ImportanceDespite its relevance for pediatric blood pressure (BP) screening, the long-term predictive utility and natural progression of pediatric BP classification remain understudied.ObjectiveTo 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 ParticipantsThe 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).ExposuresBP 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 MeasuresOutcomes 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.ResultsThis 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 RelevanceResults 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.

中文翻译：

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从儿童期到成年中期血压的跟踪和转换概率


重要性尽管它与儿科血压 （BP） 筛查相关，但儿科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 （American Academy of Pediatrics， AAP） 阈值评估从儿童期到中年期的血压跟踪，并考虑多个时间点估计 BP 分类随时间变化的转换概率。设计、设置和参与者分析于 2023 年进行，使用 1980 年 9 月至 2018 年 8 月在芬兰年轻人纵向心血管风险研究中收集的数据进行。参与者在 38 年内进行了 9 次血压检查，从儿童期 （6-12 岁） 或青少年期 （15-18 岁） 到青年期 （21-27 岁）、青年晚期 （30-37 岁） 和中年期 （39-56 岁）。暴露BP 分类（正常、升高、高血压）基于 AAP 儿童和青少年指南和 2017 年美国心脏病学会/美国心脏协会成人指南。主要结局和测量结局是随访时的血压分类。使用广义估计方程计算跟踪系数。使用多态马尔可夫模型估计 BP 分类之间的转换概率。结果本研究包括 2918 名参与者 （平均 [SD] 基线年龄，10.7 [5.0] 岁;1553 名女性 [53.2%]）。在 38 年中，维持高血压的跟踪系数 （比值比 [OR]）为 2.16 （95% CI，1.95-2.39）。男性进展为高血压和维持高血压的概率高于女性，从儿童期到成年中期恢复正常血压的可能性较低（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 对 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 对 0.58;95% CI，0.52-0.62。对于两性，与儿童高血压（过渡概率，范围为 0.23;95% CI，0.19-0.26 至 0.63;95% CI，0.61-0.66;95% CI，0.61-0.66）相比，中年中期从青少年高血压过渡到正常血压的概率较低（过渡概率，范围为 0.16;95% CI，0.14-0.19 至 0.44;95% CI，0.61-0.66）。维持正常血压的可能性在最初 5 至 10 年急剧下降，此后趋于稳定。血压正常的儿童通常保持这种状态到青春期（男性：转换概率，0.64;95% CI，0.60-0.67;女性：转换概率，0.81;95% CI，0.79-0.84），但在成年早期下降（男性：转换概率，0.41;95% CI，0.39-0.44;女性：转换概率，0.69;95% CI，0.67-0.71）。结论和相关性该队列研究的结果揭示了儿童和青少年血压 （AAP 阈值） 与以后的血压之间存在持久的关联。尽管儿童期正常血压往往维持到青春期，但从青春期到成年早期，恢复和维持正常血压的可能性显着降低。这项研究的结果强调了预防从儿童期开始维持正常血压的重要性，这表明青春期是一个潜在的关键时期。结果表明，对于最初血压正常的儿童，筛查频率可能会降低。