Early life factors, blood pressure percentile trajectories, and elevated blood pressure in children

BACKGROUND: Elevated blood pressure (BP) in childhood is a predictor of adult hypertension. METHODS: We characterized existing blood pressure (BP) percentile trajectories in children aged 3-9 years and examined factors associated with BP trajectory and elevated BP among 1040 participants in a prospective birth cohort study in Durham, North Carolina (2005-2011). We obtained BP measurements from medical records and demographic, social, and behavioral characteristics from questionnaires. We identified systolic blood pressure (SBP) percentile trajectories using group-based trajectory modeling as well as diastolic blood pressure (DBP) percentiles as a secondary outcome. We then calculated associations between trajectory group and covariates of interest using multinomial logistic regression. We also estimated the association of these covariates with elevated BP using generalized estimating equations. RESULTS: We identified four distinct SBP percentile trajectories (lower stable, lower increasing, higher stable, and higher decreasing) and three distinct DBP percentile trajectories (lower increasing, higher decreasing, and higher stable). Birthing parent race and ethnicity, pre-pregnancy BMI, relationship status, educational attainment, and gestational diabetes status were significantly associated with offspring SBP percentile trajectory group assignment. Offspring sex assigned at birth, birthing parent race and ethnicity, pre-pregnancy BMI, smoking, relationship status, educational attainment, and chronic hypertension status were significantly associated with offspring DBP percentile trajectory group assignment. Infant sex, preterm birth, birthing parent race and ethnicity, pre-pregnancy BMI, and chronic hypertension status were significantly associated with offspring elevated BP. CONCLUSION: Our results enhance understanding of pediatric SBP and DBP patterns and assist in identifying factors that contribute to elevated BP in children. IMPACT: Our research contributes to understanding of pediatric BP patterns leveraging percentiles which account for age, sex, and height. We identified four distinct SBP and three distinct DBP trajectories in children aged 3-9 years. We identified associations of several social, demographic, and clinical characteristics with childhood BP trajectories and elevated BP. Elevated blood pressure in childhood is a leading precursor for adverse cardiovascular outcomes in adults. Our research may assist in targeted interventions for high-risk groups.