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Summary of JAMA. https://doi.org/10.1001/jama.2025.14405
Dr. Alexa A. Freedman et al.

Points

• High blood pressure in childhood is a modifiable risk factor for cardiovascular disease mortality over a lifetime.
• This study followed a large cohort of 37,081 US children from age 7 into their mid-50s to assess this long-term risk.
• Elevated blood pressure and hypertension at age 7 were significantly associated with increased premature cardiovascular mortality.
• A 1-SD increase in systolic and diastolic blood pressure at age 7 predicted a higher risk of cardiovascular death.
• These findings emphasize the crucial need for early-life cardiovascular health promotion and blood pressure monitoring.

Summary

A prospective cohort study, initiated between 1959 and 1965, investigated the long-term association between blood pressure (BP) at age 7 years and cardiovascular disease (CVD) mortality, with follow-up extending into the sixth decade of life. Data from 37,081 children from the US Collaborative Perinatal Project were analyzed, with a mean (SD) age of 7.1 (0.6) years at baseline. The mean SBP was 101.9 (10.2) mm Hg and DBP was 61.2 (10.0) mm Hg. Approximately 21% of the children were categorized with hypertension (≥95th percentile). Over a median (IQR) follow-up of 54 (52-55) years, 487 cardiovascular and 2242 noncardiovascular deaths were recorded.

The study found a significant association between higher BP at age 7 and premature CVD mortality. A 1-SD increase in SBP was linked to an adjusted hazard ratio (aHR) of 1.14 (95% CI, 1.03-1.26), and for DBP, the aHR was 1.18 (95% CI, 1.07-1.29). These findings were consistent in a fixed-effects sibling analysis (359 children in 150 sibling clusters), with an aHR for SBP of 1.14 (95% CI, 0.90-1.45) and for DBP of 1.18 (95% CI, 0.93-1.51). A significant interaction by sex for SBP (P < .01) indicated a stronger association in male individuals (aHR, 1.31 [95% CI, 1.14-1.50]) compared to female individuals (aHR, 0.97 [95% CI, 0.84-1.11]).

Furthermore, both elevated BP (90th-94th percentile) and hypertension (≥95th percentile) at age 7 years were independently associated with an increased risk of CVD mortality, with adjusted hazard ratios of 1.48 (95% CI, 1.18-1.86) and 1.40 (95% CI, 1.12-1.76), respectively. These results underscore the critical importance of early-life cardiovascular health promotion and blood pressure monitoring, highlighting that elevated BP in childhood confers a substantial long-term risk for premature cardiovascular mortality.

Link to the article: https://jamanetwork.com/journals/jama/fullarticle/2838658 

References

Freedman, A. A., Perak, A. M., Ernst, L. M., Borders, A., Miller, G. E., Allen, N. B., Gilman, S. E., & Khan, S. S. (2025). High blood pressure in childhood and premature cardiovascular disease mortality. JAMA. https://doi.org/10.1001/jama.2025.14405