Perinatal & Pediatric
Nonparametric Estimation of Elevated Blood Pressure Tracking Throughout Childhood and Adolescence Lucia Petito* Lucia Petito Petito Petito Petito Northwestern University Feinberg School of Medicine
Introduction. Elevated blood pressure (BP) affects approximately 1 in 12 US children and adolescents, a condition that may persist into adulthood and is linked to increased risk of hypertension and subsequent cardiovascular events. Here we aimed to better understand how BP percentiles track over childhood.
Methods. We used data from children aged 3-19 years from the Environmental influences on Child Health Outcomes (ECHO) Consortium with ≥2 systolic BP (SBP) measurements. We estimated clinically-relevant estimands called age-integrated rank-tracking probabilities (aRTP(s)), which reflect the current risk of elevated SBP (at age a) among those who had elevated SBP s years ago (at age a – s), integrated over childhood (ages 5-19). This reflects how consistently children maintain their sex-age-height specific SBP percentile, answering the question “what is the chance a child still has elevated SBP given they had elevated SBP s years ago?” Sex-specific estimates of aRTP(s) were generated for mildly elevated SBP (SBP percentile ≥80th), elevated SBP (≥90th), and hypertension (≥95th) separately using a nonparametric kernel-based method. We estimated 95% confidence intervals using clustered bootstraps with 200 resamples.
Results. We included 2,484 girls and 2,481 boys (observed 5,278 and 5,211 times, respectively; median age 4 years; 55% non-Hispanic White) with prevalences of mildly elevated SBP of 26.2% and 24.4%, respectively. For mildly elevated SBP, aRTP declined as look-back periods increased from 2 to 8 years, decreasing from 0.67 (95% CI 0.61-0.74) to 0.31 (0.23-0.41) and 0.69 (0.65-0.75) to 0.36 (0.28-0.47) among girls and boys, respectively. This pattern was consistent for elevated SBP and hypertension (Figure).
Conclusions. Childhood BP measurements taken closely together in time track more strongly than those taken further apart, supporting population-wide rather than individualized healthy lifestyle interventions to promote early maintenance of optimal BP.
