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Background: Childhood blood pressure (BP) levels predict adult left ventricular hypertrophy (LVH). However, information is limited on the association between childhood BP trajectory and adult LVH. This longitudinal study aims to characterize longitudinal BP trajectories from childhood and examine the impact of level-independent childhood BP trajectories on adult LVH and remodeling patterns.Methods: The longitudinal cohort consisted of 1,154 adults (787 whites and 367 blacks) who had repeated measurements of BP 4-15 times from childhood (4-19 years) to adulthood (20-51 years) and assessment of echocardiographic LV dimensions in adulthood. Model-estimated levels and linear slopes of BP at childhood age points were calculated in one-year intervals using the growth curve parameters and their first derivatives, respectively.Results: Linear and nonlinear curve parameters differed significantly between race-sex groups. BP showed race and sex differences from age 15 years onwards. Adults with LVH had higher long-term BP levels than normal adults in race-sex groups. Linear and nonlinear slope parameters of BP differed consistently, significantly between LVH and normal groups. Level-independent linear slopes of systolic BP showed significantly negative associations (odds ratio=0.75~0.82, p=0.001~0.015) during pre-puberty period of 4-9 years but significantly positive associations (odd ratio=1.29~1.46, p=0.001~0.008) during the puberty period of 13-19 years with adult LVH, adjusting for covariates (see the figure below). These associations were consistent across race-sex groups. Of note, the association of childhood BP linear slopes with concentric LVH was significantly stronger than that with eccentric LVH during the puberty period of 12-19 years.Conclusions: These observations indicate that the impact of BP trajectories on adult LVH and geometric patterns originates in childhood. Puberty is a crucial period for the development of LVH in later life, which has implications for early prevention.