Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Secular changes in blood pressure in childhood, adolescence and young adulthood: systematic review of trends from 1948 to 1998

Journal of Human Hypertension volume 16, pages 677–689 (2002)Cite this article

Abstract

One plausible reason for the decline in cardiovascular disease (CVD), and in particular stroke, in the last century is population reductions in blood pressure. Blood pressure tracks from childhood into adulthood, and early-life blood pressure is associated with increased cardiovascular risk but few studies have reported on blood pressure trends among young individuals who are free of CVD and not taking antihypertensive medication. Knowledge of such trends may improve understanding of the causes of hypertension and enhance prevention. We report that declines in blood pressure have been taking place in high-income countries in 5 to 34-year-olds of both sexes and from a range of ethnic groups for at least the last 50 years, indicating that exposures acting in early life are important determinants of blood pressure. Possible explanations for these favourable trends include improvements in early-life diet and there is also intriguing evidence suggesting that blood pressure may be programmed by sodium intake in infancy. Occurring throughout the blood pressure distribution, these trends may have made important contributions to declining CVD rates. There may therefore be scope for intervening in early life to prevent high blood pressure in adulthood, and the downward trends reported in several recent studies suggest that the prevalence of adult hypertension and cardiovascular risk will continue to decline. However, persisting high rates of CVD in the developed world, the impending CVD epidemic in developing countries, along with increasing childhood obesity, and the possibility that favourable blood pressure trends may be plateauing point to the need for enhanced measures to control blood pressure, and for further research to improve understanding of its determinants.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Charlton J, Murphy M . The Health of Adult Britain 1841–1994 Stationery Office: London 1997

    Google Scholar 

  2. Labarthe DR . Stroke In: Labarthe DR (ed) Epidemiology and Prevention of Cardiovascular Diseases. A Global Challenge Aspen Publishers: Gaithersburg, MD 1998 pp 73–90

    Google Scholar 

  3. Labarthe DR . Coronary heart disease In: Labarthe DR (ed) Epidemiology and Prevention of Cardiovascular Diseases. A Global Challenge Aspen Publishers: Gaithersburg, MD 1998 pp 43–72

    Google Scholar 

  4. Hunink MG et al. The recent decline in mortality from coronary heart disease, 1980–1990. The effect of secular trends in risk factors and treatment JAMA 1997 277: 535–542

    Article  CAS  PubMed  Google Scholar 

  5. MacMahon S et al. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias Lancet 1990 335: 765–774

    Article  CAS  PubMed  Google Scholar 

  6. Stamler J, Stamler R, Neaton JD . Blood pressure, systolic and diastolic, and cardiovascular risks. US population data Arch Intern Med 1993 153: 598–615

    Article  CAS  PubMed  Google Scholar 

  7. Collins R, MacMahon S . Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease Br Med Bull 1994 50: 272–298

    Article  CAS  PubMed  Google Scholar 

  8. Nelson MJ, Ragland DR, Syme SL . Longitudinal prediction of adult blood pressure from juvenile blood pressure levels Am J Epidemiol 1992 136: 633–645

    Article  CAS  PubMed  Google Scholar 

  9. Paffenbarger Jr RS, Wing AL . Chronic disease in former college students X. The effects of single and multiple characteristics on risk of fatal coronary heart disease Am J Epidemiol 1969 90: 527–535

    Article  PubMed  Google Scholar 

  10. Paffenbarger Jr RS, Wing AL . Characteristics in youth predisposing to fatal stroke in later years Lancet 1967 1: 753–754

    Article  PubMed  Google Scholar 

  11. McCarron P, Davey Smith G, Okasha M, McEwen J . Blood pressure in young adulthood and mortality from cardiovascular disease Lancet 2000 355: 1430–1431

    Article  CAS  PubMed  Google Scholar 

  12. McCarron P, Okasha M, McEwen J, Davey Smith G . Blood pressure in early life and cardiovascular disease mortality Arch Intern Med 2002 162: 610–611

    Article  PubMed  Google Scholar 

  13. Berenson GS et al. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study N Engl J Med 1998 338: 1650–1656

    Article  CAS  PubMed  Google Scholar 

  14. McGill Jr HC et al. Relation of a postmortem renal index of hypertension to atherosclerosis and coronary artery size in young men and women. Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group Arterioscler Thromb Vasc Biol 1998 18: 1108–1118

    Article  PubMed  Google Scholar 

  15. American Heart Association. Heart and Stroke Statistical Update American Heart Association: Dallas, TX 2000

  16. Murray CJ, Lopez AD . The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injury and risk factors in 1990 and projected to 2020 In: Murray CJ, Lopez AD (eds) Global Burden of Disease and Injury Series Harvard University Press: Cambridge, MA 1996

