更高。例如，男孩的 SBP 增加了 4.4mmHg（95%置信区间：2.9-5.8），女孩增加了 4.0mmHg（2.6-5.5），在青春期期间略有缩小，在 17 岁时分别为 3.0mmHg（0.7-5.4）和 2.6mmHg（0.4-4.8）。BMI 和身高轨迹也呈上升趋势。身高的总体增长大于 BMI。当调整身体生长时，BP 轨迹的增长减少（身高比 BMI 更明显），但在儿童期仍存在（P<0.05）。
中国青少年 BP 轨迹的上升趋势在很大程度上归因于身体生长趋势，尤其是身高的增加。其他生命早期因素也可能导致 BP 趋势的变化。短期内儿童平均 BP 的大幅增加是一个公共卫生问题，将影响未来的 CVD，尤其是在发展中国家。
