Studies of blood pressure in Tecumseh, Michigan. II. Antecedents in childhood of high blood pressure in young adults.

Predictors of high blood pressure (BP) in young adults were identified in a prospective epidemiological study of 2400 persons who, at the time of their first examination in the Tecumseh Community Health Study, were under 20 years of age.They were re-examined in 1977 after an average interval of 13 years, by which time they were 12-34 years of age.The parents of 92% of the young subjects were also examined initially but not at follow-up.Persons with values above the 80th percentile for their age and sex were considered to have high BP.Mean age and sex-adjusted scores of systolic blood pressure (SBP) and rates of high SBP at follow-up were compared in young people according to whether their levels of fatness and their parents' levels of blood pressure and fatness were above or below the 80th percentile at the earlier examination.Both initial and follow-up examinations showed that mean BP and prevalence rates of high BP were highest in children whose parents had high BP, intermediate in children whose parents were fat but whose BP was below the 80th percentile, and lowest in children whose parents' BP and fatness were both below the 80th percentile.Young adults who were fat children tended to have higher BP means and rates than young adults who were not, regardless of their parents' levels of BP and fatness.Predictors of high SBP were identified by multiple logistic regression analyses.For boys aged 6-19 years at the beginning of the study, predictors were initial BP and change in fatness of the subject and mother's BP.For girls initially aged 6-19 years, predictors were the girl's initial BP and change in fatness, and father's and mother's BP.With this model, 46% of the cases were concentrated in the top two deciles of risk for males and 49% for females.If the subject's BP and the mother's BP were the only information entered into the model, 44% of the male cases and 43% of the female cases would be in the top two deciles of risk.The predictive accuracy of an initial value in the top two deciles of risk was 44% for boys and 36% for girls.Prediction improved with increasing age in boys, but not in girls.(Hypertension 2 (suppl I): 1-117-1-123, 1980) KEYWORDS • blood pressure • familial aggregation • fatness • tracking H EREDITARY, familial, and constitutionalfactors have been implicated as determinants of high blood pressure (BP).These influences operate from a very early age; therefore, if they could be recognized in childhood they could lead to identification of high-risk children and preventive action.The effect of modifying risk factors would, of course, have to be determined.The Tecumseh Community Health Study (TCHS), begun in 1959 as a comprehensive prospective epidemiological investigation of health and disease in