Childhood maltreatment and adult blood pressure-based outcomes: age- and sex-specific associations in the German National Cohort (NAKO)

Abstract Background Childhood maltreatment (CM) is associated with adult cardiovascular disease (CVD) risk. Systolic (SBP) and diastolic (DBP) blood pressure (BP), key markers of CVD risk, exhibit age- and sex-dependent variability, which was insufficiently accounted for in previous studies on the CM-BP relationship. This study therefore aimed to assess age- and sex-specific associations between CM and adult BP-based outcomes and hypertension using cross-sectional data from the population based German National Cohort (NAKO). Methods Complete data were available for 150,983 participants (49.3% female), who took part in the baseline assessment between 2014 and 2019. CM was assessed via the Childhood Trauma Screener (CTS). Resting BP was assessed using a standardized procedure. Hypertension was defined as either SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or intake of antihypertensive medication. Age- and sex-stratified multivariable regression models estimated age- and sex-specific associations between CM and BP-based markers and sex-stratified logistic regression models were calculated for hypertension as the outcome. Results A pattern of inverse associations between CTS sum score (CTS SUM ) and BP markers emerged. Compared to their non-exposed counterparts, females (OR = 0.87, 95%-CI: 0.80; 0.94) but not males (OR = 1.01, 95%-CI: 0.91; 1.13) with high cumulative CM exposure (i.e., ≥ 3 CM categories) had lower odds of hypertension. Age-dependent inverse associations between CTS SUM and BP markers revealed sex-specific patterns. The age- and sex-dependent inverse associations of CM with BP markers were more consistent for the abuse vs. neglect subscales. Conclusions The association between CM and BP revealed age- and sex-dependent patterns, highlighting the complexity of physical consequences in adulthood associated with CM.

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Journal
BMC Public Health
Published
2026-09-09
DOI
https://doi.org/10.1186/s12889-026-29019-z
Primary Topic
Child Abuse and Trauma
Type
article
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article

Childhood maltreatment and adult blood pressure-based outcomes: age- and sex-specific associations in the German National Cohort (NAKO)

Margit Heier, Karin Halina Greiser, Margarethe Woeckel, Marcello Ricardo Paulista Markus et al.
BMC Public Health
Child Abuse and Trauma
article

Childhood maltreatment and adult blood pressure-based outcomes: age- and sex-specific associations in the German National Cohort (NAKO)

Margit Heier, Karin Halina Greiser, Margarethe Woeckel, Marcello Ricardo Paulista Markus, Carsten Oliver Schmidt, Ilais Moreno Velásquez, Stefanie Castell, Philipp Töpfer, Tobias Pischon, Johanna Klinger-König, Ulrike Siewert‐Markus, Till Ittermann, Hans J. Grabe, Sabine Schipf, Rafael Mikolajczyk, Henry Völzke, Michael Leitzmann, Nadia Obi, Seraina Lerch, Thomas Keil, Claudia Meinke-Franze, Sylvia Stracke, Lilian Krist, Klaus Berger, Volker Harth, André Karch, Tara Alissa Thielcke
article en

Abstract

Abstract Background Childhood maltreatment (CM) is associated with adult cardiovascular disease (CVD) risk. Systolic (SBP) and diastolic (DBP) blood pressure (BP), key markers of CVD risk, exhibit age- and sex-dependent variability, which was insufficiently accounted for in previous studies on the CM-BP relationship. This study therefore aimed to assess age- and sex-specific associations between CM and adult BP-based outcomes and hypertension using cross-sectional data from the population based German National Cohort (NAKO). Methods Complete data were available for 150,983 participants (49.3% female), who took part in the baseline assessment between 2014 and 2019. CM was assessed via the Childhood Trauma Screener (CTS). Resting BP was assessed using a standardized procedure. Hypertension was defined as either SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or intake of antihypertensive medication. Age- and sex-stratified multivariable regression models estimated age- and sex-specific associations between CM and BP-based markers and sex-stratified logistic regression models were calculated for hypertension as the outcome. Results A pattern of inverse associations between CTS sum score (CTS SUM ) and BP markers emerged. Compared to their non-exposed counterparts, females (OR = 0.87, 95%-CI: 0.80; 0.94) but not males (OR = 1.01, 95%-CI: 0.91; 1.13) with high cumulative CM exposure (i.e., ≥ 3 CM categories) had lower odds of hypertension. Age-dependent inverse associations between CTS SUM and BP markers revealed sex-specific patterns. The age- and sex-dependent inverse associations of CM with BP markers were more consistent for the abuse vs. neglect subscales. Conclusions The association between CM and BP revealed age- and sex-dependent patterns, highlighting the complexity of physical consequences in adulthood associated with CM.

BMC Public Health
Universität Hamburg (DE), German Cancer Research Center (DE), Max Delbrück Center (DE), Heidelberg University (DE), University of Münster (DE), University of Würzburg (DE), Universitätsmedizin Greifswald (DE), Luther University (KR), German Center for Neurodegenerative Diseases (DE), University Hospital Augsburg (DE), Helmholtz Zentrum München (DE), LMU Klinikum (DE), Humboldt-Universität zu Berlin (DE), University Medical Center Hamburg-Eppendorf (DE), Helmholtz Centre for Infection Research (DE), German Centre for Cardiovascular Research (DE), Deutsches Diabetes-Zentrum e.V. (DE), German Center for Diabetes Research (DE), Heinrich Heine University Düsseldorf (DE), University of Regensburg (DE), Martin Luther University Halle-Wittenberg (DE), Freie Universität Berlin (DE), Charité - Universitätsmedizin Berlin (DE), Ludwig-Maximilians-Universität München (DE)
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Child Abuse and Trauma
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