Meng Yaxing, Sharman James E, Iiskala Fiia, Wu Feitong, Juonala Markus, Pahkala Katja, Rovio Suvi P, Fraser Brooklyn J, Kelly Rebecca K, Hutri Nina, Kähönen Mika, Laitinen Tomi, Jula Antti, Viikari Jorma S A, Raitakari Olli T, Magnussen Costan G
Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia.
JAMA Pediatr. 2025 Jan 1;179(1):34-45. doi: 10.1001/jamapediatrics.2024.4368.
Despite its relevance for pediatric blood pressure (BP) screening, the long-term predictive utility and natural progression of pediatric BP classification remain understudied.
To evaluate BP tracking from childhood to midadulthood using the American Academy of Pediatrics (AAP) thresholds and estimate transition probabilities among BP classifications over time considering multiple time points.
DESIGN, SETTING, AND PARTICIPANTS: The analyses were performed in 2023 using data gathered from September 1980 to August 2018 within the longitudinal Cardiovascular Risk in Young Finns Study. Participants had BP examined 9 times over 38 years, from childhood (aged 6-12 years) or adolescence (15-18 years) to young adulthood (21-27 years), late young adulthood (30-37 years), and midadulthood (39-56 years).
BP classifications (normal, elevated, hypertension) were based on AAP guidelines for children and adolescents and the 2017 American College of Cardiology/American Heart Association guidelines for adults.
Outcomes were BP classifications at follow-up visits. Tracking coefficients were calculated using generalized estimated equations. Transition probabilities among BP classifications were estimated using multistate Markov models.
This study included 2918 participants (mean [SD] baseline age, 10.7 [5.0] years; 1553 female [53.2%]). Over 38 years, the tracking coefficient (odds ratio [OR]) for maintaining elevated BP/hypertension was 2.16 (95% CI, 1.95-2.39). Males had a higher probability than females of progressing to and maintaining hypertension and a lower probability of reverting to normal BP from childhood to midadulthood (transition probability: from normal BP to stage 2 hypertension, 0.20; 95% CI, 0.17-0.22 vs 0.08; 95% CI, 0.07-0.10; maintaining stage 2 BP, 0.32; 95% CI, 0.27-0.39 vs 0.14; 95% CI, 0.09-0.21; from stage 2 hypertension to normal BP, 0.23; 95% CI, 0.19-0.26 vs 0.58; 95% CI, 0.52-0.62. For both sexes, the probability of transitioning from adolescent hypertension to normal BP in midadulthood was lower (transition probability, ranging from 0.16; 95% CI, 0.14-0.19 to 0.44; 95% CI, 0.39-0.48) compared with childhood hypertension (transition probability, ranging from 0.23; 95% CI, 0.19-0.26 to 0.63; 95% CI, 0.61-0.66). The probability of maintaining normal BP sharply decreased in the first 5 to 10 years, stabilizing thereafter. Children with normal BP generally maintained this status into adolescence (male: transition probability, 0.64; 95% CI, 0.60-0.67; female: transition probability, 0.81; 95% CI, 0.79-0.84) but decreased by young adulthood (male: transition probability, 0.41; 95% CI, 0.39-0.44; female: transition probability, 0.69; 95% CI, 0.67-0.71).
Results of this cohort study reveal an enduring association of childhood and adolescent BP (AAP thresholds) with later BP. Although childhood normal BP tends to be maintained into adolescence, the probability of reverting to and sustaining normal BP decreases notably from adolescence to young adulthood. The findings of this study underscore the importance of prevention to maintain normal BP starting in childhood, suggesting adolescence as a potential critical period. The results suggest the potential for less frequent screenings for children with initially normal BP.
尽管儿童血压（BP）筛查具有相关性，但儿童血压分类的长期预测效用和自然进展仍未得到充分研究。
使用美国儿科学会（AAP）的阈值评估从儿童期到中年期的血压轨迹，并考虑多个时间点估计随时间推移血压分类之间的转换概率。
设计、背景和参与者：2023年利用1980年9月至2018年8月在芬兰年轻人心血管风险纵向研究中收集的数据进行分析。参与者在38年中接受了9次血压检查，从儿童期（6 - 12岁）或青春期（15 - 18岁）到青年期（21 - 27岁）、青年晚期（30 - 37岁）和中年期（39 - 56岁）。
血压分类（正常、升高、高血压）基于AAP针对儿童和青少年的指南以及2017年美国心脏病学会/美国心脏协会针对成年人的指南。
结局是随访时的血压分类。使用广义估计方程计算追踪系数。使用多状态马尔可夫模型估计血压分类之间的转换概率。
本研究纳入2918名参与者（平均[标准差]基线年龄，10.7[5.0]岁；1553名女性[53.2%]）。在38年期间，维持血压升高/高血压的追踪系数（优势比[OR]）为2.16（95%CI，1.95 - 2.39）。从儿童期到中年期，男性进展为并维持高血压的概率高于女性，从高血压恢复到正常血压的概率低于女性（转换概率：从正常血压到2期高血压，0.20；95%CI，0.17 - （此处原文有误，应为0.22）0.22对0.08；95%CI，0.07 - 0.10；维持2期血压，0.32；95%CI，0.27 - 0.39对0.14；95%CI，0.09 - 0.21；从2期高血压到正常血压，0.23；95%CI，0.19 - 0.26对0.58；95%CI，0.52 - 0.62）。对于两性而言，与儿童期高血压（转换概率范围为0.23；95%CI，0.19 - 0.26至0.63；95%CI，0.61 - 0.66）相比，中年期从青少年高血压转变为正常血压的概率较低（转换概率范围为0.16；95%CI，0.14 - 0.19至0.44；95%CI，0.39 - 0.48）。维持正常血压的概率在前5至10年急剧下降，此后趋于稳定。血压正常的儿童通常在青春期维持这种状态（男性：转换概率，0.64；95%CI，0.60 - 0.67；女性：转换概率，0.81；95%CI，0.79 - 0.84），但在青年期有所下降（男性：转换概率，0.41；95%CI，0.39 - 0.44；女性：转换概率，0.69；95%CI，0.67 - 0.71）。
这项队列研究的结果揭示了儿童期和青少年期血压（AAP阈值）与后期血压之间的持久关联。尽管儿童期正常血压倾向于维持到青春期，但从青春期到青年期恢复并维持正常血压的概率显著降低。本研究结果强调了从儿童期开始预防以维持正常血压的重要性，表明青春期可能是一个关键时期。结果表明，对于初始血压正常的儿童，有可能减少筛查频率。
