There is a known association between adiposity and hypertension (HTN). However, whether and to what extent body mass index (BMI) predicts adult HTN has not been well examined longitudinally. In this study, we attempt to quantify the effects of childhood overweight and obesity on adult HTN in a prospective cohort.
The original cohort was established in 1986, and consisted of 1117 healthy children (47% male), recruited from schools in Indianapolis, Indiana (mean age 12.1; SD 5.7 years). During the course of follow-up, blood pressure, height, and weight were measured semiannually with a mean of 8.4 visits per child (SD 7.2). BMI was calculated from recorded height and weight; weight status was determined by age and sex-adjusted BMI percentile values (BMI%). Subjects were classified as normal weight, overweight (BMI% ≥ 85% and < 95%), or obese (BMI% ≥ 95%) based on either their mean BMI % or maximum BMI % during childhood. Evaluation based on mean childhood BMI % revealed that 765 (68%) were normal weight, 176 (16%) were overweight, and 176 (16%) were obese. The mean age of the subjects as of 2013 was 33.4 years (SD 3.9). From the cohort, we identified 119 adult cases of HTN through active follow up and medical chart review. In those with normal weight as children, 6% were hypertensive as adults. The rate of HTN was higher for those classified as overweight or obese as children (14% and 26% respectively, p = <0.0001). Children classified as overweight or obese had double and quadruple the risk to have a diagnosis of HTN in adulthood, respectively, as compared to normal weight children [OR = 2.2 (95% CI = 1.3, 3.6), OR = 4.4 (95% CI = 2.8, 6.9) respectively]. Additional measures of adiposity were similarly associated with HTN in adulthood including waist circumference and tricep skinfold. This pattern was also seen when analyzed by maximum BMI%. However, the increased risk of HTN in adulthood for children classified as overweight or obese was not as great [OR = 1.3 (95% CI = 0.7, 2.3), OR = 3.7 = (2.4, 5.7) respectively].
In conclusion, the degree of adiposity in childhood significantly impacts the risk for HTN in adulthood. Childhood obesity is associated with a quadrupled risk of adult HTN. This has significant implications for early prevention of childhood obesity and public health.