A prospective analysis to assess the multifactorial risk of childhood-onset hypertension: the ExAMIN Youth SA study

Childhood-onset hypertension tracks into adulthood and is on the rise globally. Identifying risk factors in early childhood remains of epidemiological importance for developing early intervention and prevention strategies to mitigate premature hypertension onset. This study explored the changes in blood pressure and the predictive value of individual and composite baseline risk factors for elevated blood pressure over a 4-year period in South African children. We included 767 healthy children (aged 5-9 years at baseline) with a mean follow-up time of four years. Office blood pressure, anthropometry, cardiorespiratory fitness, health-related quality of life, food intake and urinary biomarkers were measured. Children were stratified by blood pressure status according to the 2017 American Academy of Pediatrics guidelines. Individual baseline risk factors as well as composite risk factors were assessed to predict follow-up blood pressure status. The prevalence of elevated blood pressure declined by 6% over four years. Longitudinally, age (HR:1.78; p = 0.005), ethnicity (HR:0.048; p = 0.001), socioeconomic status (HR:0.42; p = 0.004) and sugar-sweetened beverages intake (HR:1.67; p = 0.026) predicted elevated blood pressure over four years. No significant results were observed with composite risk factors cross-sectionally, however factor pattern 1 (socioeconomic status, family history, meat and milk product intake) indicated a lower risk of elevated blood pressure at follow-up (HR:0.74; p = 0.042). Multiple risk factors, including diet and socioeconomic status, contribute to elevated blood pressure in South African children. Early multifaceted interventions targeting these factors are essential to prevent long-term cardiovascular disease.