title: Combined effects of child and adult elevated blood pressure on subclinical atherosclerosis: the International Childhood Cardiovascular Cohort Consortium.
abstract: BACKGROUND
  Elevated blood pressure (BP) levels in childhood have been associated with subsequent atherosclerosis. However, it is uncertain whether this risk is attenuated in individuals who acquire normal BP by adulthood. The present study examined the effect of child and adult BP levels on carotid artery intima-media thickness (IMT) in adulthood.
  
  
  RESULTS
  The cohort consisted of 4210 participants from 4 prospective studies (mean follow-up, 23 years). Childhood elevated BP was defined according to the tables from the National High Blood Pressure Education Program. In adulthood, BP was classified as elevated for individuals with systolic BP ≥120 mm Hg, diastolic BP ≥80 mm Hg or with self-reported use of antihypertensive medications. Carotid artery IMT was measured in the left common carotid artery. High IMT was defined as an IMT ≥90th percentile according to age-, sex-, race-, and cohort-specific levels. Individuals with persistently elevated BP and individuals with normal childhood BP, but elevated adult BP had increased risk of high carotid artery IMT (relative risk [95% confidence interval]) 1.82[1.47-2.38] and 1.57[1.22-2.02], respectively) in comparison with individuals with normal child and adult BP. In contrast, individuals with elevated BP as children but not as adults did not have significantly increased risk (1.24[0.92-1.67]). In addition, these individuals had a lower risk of increased carotid artery IMT (0.66[0.50-0.88]) in compared with those with persistently elevated BP. The results were consistent when controlling for age, sex, and adiposity and when different BP definitions were applied.
  
  
  CONCLUSIONS
  Individuals with persistently elevated BP from childhood to adulthood had increased risk of carotid atherosclerosis. This risk was reduced if elevated BP during childhood resolved by adulthood.
authors.affiliation: Research Centre of Applied and Preventive Cardiovascular Medicine and the Departments of Clinical Physiology and Nuclear Medicine and Medicine, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Jonna
authors.initials: J
authors.lastname: Juhola
authors.affiliation: Research Centre of Applied and Preventive Cardiovascular Medicine and the Departments of Clinical Physiology and Nuclear Medicine and Medicine, University of Turku and Turku University Hospital, Turku, Finland.|Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
authors.forename: Costan G
authors.initials: CG
authors.lastname: Magnussen
authors.affiliation: Tulane Center for Cardiovascular Health, Tulane University, New Orleans, LA.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Berenson
authors.affiliation: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Venn
authors.affiliation: Department of Epidemiology, College of Public Health, and Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA.
authors.forename: Trudy L
authors.initials: TL
authors.lastname: Burns
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Australia.|The University of Melbourne, Department of Paediatrics at the Royal Children's Hospital, Melbourne, Australia.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Sabin
authors.affiliation: Tulane Center for Cardiovascular Health, Tulane University, New Orleans, LA.
authors.forename: Sathanur R
authors.initials: SR
authors.lastname: Srinivasan
authors.affiliation: Department of Pediatrics, University of Colorado Denver and Health Science Center, Aurora, CO.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Daniels
authors.affiliation: Department of Epidemiology, College of Public Health, and Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA.
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Davis
authors.affiliation: Tulane Center for Cardiovascular Health, Tulane University, New Orleans, LA.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Clinical Physiology (MK), University of Tampere and Tampere University Hospital, Tampere, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Kähönen
authors.affiliation: Department of Pediatrics (LT), University of Oulu, Oulu, Finland; Vaasa Central Hospital Vaasa, Finland.
authors.forename: Leena
authors.initials: L
authors.lastname: Taittonen
authors.affiliation: Department of Pediatrics (EU), Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH.
authors.forename: Elaine
authors.initials: E
authors.lastname: Urbina
authors.affiliation: Research Centre of Applied and Preventive Cardiovascular Medicine and the Departments of Clinical Physiology and Nuclear Medicine and Medicine, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Jorma S A
authors.initials: JSA
authors.lastname: Viikari
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Terence
authors.initials: T
authors.lastname: Dwyer
authors.affiliation: Research Centre of Applied and Preventive Cardiovascular Medicine and the Departments of Clinical Physiology and Nuclear Medicine and Medicine, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Olli T
authors.initials: OT
authors.lastname: Raitakari
authors.affiliation: Research Centre of Applied and Preventive Cardiovascular Medicine and the Departments of Clinical Physiology and Nuclear Medicine and Medicine, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Markus
authors.initials: M
authors.lastname: Juonala
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001794:Blood Pressure; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000517:prevention & control; D059168:Carotid Intima-Media Thickness; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000517:prevention & control; D038622:Internationality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
keywords: atherosclerosis; blood pressure; epidemiology; hypertension; risk factors