Gillman M W, Cook N R, Rosner B, Evans D A, Keough M E, Taylor J O, Hennekens C H
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
J Pediatr. 1993 Jun;122(6):837-46. doi: 10.1016/s0022-3476(09)90005-1.
Because blood pressure (BP) tracks from childhood to adulthood, some have recommended screening to identify children at high risk for the development of essential hypertension as adults. Others, however, have argued against this strategy because they believe that correlations between childhood and adulthood BP levels are too low. To address these issues, we considered prediction of adult BP from childhood levels.
Cohort study with follow-up of participants from childhood to early adulthood.
We ascertained BP in 337 schoolchildren from East Boston, Mass., and reexamined 317 (94%) of them 8 to 12 years later, at ages 18 to 26 years. MEASUREMENTS AND DATA ANALYSIS: On each of several visits, 1 week apart (four for children, three for adults), we obtained three BP readings with a random-zero sphygmomanometer. To calculate correlation coefficients (tracking correlations) between childhood and adult BP, we assumed a multivariate normal distribution and used an iterative maximal likelihood approach in a longitudinal model. We then used these correlations in expressions for sensitivity and specificity of childhood BP as a screening test and for positive predictive value for adult BP above specified cutoff points.
During the 8- to 12-year interval, tracking correlations, corrected for within-person variability and adjusted for age, sex, smoking, and medication and alcohol use, were 0.55 for systolic BP and 0.44 for diastolic BP. The corresponding positive predictive values indicated that, for example, the probability that a 20-year-old man's true systolic BP will be > 139 mm Hg (> 90th percentile) was 0.44, given that his observed average systolic BP at age 10 years was > 95th percentile (> 117 mm Hg). The sensitivity of a 10-year old boy's systolic BP > 95th percentile to detect systolic BP > 139 mm Hg 10 years later was 0.17. The specificity of his BP < 95th percentile at age 10 years to detect systolic BP < 139 mm Hg at age 20 years was 0.97. For diastolic BP, predictive values and sensitivities were somewhat lower.
After correction for within-person variability, tracking correlations from childhood to early adulthood are higher than previously reported. However, the resulting sensitivities and predictive values for childhood BP as a screening test for adult BP are of only modest magnitude. These data call into question the usefulness of routine BP measurement to identify children at high risk for the development of essential hypertension.
由于血压从儿童期到成年期具有轨迹性，一些人建议进行筛查，以识别日后患原发性高血压风险较高的儿童。然而，另一些人则反对这一策略，因为他们认为儿童期与成年期血压水平之间的相关性过低。为解决这些问题，我们考虑从儿童期血压水平预测成年期血压。
队列研究，对参与者从儿童期到成年早期进行随访。
我们确定了马萨诸塞州东波士顿337名学童的血压，并在8至12年后，当他们18至26岁时，对其中317名（94%）进行了复查。测量与数据分析：在几次间隔为1周的访视中（儿童4次，成人3次），我们使用随机零点血压计获取3次血压读数。为计算儿童期与成年期血压之间的相关系数（轨迹相关性），我们假定为多元正态分布，并在纵向模型中使用迭代最大似然法。然后，我们将这些相关性用于儿童期血压作为筛查试验的敏感度和特异度以及成年期血压高于指定临界点时的阳性预测值的表达式中。
在8至12年的间隔期内，校正个体内变异性并对年龄、性别、吸烟、用药及饮酒情况进行调整后，收缩压的轨迹相关性为0.55，舒张压为0.44。相应的阳性预测值表明，例如，一名20岁男性若10岁时观察到的平均收缩压>第95百分位数（>117 mmHg），那么其真实收缩压>139 mmHg（>第90百分位数）的概率为0.44。一名10岁男孩收缩压>第95百分位数，10年后检测收缩压>139 mmHg的敏感度为0.17。他10岁时血压<第95百分位数，检测20岁时收缩压<139 mmHg的特异度为0.97。对于舒张压，预测值和敏感度略低。
校正个体内变异性后，从儿童期到成年早期的轨迹相关性高于先前报道。然而，儿童期血压作为成年期血压筛查试验所得到的敏感度和预测值仅处于中等水平。这些数据使人质疑常规血压测量用于识别原发性高血压高危儿童的实用性。
