Kwon Junhyun, Kim Eunji
Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea.
Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
Clin Exp Pediatr. 2025 Apr;68(4):278-286. doi: 10.3345/cep.2024.01445. Epub 2024 Nov 28.
Elevated blood pressure (BP) during childhood and adolescence is increasingly being recognized as a precursor to adult hypertension and cardiovascular disease (CVD). This review examines the existing evidence of the relationship between early BP elevations and long-term cardiovascular (CV) outcomes. Previous studies demonstrated a moderate association between childhood BP and adult hypertension, with early BP elevations contributing to subclinical CV changes such as left ventricular hypertrophy and increased carotid intima-media thickness as well as major premature CVD events in adulthood. However, evidence also indicates that BP normalization before adulthood may mitigate these risks, suggesting a critical interventional window before irreversible CV changes occur. Multiple modifiable and nonmodifiable factors contribute to early-life BP elevations, including genetic predisposition, a high sodium intake, obesity, sedentary behavior, and sleep disturbances. Although establishing a direct causal association between childhood BP and adult hypertension or CVD remains challenging owing to the need for longterm follow-up and large sample sizes, further research is essential to addressing the existing knowledge gaps in pediatric hypertension prevention, detection, impact, and treatment. This review highlights the importance of preventing BP elevations early in life to reduce the longterm burden of hypertension and CVD. Promoting healthy behaviors, such as maintaining a healthy weight, reducing one's sodium intake, engaging in physical activity, and ensuring adequate sleep, is essential for managing BP at an early age. These efforts reduce individual CV risk and help alleviate the broader future public health burden of hypertension and CVD.
儿童期和青少年期的血压升高日益被视为成人高血压和心血管疾病（CVD）的先兆。本综述考察了早期血压升高与长期心血管（CV）结局之间关系的现有证据。先前的研究表明儿童期血压与成人高血压之间存在中度关联，早期血压升高会导致亚临床CV变化，如左心室肥厚和颈动脉内膜中层厚度增加，以及成年期主要的过早CVD事件。然而，证据也表明成年前血压正常化可能会降低这些风险，这表明在不可逆转的CV变化发生之前存在一个关键的干预窗口期。多种可改变和不可改变的因素导致生命早期血压升高，包括遗传易感性、高钠摄入、肥胖、久坐行为和睡眠障碍。尽管由于需要长期随访和大样本量，在儿童期血压与成人高血压或CVD之间建立直接因果关联仍然具有挑战性，但进一步的研究对于解决儿科高血压预防、检测、影响和治疗方面现有的知识差距至关重要。本综述强调了在生命早期预防血压升高对于减轻高血压和CVD长期负担的重要性。促进健康行为，如保持健康体重、减少钠摄入、进行体育活动和确保充足睡眠，对于在早年控制血压至关重要。这些努力降低了个体的CV风险，并有助于减轻未来高血压和CVD更广泛的公共卫生负担。
