Takeaways
- The study in JAMA Pediatrics reveals the impact of blood pressure (BP) at various life stages on adulthood carotid intima-media thickness (cIMT), a predictor of cardiovascular disease (CVD).
- Cardiovascular disease initiation occurs early in life, with high BP identified as a significant risk factor, sparking debates over the value of pediatric BP screening.
- The study, using data from the Special Turku Coronary Risk Factor Intervention Project (STRIP), involves 534 participants, measuring BP and cIMT across different life stages.
- Findings highlight that each life stage, from infancy to young adulthood, contributes to cIMT, with systolic BP (SBP) consistently impacting measures, emphasizing the need for early intervention.
- Elevated or hypertensive SBP from infancy to adulthood is associated with higher cIMT, and the severity of SBP correlates with a lifetime effect on cIMT, underscoring the importance of maintaining lower BP levels throughout life.
Measures to achieve and maintain normal blood pressure (BP) levels in multiple stages of life, including infancy, was supported following the conclusion of a study published in JAMA Pediatrics, highlighting that risk exposure to BP levels in multiple stages of life contributed to adulthood carotid intima-media thickness (cIMT).
Cardiovascular disease (CVD) begins early in life and high blood pressure can be a key risk factor.
Authorities including the American Academy of Pediatrics, the European Society of Hypertension, and the American Heart Association have supported pediatric BP screenings to prevent CVD, though the value of screening and treating BP in pediatrics in controversial, the study authors wrote.
It is unclear if timing of exposure to heightened BP matters in shaping an association to CVD. Investigators sought to determine the relative contribution of BP at different life stages with cIMT, which indicates early vascular modeling and can predict future CVD.
The investigators used data from the infancy-onset randomized clinical Special Turku Coronary Risk Factor Intervention Project (STRIP) study that included 534 participants. The study featured infants aged 5 months from well-infant clinics in Finland. Data was gathered from July 1989 through January 2018.
In the study, annual BP was measured from age 7 months to 20 years, and biennial IMT measurements from ages 13 years to 19 years, plus an additional follow up at age 26 years.
The primary outcome was cIMT measured in young adulthood at age 26 years in categories of infancy (aged 7-13 months), preschool (aged 2-5 years), childhood (aged 6-12 years), adolescence (13-17 years), and young adulthood (aged 18-26 years). Bayesian relevant life-course exposure models assessed the relative contribution of BP at each stage of life, the authors wrote.
Examiners measured sitting systolic BP (SBP) and diastolic BP (DBP) on the participants’ right arms after a 15-minute rest using oscillometric monitor.
Results demonstrated that each life stage contributed to cIMT in young adulthood. The degree to which exposure to SBP associated with cIMT was “largely similar across the observed life stages (from 13.5%-27.0%).
Findings were consistent with age-specific analyses, revealing that contribution of SBP was present at the age of 7 months and remained across all observed ages, the investigators wrote.
A 0.05 mm (95% credible interval [crl], 0.03-0.07) higher cIMT was associated with elevated or hypertensive SBP from infancy to young adulthood, with exposure at each life stage contributing equally.
As severity of SBP increased, the lifetime effect on cIMT increased (hypertensive SBP: β = 0.06; 95% CrI, 0.03-0.10 and elevated SBP: β = 0.04; 95% CrI, 0.01-0.08). DBP or hypertensive DBP was not linked to cIMT in young adulthood.
Relative contribution of BP to cIMT was found to be consistent at all life stages that were observed in the study, which the authors stated builds on the already established links between BP and cIMT.
The investigators concluded that findings suggest “achieving lower BP levels from very early life and maintaining them throughout potentially can reduce the risk of arterial thickening, and by inference, CVD.”
Reference:
Meng Y, Sharman JE, Koskinen JS, et al. Blood pressure at different life stages over the early life Course and intima-media thickness. JAMA Pediatr. Published online December 04, 2023. doi:10.1001/jamapediatrics.2023.5351
