Childhood isolated systolic hypertension is not benign: adult hypertension and cardiovascular remodeling

The long-term consequences of childhood hypertension (HTN) subtypes remain unclear. In this cohort study, we examined whether childhood isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH) are differentially associated with adult HTN and subclinical target organ damage (TOD). The study included 1228 participants from the Beijing Blood Pressure Cohort Study with a mean follow-up of 22.9 ± 0.6 years. Childhood blood pressure subtypes were classified as non-hypertensive, ISH, IDH, or SDH. Adult outcomes included HTN, cardiac remodeling, arterial stiffness, kidney damage, and overall TOD, defined as the presence of any of these abnormalities. We found that ISH was the predominant childhood hypertensive subtype (78.4%). Compared with non-hypertensive children, those with childhood ISH had a higher risk of adult HTN and cardiac remodeling and showed adverse arterial stiffness phenotypes, including higher carotid-femoral and brachial-ankle pulse wave velocity and greater risks of aortic and peripheral arterial stiffness. Childhood IDH and SDH showed distinct patterns of association, mainly involving aortic stiffness and left ventricular hypertrophy, respectively; these subgroup-specific estimates should be interpreted cautiously. In conclusion, childhood hypertensive subtypes were associated with differing long-term cardiovascular phenotypes, with the most consistent evidence observed for ISH. These findings support closer long-term surveillance of childhood HTN, particularly ISH.