    Google Scholar 

  17. Roberts J, Maurer K . Blood pressure of youths 12–17 years: United States Vital Health Stat 1977 1: iii–62

    Google Scholar 

  18. Roberts J . Cardiovascular conditions of children 6–11 years and youths 12–17 years. United States, 1963–1965 and 1966–1970 Vital Health Stat 1978 11: 1–47

    Google Scholar 

  19. Rowland M, Roberts J . Blood pressure levels and hypertension in persons ages 6–74 years: United States, 1976–80 Adv Data 1982 84: 1–11

    Google Scholar 

  20. Gidding SS, Bao W, Srinivasan SR, Berenson GS . Effects of secular trends in obesity on coronary risk factors in children: the Bogalusa Heart Study J Pediatr 1995 127: 868–874

    Article  CAS  PubMed  Google Scholar 

  21. Luepker RV, Jacobs DR, Prineas RJ, Sinaiko AR . Secular trends of blood pressure and body size in a multi-ethnic adolescent population: 1986 to 1996 J Pediatr 1999 134: 668–674

    Article  CAS  PubMed  Google Scholar 

  22. Department of Health. Health Survey for England: Trend Data for Children 1995–1998. Department of Health 2002 Available at:http://www.doh.gov.uk/stats/trends2.htm

  23. Drizd T, Dannenberg AL, Engel A . Blood pressure levels in persons 18–74 years of age in 1976–80, and trends in blood pressure from 1960 to 1980 in the United States Vital Health Stat 1986 11: 1–68

    Google Scholar 

  24. Burt VL et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991 Hypertension 1995 26: 60–69

    Article  CAS  PubMed  Google Scholar 

  25. Luepker RV et al. Cardiovascular risk factor change—1973–74 to 1980–82: the Minnesota Heart Survey J Clin Epidemiol 1988 41: 825–833

    Article  CAS  PubMed  Google Scholar 

  26. Sprafka JM et al. Continued decline in cardiovascular disease risk factors: results of the Minnesota Heart Survey, 1980–1982 and 1985–1987 Am J Epidemiol 1990 132: 489–500

    Article  CAS  PubMed  Google Scholar 

  27. Department of Health. Health Survey for England: Trend Data for Adults 1993–2000. Department of Health 2002 Available at:http://www.doh.gov.uk/stats/trends1.htm

  28. Shaw A, McMunn A, Field J . The Scottish Health Survey 1998 Edinburgh Joint Health Surveys Unit of Social and Community Planning Research and University College London 2000 Available at:http://www.show.scot.nhs.uk/scottishhealthsurvey/sh8-00.html

  29. Sjol A, Thomsen KK, Schroll M . Secular trends in blood pressure levels in Denmark 1964–1991 Int J Epidemiol 1998 27: 614–622

    Article  CAS  PubMed  Google Scholar 

  30. Heinemann L, Barth W, Hoffmeister H . Trend of cardiovascular risk factors in the East German population 1968–1992 J Clin Epidemiol 1995 48: 787–795

    Article  CAS  PubMed  Google Scholar 

  31. Hoffmeister H, Mensink GB, Stolzenberg H . National trends in risk factors for cardiovascular disease in Germany Prev Med 1994 23: 197–205

    Article  CAS  PubMed  Google Scholar 

  32. Bennett SA, Magnus P . Trends in cardiovascular risk factors in Australia. Results from the National Heart Foundation's Risk Factor Prevalence Study, 1980–1989 Med J Aust 1994 161: 519–527

    CAS  PubMed  Google Scholar 

  33. Johnston W, Cheeseman EA, Merrett JD . Observations on routine medical examinations of university entrants in Northern Ireland Br J Prev Soc Med 1957 11: 152–161

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Johnston W, Merrett JD . Further observations on routine medical examinations of university entrants in Northern Ireland Br J Prev Soc Med 1962 16: 76–83

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Harland RW . Sociological, anatomical and physiological changes in first-year students entering Queen's University, Belfast, over thirty years, 1948—77. 1. Preliminary report Ulster Med J 1980 49: 37–47

    CAS  PubMed  PubMed Central  Google Scholar 

  36. McCarron P, Okasha M, McEwen J, Davey Smith G . Changes in blood pressure among students attending Glasgow University between 1948 and 1968: analyses of cross sectional surveys BMJ 2001 322: 885–889

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Goff DC, Howard G, Russell GB, Labarthe DR . Birth cohort evidence of population influences on blood pressure in the United States, 1887–1994 Ann Epidemiol 2001 11: 271–279

    Article  CAS  PubMed  Google Scholar 

  38. The Research Group ATS-RF2-OB43 of the Italian National Research Council. Time trends of some cardio-vascular risk factors in Italy. Results from the Nine Communities Study Am J Epidemiol 1987 126: 95–103

  39. Dobson AJ . Trends in cardiovascular risk factors in Australia, 1966–1986: evidence from prevalence surveys Community Health Stud 1987 11: 2–14

