Elevated Blood Pressure and Worsening Cardiac Damage During Adolescence

Objectives
To examine the longitudinal course for the development of elevated blood pressure (BP)/hypertension and cardiac damage in adolescents.
Study design
From the Avon Longitudinal Study of Parents and Children, UK birth cohort, 1856 (1011 females) 17-year-olds were followed-up for 7 years. BP and echocardiography were assessed at ages 17 and 24 years. Elevated/hypertensive BP was defined as ≥130mmHg systolic and ≥85mmHg diastolic. Left ventricular (LV) mass indexed for height2.7 (LVMI2.7) ≥51g/m2.7 was defined as LV hypertrophy (LVH) and LV diastolic function (LVDF) E/A <1.5 as LVD dysfunction (LVDD). Data were analysed with generalized logit mixed-effect models and cross-lagged structural equation temporal path models adjusting for cardiometabolic and lifestyle factors.

Results
Over follow-up, the prevalence of elevated systolic BP/hypertension increased from 6.4% to 12.2%, LVH from 3.6% to 7.2%, and LVDD from 11.1 to 16.3%. Cumulative elevated systolic BP/hypertension was associated with worsening LVH in females (Odds ratio [OR] 1.61 (1.43 – 1.80); p<0.0010 only. Elevated systolic BP/hypertension was associated with worsening LVDD in males and females. Elevated diastolic BP/hypertension was associated with worsening LVH in males and females. In cross-lagged temporal path models, higher baseline systolic BP was associated with LVDF (β=0.09, SE=0.002, p=0.029), but not LVMI2.7 at follow-up. Higher baseline cardiac indices were not associated with follow-up systolic BP. Higher baseline diastolic BP was associated with follow-up higher cardiac indices except LVDF. Baseline LVMI2.7 was not associated with follow-up diastolic BP.

Conclusion
Elevated BP/hypertension may temporally precede premature cardiac damage in youth