从童年到中年的血压跟踪和过渡概率。

IF 24.7 1区 医学 Q1 PEDIATRICS JAMA Pediatrics Pub Date : 2024-11-04 DOI:10.1001/jamapediatrics.2024.4368
Yaxing Meng, James E Sharman, Fiia Iiskala, Feitong Wu, Markus Juonala, Katja Pahkala, Suvi P Rovio, Brooklyn J Fraser, Rebecca K Kelly, Nina Hutri, Mika Kähönen, Tomi Laitinen, Antti Jula, Jorma S A Viikari, Olli T Raitakari, Costan G Magnussen
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引用次数: 0

摘要

重要性:尽管小儿血压(BP)筛查与此相关,但小儿血压分类的长期预测效用和自然进展仍未得到充分研究:目的:使用美国儿科学会(AAP)阈值评估从儿童到成年中期的血压跟踪,并考虑多个时间点,估算血压分类随时间推移的过渡概率:分析于 2023 年进行,使用的是 "芬兰年轻人心血管风险纵向研究 "从 1980 年 9 月至 2018 年 8 月期间收集的数据。参与者在 38 年中接受了 9 次血压检查,从童年(6-12 岁)或青春期(15-18 岁)到青年期(21-27 岁)、青年晚期(30-37 岁)和中年期(39-56 岁):血压分类(正常、升高、高血压)基于美国儿童和青少年协会指南以及 2017 年美国心脏病学会/美国心脏协会成人指南:结果为随访时的血压分类。采用广义估计方程计算追踪系数。使用多态马尔可夫模型估算血压分类之间的转换概率:本研究共纳入 2918 名参与者(平均 [SD] 基线年龄为 10.7 [5.0] 岁;1553 名女性 [53.2%])。在 38 年的时间里,血压/高血压持续升高的追踪系数(几率比 [OR])为 2.16(95% CI,1.95-2.39)。与女性相比,男性从儿童期到中年期发展为高血压并维持高血压的概率更高,而恢复正常血压的概率更低(过渡概率:从正常血压到 2 期高血压,0.20;95% CI,0.17-0.22 vs 0.08;95% CI,0.07-0.10;维持 2 期血压,0.32;95% CI,0.27-0.39 vs 0.14;95% CI,0.09-0.21;从 2 期高血压到正常血压,0.23;95% CI,0.19-0.26 vs 0.58;95% CI,0.52-0.62。与儿童期高血压(过渡概率从 0.23;95% CI,0.19-0.26 到 0.63;95% CI,0.61-0.66)相比,中年期男女从青春期高血压过渡到正常血压的概率较低(过渡概率从 0.16;95% CI,0.14-0.19 到 0.44;95% CI,0.39-0.48)。血压保持正常的概率在最初的 5 到 10 年间急剧下降,之后趋于稳定。血压正常的儿童一般会在青春期保持这种状态(男性:过渡概率,0.64;95% CI,0.60-0.67;女性:过渡概率,0.81;95% CI,0.79-0.84),但到了青年期,这种状态会有所下降(男性:过渡概率,0.41;95% CI,0.39-0.44;女性:过渡概率,0.69;95% CI,0.67-0.71):这项队列研究的结果表明,儿童和青少年时期的血压(AAP 阈值)与日后的血压有持久的联系。虽然儿童期正常血压往往会维持到青春期,但从青春期到青年期,恢复和维持正常血压的概率会明显下降。这项研究结果强调了从儿童时期开始预防以维持正常血压的重要性,并指出青春期是一个潜在的关键时期。研究结果表明,对于最初血压正常的儿童,可以减少筛查的频率。
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Tracking and Transition Probability of Blood Pressure From Childhood to Midadulthood.

Importance: Despite its relevance for pediatric blood pressure (BP) screening, the long-term predictive utility and natural progression of pediatric BP classification remain understudied.

Objective: To evaluate BP tracking from childhood to midadulthood using the American Academy of Pediatrics (AAP) thresholds and estimate transition probabilities among BP classifications over time considering multiple time points.

Design, setting, and participants: The analyses were performed in 2023 using data gathered from September 1980 to August 2018 within the longitudinal Cardiovascular Risk in Young Finns Study. Participants had BP examined 9 times over 38 years, from childhood (aged 6-12 years) or adolescence (15-18 years) to young adulthood (21-27 years), late young adulthood (30-37 years), and midadulthood (39-56 years).

Exposures: BP classifications (normal, elevated, hypertension) were based on AAP guidelines for children and adolescents and the 2017 American College of Cardiology/American Heart Association guidelines for adults.

Main outcomes and measures: Outcomes were BP classifications at follow-up visits. Tracking coefficients were calculated using generalized estimated equations. Transition probabilities among BP classifications were estimated using multistate Markov models.

Results: This study included 2918 participants (mean [SD] baseline age, 10.7 [5.0] years; 1553 female [53.2%]). Over 38 years, the tracking coefficient (odds ratio [OR]) for maintaining elevated BP/hypertension was 2.16 (95% CI, 1.95-2.39). Males had a higher probability than females of progressing to and maintaining hypertension and a lower probability of reverting to normal BP from childhood to midadulthood (transition probability: from normal BP to stage 2 hypertension, 0.20; 95% CI, 0.17-0.22 vs 0.08; 95% CI, 0.07-0.10; maintaining stage 2 BP, 0.32; 95% CI, 0.27-0.39 vs 0.14; 95% CI, 0.09-0.21; from stage 2 hypertension to normal BP, 0.23; 95% CI, 0.19-0.26 vs 0.58; 95% CI, 0.52-0.62. For both sexes, the probability of transitioning from adolescent hypertension to normal BP in midadulthood was lower (transition probability, ranging from 0.16; 95% CI, 0.14-0.19 to 0.44; 95% CI, 0.39-0.48) compared with childhood hypertension (transition probability, ranging from 0.23; 95% CI, 0.19-0.26 to 0.63; 95% CI, 0.61-0.66). The probability of maintaining normal BP sharply decreased in the first 5 to 10 years, stabilizing thereafter. Children with normal BP generally maintained this status into adolescence (male: transition probability, 0.64; 95% CI, 0.60-0.67; female: transition probability, 0.81; 95% CI, 0.79-0.84) but decreased by young adulthood (male: transition probability, 0.41; 95% CI, 0.39-0.44; female: transition probability, 0.69; 95% CI, 0.67-0.71).

Conclusion and relevance: Results of this cohort study reveal an enduring association of childhood and adolescent BP (AAP thresholds) with later BP. Although childhood normal BP tends to be maintained into adolescence, the probability of reverting to and sustaining normal BP decreases notably from adolescence to young adulthood. The findings of this study underscore the importance of prevention to maintain normal BP starting in childhood, suggesting adolescence as a potential critical period. The results suggest the potential for less frequent screenings for children with initially normal BP.

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来源期刊
JAMA Pediatrics
JAMA Pediatrics PEDIATRICS-
CiteScore
31.60
自引率
1.90%
发文量
357
期刊介绍: JAMA Pediatrics, the oldest continuously published pediatric journal in the US since 1911, is an international peer-reviewed publication and a part of the JAMA Network. Published weekly online and in 12 issues annually, it garners over 8.4 million article views and downloads yearly. All research articles become freely accessible online after 12 months without any author fees, and through the WHO's HINARI program, the online version is accessible to institutions in developing countries. With a focus on advancing the health of infants, children, and adolescents, JAMA Pediatrics serves as a platform for discussing crucial issues and policies in child and adolescent health care. Leveraging the latest technology, it ensures timely access to information for its readers worldwide.
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