Combining annual blood pressure measurements in childhood to improve prediction of young adult blood pressure

Tracking correlations of blood pressure (BP) have been reported between levels measured in a single year during both childhood and adulthood. Because of the variability of BP, these correlations increase with the number of visits and measurements per visit in each year. It remains unclear, however, whether such correlations would improve further by combining BP data collected over several years. From 1978-1981, BP was measured annually in a cohort of 339 children in East Boston, MA, at four visits one week apart with three measurements per visit. Of this cohort, then aged 18-26 years, 316 were re-examined in 1989-1990 at three visits one week apart with three measures per visit. Tracking correlations were estimated from levels measured in a single year as well as means averaged over several years in childhood, adjusting for age, year of measurement, as well as smoking, alcohol and oral contraceptive use. Multivariate models were fit to estimate tracking correlations from childhood to young adulthood adjusting for within-person variability. Using a single year in childhood, these were 0.49 in boys and 0.59 in girls for systolic BP and 0.39 and 0.48 for diastolic BP (all p<0.001). Using the long-term average in childhood and adjusting for variability across years, these values were 0.55 in boys and 0.66 in girls for systolic BP and 0.47 and 0.57 for diastolic BP (all p<0.001). We observed concomitant increases in the predictive value of childhood BP for young adult BP. These results suggest that averaging BP over at least two years during childhood increases tracking correlations and improves the prediction of adult values from childhood levels.