Does Childhood BP Matter?
In a recent editorial commentary published in Hypertension, Dr Joseph Flynn, from the Division of Nephrology, Seattle Children’s Hospital, critically examines this very important question.  The intuitive answer is yes of course it is, but it is it that simple!
In adults there is incontrovertible evidence BP is leading cause of death, and there are direct correlations between BP level and rates of stroke, myocardial infarction, and the risk of end-stage renal disease. Furthermore, there are innumerable clinical trials showing that reduction in BP lowers event rates and there are evidence-based recommendations for definition of hypertension, BP levels for intervention and target.
In contrast, hypertension-related events are very rare in children and adolescents. An evidence-based review conducted by the United States Preventative Services Task Force, showed that there is a lack of clinical trial data linking childhood BP levels to long-term cardiovascular outcomes. Definitions of hypertension are, therefore, based on the normal distribution of BP values in healthy children. Some have even questioned the value of routine BP in children and adolescents despite the growing number of children and adolescents with hypertension based on these criteria.
Others have maintained that other sources of evidence can be examined to ascertain the immediate and future effects of high BP in children and adolescents. For example, cross-sectional studies have demonstrated associations between high BP and target-organ damage. Furthermore, studies have consistently shown tracking of BP levels from childhood into adulthood. Longitudinal cohort studies constitute yet another body of evidence to determine the long-term cardiovascular risk of elevated BP in childhood. Recent studies have linked childhood BP to markers of CV damage in adulthood. Unfortunately, these important pieces of evidence were excluded from the United States Preventative Services Task Force analysis. However, careful review of these data supports the conclusion that childhood BP levels do indeed have important future cardiovascular implications.
The 2nd International Congress of Hypertension in Children and Adolescents will be held in Warsaw to be held in May 2019. A distinguished faculty has been assembled to examine all the critical issues of hypertension in children and adolescents in a comprehensive programme. Childhood BP does really matter!
1. Flynn JT. Childhood blood pressure matters. Hypertension 2019; 298: 296-7.