Utility of Different Blood Pressure Measurement Components in Childhood to Predict Adult Carotid Intima-Media Thickness: The i3C Consortium Study

Juha Koskinen, Markus Juonala, Terence Dwyer, Alison Venn, Janina Petkeviciene, Indrė Čeponienė, Lydia Bazzano, Wei Chen, Matthew A. Sabin, Trudy L. Burns, Jorma S.A. Viikari, Jessica G. Woo, Elaine M. Urbina, Ronald Prineas, Nina Hutri-Kähönen, Alan Sinaiko, David R. Jacobs, Julia Steinberger, Stephen Daniels, Olli RaitakariCostan G. Magnussen

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Childhood blood pressure (BP) levels predict adult subclinical atherosclerosis. However, the best childhood BP component for prediction has not been determined. This study comprised 5925 participants aged 3 to 18 years from 6 cohorts who were followed into adulthood (mean follow-up 25.8±6.2 years). Childhood BP was measured by using a standard mercury sphygmomanometer in all cohorts. Study-specific carotid intima-media thickness ≥90th percentile was used to define subclinical atherosclerosis. Per SD change in the predictor, childhood systolic BP (SBP; age- and sex-adjusted odds ratio [95% CI], 1.24 [1.13-1.37]), mean arterial pressure (1.10 [1.07-1.13]), and pulse pressure (1.15 [1.05-1.27]) were associated with increased adulthood intima-media thickness. In age- and sex-adjusted analyses, area under the receiver operating characteristic curves for SBP (C value [95% CI], 0.677 [0.657-0.704]) showed significantly improved prediction compared with diastolic BP (0.669 [0.646-0.693], P=0.006) or mean arterial pressure (0.674 [0.653-0.699], P=0.01). Pulse pressure provided a C value that was not different from SBP (0.676 [0.653-0.699], P=0.16). Combining different BP components did not improve prediction over SBP measurement alone. Based on the associations with adult carotid intima-media thickness, cut points for elevated SBP were 105 mm Hg for 3- to 6-year-old boys, 108 mm Hg for 3- to 6-year-old girls, 108 mm Hg for 7- to 12-year-old boys, 106 mm Hg for 7- to 12-year-old girls, 123 mm Hg for 13- to 18-year-old boys, and 115 mm Hg for 13- to 18-year-old girls. Our analyses suggest that several childhood BP measurement components are related to adulthood carotid intima-media thickness. Of these, SBP provided the best predictive ability.

Original languageEnglish (US)
Pages (from-to)335-341
Number of pages7
Issue number2
StatePublished - 2019

Bibliographical note

Funding Information:
This study was supported by a grant from the US National Institutes of Health (NIH/National Heart, Lung and Blood Institute [NHLBI]) number R01 HL121230 and the Australian National Health and Medical Research Council Project Grant (APP1098369 and APP211316). C.G. Magnussen was supported by a National Heart Foundation of Australia Future Leader Fellowship (100849). The Young Finns has been financially supported by the Academy of Finland (grants 126925, 121584, 124282, 129378, 117787, and 41071), the Social Insurance Institution of Finland; Kuopio, Tampere, and Turku University Hospital Medical Funds, Juho Vainio Foundation, Paavo Nurmi Foundation, Finnish Foundation of Cardiovascular Research, Finnish Cultural Foundation, Sigrid Juselius Foundation, Yrjö Jahnsson Foundation. J. Koskinen was supported by Turku University foundation (11–2259), Emil Aaltonen Foundation and Urmas Pekkala Foundation. The Muscatine Study was supported by a Specialized Center of Research (SCOR) in Atherosclerosis grant from the NHLBI HL-14230, by RR-00059 from the General Clinical Research Centers Program, NCRR, NIH, and by the following NHLBI (NHLBI) R01s HL-48050, HL-54730, and HL-61857. The Kaunas Cardiovascular Cohort Study was supported by research grants from the Research Council of Lithuania (LIG-01/2012).

Publisher Copyright:
© 2018 American Heart Association, Inc.


  • arterial pressure
  • atherosclerosis
  • blood pressure
  • epidemiology
  • pediatrics


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