    Article  CAS  PubMed  Google Scholar 

  40. Huxley RR, Shiell AW, Law CM . The role of size at birth and postnatal catch-up growth in determining systolic blood pressure: a systematic review of the literature J Hypertens 2000 18: 815–831

    Article  CAS  PubMed  Google Scholar 

  41. Law CM, Shiell AW . Is blood pressure inversely related to birth weight? The strength of evidence from a systematic review of the literature J Hypertens 1996 14: 935–941

    Article  CAS  PubMed  Google Scholar 

  42. Alberman E . Are our babies becoming bigger? J R Soc Med 1991 84: 257–260

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Berkey CS, Gardner J, Colditz GA . Blood pressure in adolescence and early adulthood related to obesity and birth size Obes Res 1998 6: 187–195

    Article  CAS  PubMed  Google Scholar 

  44. Falkner B, Hulman S, Kushner H . Birth weight versus childhood growth as determinants of adult blood pressure Hypertension 1998 31: 145–150

    Article  CAS  PubMed  Google Scholar 

  45. Montgomery SM, Berney LR, Blane D . Prepubertal stature and blood pressure in early old age Arch Dis Child 2000 82: 358–363

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Davey Smith G et al. Leg length, insulin resistance, and coronary heart disease risk: the Caerphilly Study J Epidemiol Community Health 2001 55: 867–872

    Article  Google Scholar 

  47. Law CM et al. Fetal, infant, and childhood growth and adult blood pressure: a longitudinal study from birth to 22 years of age Circulation 2002 105: 1088–1092

    Article  CAS  PubMed  Google Scholar 

  48. Ebrahim S, Davey Smith G . Lowering blood pressure: a systematic review of sustained effects of non-pharmacological interventions J Public Health Med 1998 20: 441–448

    Article  CAS  PubMed  Google Scholar 

  49. Geleijnse JM et al. Long-term effects of neonatal sodium restriction on blood pressure Hypertension 1997 29: 913–917

    Article  CAS  PubMed  Google Scholar 

  50. Wright AL . The rise of breastfeeding in the United States Pediatr Clin North Am 2001 48: 1–12

    Article  CAS  PubMed  Google Scholar 

  51. Martin J . Infant feeding 1975: Attitudes and Practice in England and Wales HMSO: London 1978

    Google Scholar 

  52. Infant Feeding Survey 2000 The Stationery Office: London 2002

  53. Filer Jr LJ . Salt in infant foods Nutr Rev 1971 29: 27–30

    Article  PubMed  Google Scholar 

  54. Pennington JA et al. Selected minerals in foods surveys, 1974 to 1981/82 J Am Diet Assoc 1984 84: 771–780

    CAS  PubMed  Google Scholar 

  55. Appel LJ et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group N Engl J Med 1997 336: 1117–1124

    Article  CAS  PubMed  Google Scholar 

  56. Orr JB . Food Health and Income Macmillan: London 1936

    Google Scholar 

  57. The urban working-class household diet 1940–1949 First report of the National Food Survey Committee, Ministry of Food HMSO: London 1951

  58. Baines AHJ, Hollingsworth DF, Leitch I . Diets of working-class families with children before and after the second world war: with a section on height and weight of children Nutr Abstr Rev 1963 33: 653–659

    CAS  PubMed  Google Scholar 

  59. Prynne CJ et al. Food and nutrient intake of a national sample of 4-year-old children in 1950: comparison with the 1990s Public Health Nutr 1999 2: 537–547

    Article  CAS  PubMed  Google Scholar 

  60. Cavadini C, Siega-Riz AM, Popkin BM . US adolescent food intake trends from 1965 to 1996 Arch Dis Child 2000 83: 18–24

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Dobson A, Porteous J, McElduff P, Alexander H . Dietary trends: estimates from food supply and survey data Eur J CIin Nutr 1997 51: 193–198

    Article  CAS  Google Scholar 

  62. Enos WF, Holmes RH, Beyer J . Landmark article, July 18, 1953: coronary disease among United States soldiers killed in action in Korea. Preliminary report. By William F. Enos, Robert H. Holmes and James Beyer JAMA 1986 256: 2859–2862

    Article  CAS  PubMed  Google Scholar 

  63. McNamara JJ, Molot MA, Stremple JF, Cutting RT . Coronary artery disease in combat casualties in Vietnam JAMA 1971 216: 1185–1187

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. N. Ireland Cancer Registry, The Queen's University, Belfast, UK

    P McCarron

  2. Department of Social Medicine, University of Bristol, UK

    G Davey Smith & M Okasha

Authors
  1. P McCarron
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G Davey Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Okasha
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P McCarron.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McCarron, P., Smith, G. & Okasha, M. Secular changes in blood pressure in childhood, adolescence and young adulthood: systematic review of trends from 1948 to 1998. J Hum Hypertens 16, 677–689 (2002). https://doi.org/10.1038/sj.jhh.1001471

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1001471

Keywords

This article is cited by

Search

Advanced search

Quick links