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Secular trends in blood pressure during early-to-middle adulthood: the Fels Longitudinal Study

Choh, Audrey Ca; Nahhas, Ramzi Wa; Lee, Miryounga,b; Choi, Youn Sua; Chumlea, William Ca,b; Duren, Dana La,c; Sherwood, Richard Ja,b; Towne, Bradforda,b; Siervogel, Roger Ma,b; Demerath, Ellen Wd; Czerwinski, Stefan Aa

doi: 10.1097/HJH.0b013e328344da30
Original papers: Epidemiology

Background: Some studies have shown a decline in blood pressure (BP) over the second half of the twentieth century. However, the increasing prevalence of obesity may have opposite effects on recent cohorts.

Method: Using serial BP data from the Fels Longitudinal Study, we examined secular trends in mean BP, the rate of change in BP with age (slopes), and the influence of obesity (i.e., BMI) and height on these trends during young-to-middle adulthood. The study sample consisted of 970 adults, aged 18–40 years, who were born between 1920 and 1979. Participants were grouped into birth decade cohorts and had up to 11 serial measurements of SBP, DBP, and BMI. Sex-stratified mixed longitudinal analyses were used to identify cohort effects on mean BP at ages 19, 29, and 39 years, and on the rate of change in BP with age.

Results: For both sexes, mean SBP did not vary significantly by birth cohort, before and after adjusting for height and BMI. Mean DBP exhibited a U-shaped secular trend even after adjusting for BMI and height that was influenced by age-by-cohort effects. By age 39 years, those born most recently had the highest mean DBP.

Conclusion: There were cohort effects on the rate of change in DBP with age, but not on rate of SBP change. The most recent cohorts had higher rates of DBP change with age compared to the earlier cohorts. The secular trend was partially influenced by the trends in BMI.

aLifespan Health Research Center, USA

bDepartment of Pediatrics, USA

cDepartment of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA

dDivision of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA

Received 14 July, 2010

Revised 19 January, 2011

Accepted 20 January, 2011

Correspondence to Audrey C. Choh, PhD, Lifespan Health Research Center, Wright State University Boonshoft School of Medicine, 3171 Research Boulevard, Dayton, OH 45420-4006, USA Tel: +1 937 775 1459; fax: +1 937 775 1456; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.