Abstract: Objective To investigate the effect of childhood high blood pressure (BP) on the risk of hypertension in adulthood, in order to provide evidence for the early prevention of high BP in adults. Methods Based on the data from the China Health and Nutrition Survey (CHNS, 1991-2011), a total of 1 984 subjects aged 6 to 17 years and followed up from childhood (6-17 years) to young adulthood (18-38 years) with complete data were included. In childhood, elevated BP was defined as systolic and/or diastolic BP (SBP/DBP) ≥P₉₀ cut-off value and<P₉₅ cut-off value for sex and age, and high BP as SBP and/or DBP≥P₉₅ cut-off value for age and sex according to the references of high blood pressure in Chinese children and adolescents. In adulthood, pre-hypertension was defined as SBP/DBP≥120/80 mmHg and<140/90 mmHg, and hypertension as SBP/DBP≥140/90 mmHg, or having hypertension history or self-reported use of antihypertensive medications. Covariance analysis and Cox proportional hazards models were used to assess the influence of childhood elevated and high BP on the risk of development of pre-hypertension and hypertension in adulthood, with adjustment for sex and age in childhood, and body mass index (BMI), smoking status and alcohol intake in adulthood. Results Totally 1 984 subjects aged 6 to 17 years were included, with a median follow-up duration of 11.7 years. There were 108 (5.4%) subjects with elevated BP and 199(10.0%) subjects with high BP at childhood baseline. In adulthood, there were 697(35.1%) subjects with pre-hypertension and 104(5.2%) subjects with hypertension. After adjusting for confounding factors, SBP and DBP levels in adulthood increased with the increase of BP percentiles in childhood (P_{for trend}<0.001). Children with high BP had an increased risk of pre-hypertension in adulthood (HR=1.41, 95% CI: 1.12-1.77) and hypertension in adulthood (HR=1.73, 95% CI: 1.01-2.98). Conclusions Childhood high BP increases risk of pre-hypertension and hypertension in adulthood. It is important to monitor BP status in childhood and to prevent and control high BP during this period, so as to reduce the risk of hypertension in adulthood.

Key words: childhood, adulthood, hypertension, cohort study

摘要： 目的 本研究旨在探讨儿童期血压偏高对成年期高血压的影响,为成人高血压的早期防控提供科学依据。方法 基于“中国居民健康与营养调查”资料(1991-2011年),纳入儿童期(6~17岁)和成年期(18~38岁)均进行至少1次随访的研究对象。儿童期血压偏高前期定义采用中国儿童青少年血压参考值性别和年龄的第90百分位(P₉₀)至第95百分位(P₉₅),儿童期血压偏高采用≥P₉₅。成年期高血压前期为收缩压/舒张压≥120/80 mmHg且<140/90 mmHg;成年期高血压为收缩压/舒张压≥140/90 mmHg,或有高血压史,或目前正服用降压药物。采用协方差分析和Cox比例风险回归模型分析儿童期血压偏高对成年期高血压前期和高血压的影响,控制混杂因素包括儿童期性别和年龄,成年期的体重指数(BMI)、吸烟和饮酒。结果 本研究共纳入1 984名数据完整的研究对象,中位随访时间为11.7年。基线儿童期共有108人(5.4%)为血压偏高前期,199人(10.0%)为血压偏高。随访成年期共有697人(35.1%)为高血压前期,104人(5.2%)为高血压。协方差分析表明,成年期收缩压和舒张压水平均随着儿童期血压百分位的增加而增加(P_趋势<0.001)。多因素Cox回归分析显示,儿童期血压偏高者成年后为高血压前期的风险增加(HR=1.41,95%CI:1.12~1.77)。儿童期血压偏高者成年后为高血压的风险显著增加(HR=1.73,95%CI:1.01~2.98)。结论 儿童期血压偏高会增加成年期罹患高血压的风险。应该重视儿童青少年血压监测,对血压偏高的高危儿童应及时采取干预措施。

关键词: 儿童期, 成年期, 高血压, 队列研究