Childhood Adversity and Blood Pressure Trajectories | Journal Scan

Study Questions:

Do adverse experiences during childhood increase blood pressure over time?

Methods:

Data from the Georgia Stress and Heart Study were used for the present analysis. This was an ongoing, longitudinal study, which examined cardiovascular risk factors among youth and young adults over a 23-year period (1989-2012). Up to 16 assessments including resting blood pressure were collected. Average number of blood pressure assessments for this study population was 13. Data on traumatic experiences including abuse, neglect, and household dysfunction were collected retrospectively. Adverse experiences were grouped into three categories and 10 subscales including childhood abuse (emotional, physical, and sexual), neglect (emotional and physical), and growing up with household dysfunction (substance abuse, mental illness, domestic violence, criminal household member, and parental marital discord). An adverse childhood experience (ACE) score was used to quantify the number of adverse experiences for each subject. The primary outcome of interest was blood pressure, including average blood pressure and change in blood pressure over time.

Results:

A total of 213 African Americans and 181 European Americans (aged 5-38 years) were included in the present analysis. African American youth had higher body mass index, systolic blood pressure (SBP), and diastolic blood pressure (DBP), and lower socioeconomic status compared to European American youth. European Americans were more likely to smoke and/or use illicit drugs, but were also more likely to report exercising compared to African American youth. Prevalence of physical neglect was 9.4%, which was the lowest reported adverse experience, while parental marital discord (38.2%) was the highest reported adverse experience. A total of 69% of participants reported one or more adverse experience including mild (1-2 ACEs), moderate (3 ACEs), and severe (≥4 ACEs) exposure to ACEs representing 37.9%, 12.5%, and 18.8%, respectively. No gender differences were observed for adverse experiences; however, the number of adverse experiences was higher for African Americans compared to European Americans. No main effect of adverse experiences on average blood pressure was observed. Interaction between adverse experience score and age was observed for both SBP and DBP, such that a greater number of traumatic events during childhood was associated with a greater rise in blood pressure after the age of 30 years, compared to those who reported no adverse experiences. An association between adverse experiences and childhood socioeconomic status and negative health behaviors was also observed. However, the association between adverse experiences and SBP was not fully explained by such factors (socioeconomic status and negative health behaviors).

Conclusions:

The investigators concluded that children who were exposed to multiple adverse experiences had greater increases in blood pressure in young adulthood compared to those who experienced little to no adverse experiences.

Perspective:

These data suggest that reducing risk for adverse experiences during childhood may reduce cardiovascular risk factors such as elevated blood pressure. Further research to test this hypothesis is warranted.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Prevention, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement, Exercise, Smoking

Keywords: Adolescent, Blood Pressure, Body Mass Index, Cardiovascular Diseases, Child, Domestic Violence, Ethnic Groups, Exercise, Family Characteristics, Health Behavior, Longitudinal Studies, Metabolic Syndrome X, Prevalence, Retrospective Studies, Risk Factors, Secondary Prevention, Smoking, Social Class, Substance-Related Disorders


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