TRACKING OF BLOOD-PRESSURE IN CHILDREN AND YOUTH

Part of a preventive pediatric strategy against cardiovascular diseases is the early identification of hypertension in childhood. There is a clearly established relationship between blood pressure measured during childhood and at later periods for the same individual. This relationship was investigated in studies of blood pressure tracking in children over the past two decades. This report reviews longitudinal studies that analysed tracking of blood pressure between the ages of 4 and 20 years. The results confirm the existence of tracking, but the statistical relationship seems too weak to justify preventive pediatric strategies based on blood pressure in childhood. However, during adolescence, tracking of blood pressure is affected by the processes of growth and maturation. Methodological problems may have also resulted in underestimation of the amount of tracking. An increase in the number of blood pressure measurements and the use of vertex-corrected blood pressure values would probably improve tracking. It is important to analyse the improvement in tracking coefficients when these new methods are used in order to determine the maximal extent to which blood pressure in childhood can predict future levels. Recently, several studies that were able to relate blood pressure values from childhood to adulthood suggested that tracking seems to persist over this long period. Together with comparable results from future analyses of studies considered in this review, more detailed information will become available about the predictability of blood pressure in children. Although blood pressure is the best single predictor of future blood pressure, results of this review indicate that its predictability is not sufficiently strong for preventive strategies in childhood. Therefore, the development of blood pressure predictors based on more than one parameter is recommended.