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Does a routinely measured blood pressure in young adolescence accurately predict hypertension and total cardiovascular risk in young adulthood?

Vos, Lydia Ea; Oren, Anatha; Bots, Michiel La; Gorissen, Wim HMb; Grobbee, Diederick Ea; Uiterwaal, Cuno SPMa

Original papers: Epidemiology
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Background It is insufficiently known if routine blood pressure (BP) measurement by school doctors has added predictive value for later hypertension and cardiovascular risk.

Objective To assess whether screening of BP in adolescence has additional predictive value to already routinely collected indicators of later hypertension and cardiovascular risk.

Methods In the Dutch city of Utrecht, routine BPs and anthropometry were collected from school health records of 750 adolescents. In The Hague, standardized repeated BP measurements and anthropometry were available for 262 adolescents. Of both cohorts, 998 now young adults were recently re-examined. Predictors of adult hypertension, systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg) and 10-year cardiovascular risk were analysed by logistic regression and area under receiver operator characteristics curve (AUC).

Results A total of 167 young adults had hypertension. Single adolescent SBP and DBP predicted hypertension: odds ratio (OR) 1.04 per mmHg [95% confidence interval (CI): 1.03–1.06], OR 1.02 (1.00–1.04), respectively, but with little discriminative power. Gender, adolescent body mass index (BMI) and age combined predicted hypertension: AUC 0.71 (0.67–0.75), which slightly improved by adding SBP: AUC 0.74 (0.70–0.77); difference in AUC 0.03 (0.002–0.06). SBP exclusively predicted hypertension within men: OR 1.03 (1.01–1.04), AUC: 0.59 (0.53–0.65), and within women: OR 1.08 (1.05–1.11), AUC 0.74 (0.67–0.82). However, an adolescent BP of ≥ 120 mmHg did not efficiently detect hypertensive men, while it detected 57.9% of hypertensive women. Only young adult men had meaningful 10-year cardiovascular risks, which only SBP predicted: OR risk score > 95th percentile 1.04 (1.02–1.07), AUC 0.67 (0.60–0.75).

Conclusion A single routine BP measurement in adolescent girls efficiently predicts young adult hypertension. In adolescent boys, BP predicts young adult 10-year cardiovascular risk.

aJulius Center for Health Sciences and Primary Care, University Medical Center, Utrecht and bDepartment of Child and Adolescent Health, Municipal Health Service, Utrecht, The Netherlands.

Sponsorship: The ARYA study was financially supported by The Netherlands Organization of Health Research and Development Council (ZonMW).

Correspondence and requests for reprints to Cuno S.P.M. Uiterwaal, Julius Center for Health Sciences and Primary Care, University Medical Center, HP D01.335, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. Tel: +31 30 250 9369; fax: +31 30 250 5485; e-mail: C.S.P.M.Uiterwaal@jc.azu.nl

Received 24 March 2003 Revised 6 June 2003 Accepted 24 July 2003

See editorial commentary on page 2001

© 2003 Lippincott Williams & Wilkins, Inc.