Ambulatory Blood Pressure and Its Variability in Adults Born Preterm

Adults born preterm have higher blood pressure (BP) than those born at term. Most studies have focused on preterm birth, and few have assessed BP variability, an independent risk factor of cardiovascular disease. We studied the association of preterm birth with 24-hour ambulatory BP, measured by an oscillometric device, in 42 young adults born early preterm (<34 weeks), 72 born late preterm (34–36 weeks), and 103 controls (≥37 weeks). Sleep was confirmed with accelerometry in 72.4% of subjects. The 24-hour systolic BP of adults born early preterm was 5.5 mm Hg higher (95% confidence interval, 1.9–9.3), awake systolic BP was 6.4 mm Hg higher (95% confidence interval, 2.8–10.1), and sleeping systolic BP was 2.9 mm Hg higher (95% confidence interval 0.3–7.5) when adjusted for age, sex, and use of accelerometry. The differences remained similar when adjusted for height, body mass index, physical activity, smoking, parental education, maternal body mass index, smoking during pregnancy, and gestational diabetes mellitus and attenuated slightly when adjusted for maternal hypertensive pregnancy disorders. Adults born early preterm also had higher BP variability as indicated by higher individual standard deviations of systolic BP and diastolic BP. Although our results were consistent with a dose–response relationship between shorter gestation and higher BP, the difference between the late preterm and term groups was not statistically significant. Our results suggest that the higher BP in adults born early preterm is present during both waking and sleeping hours, may be more pronounced during waking hours, and is accompanied by higher individual BP variability.

[1]  M. Järvelin,et al.  Cardiovascular Risk Factors in Adolescents Born Preterm , 2014, Pediatrics.

[2]  J. Eriksson,et al.  Adrenalin, noradrenalin and heart rate responses to psychosocial stress in young adults born preterm at very low birthweight , 2014, Clinical endocrinology.

[3]  L. Doyle,et al.  Higher ambulatory blood pressure at 18 years in adolescents born less than 28 weeks’ gestation in the 1990s compared with term controls , 2014, Journal of hypertension.

[4]  E. Moltchanova,et al.  Blunted hypothalamic‐pituitary‐adrenal axis and insulin response to psychosocial stress in young adults born preterm at very low birth weight , 2013, Clinical endocrinology.

[5]  H. Matsuoka [Masked hypertension]. , 2014, Nihon rinsho. Japanese journal of clinical medicine.

[6]  Shalini Santhakumaran,et al.  Preterm Birth and the Metabolic Syndrome in Adult Life: A Systematic Review and Meta-analysis , 2013, Pediatrics.

[7]  Alan D. Lopez,et al.  A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[8]  Ann-Beth Moller,et al.  National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications , 2012, The Lancet.

[9]  M. Monuteaux,et al.  Systematic Review and Meta-Analysis of Preterm Birth and Later Systolic Blood Pressure , 2012, Hypertension.

[10]  Neil Marlow,et al.  Cardiovascular consequences of extreme prematurity: the EPICure study , 2011, Journal of hypertension.

[11]  K. Räikkönen,et al.  Early life predictors of the physiological stress response later in life , 2010, Neuroscience & Biobehavioral Reviews.

[12]  J. Eriksson,et al.  Ambulatory blood pressure in young adults with very low birth weight. , 2010, The Journal of pediatrics.

[13]  F. Dekker,et al.  Reduced renal length and volume 20 years after very preterm birth , 2009, Pediatric Nephrology.

[14]  F. Dekker,et al.  Very preterm birth is a risk factor for increased systolic blood pressure at a young adult age , 2009, Pediatric Nephrology.

[15]  J. Eriksson,et al.  Blood Pressure Responses to Psychosocial Stress in Young Adults With Very Low Birth Weight: Helsinki Study of Very Low Birth Weight Adults , 2009, Pediatrics.

[16]  K. Kario,et al.  Prediction of strokes versus cardiac events by ambulatory monitoring of blood pressure: results from an international database , 2007, Blood pressure monitoring.

[17]  R. de Caterina,et al.  Awake Systolic Blood Pressure Variability Correlates With Target-Organ Damage in Hypertensive Subjects , 2007, Hypertension.

[18]  O. Mäkitie,et al.  Glucose regulation in young adults with very low birth weight. , 2007, The New England journal of medicine.

[19]  Gianfranco Parati,et al.  Prognostic relevance of blood pressure variability. , 2006, Hypertension.

[20]  M. Schluchter,et al.  Blood Pressure Among Very Low Birth Weight (<1.5 kg) Young Adults , 2005, Pediatric Research.

[21]  Gianfranco Parati,et al.  Blood pressure variability: Its measurement and significance in hypertension , 2006, Current hypertension reports.

[22]  B. Casadei,et al.  Is there a strong rationale for deferring elective surgery in patients with poorly controlled hypertension? , 2005, Journal of hypertension.

[23]  Mark I. McCarthy,et al.  Early Life Factors and Blood Pressure at Age 31 Years in the 1966 Northern Finland Birth Cohort , 2004, Hypertension.

[24]  S. Duara,et al.  Histomorphometric Analysis of Postnatal Glomerulogenesis in Extremely Preterm Infants , 2004, Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society.

[25]  D. Bacquer,et al.  Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension ☆ , 2003 .

[26]  Peter W de Leeuw,et al.  Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. , 2003, The New England journal of medicine.

[27]  S. Lewington Prospective studies collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies (vol 360, pg 1903, 2002) , 2003 .

[28]  L. Doyle,et al.  Blood pressure in late adolescence and very low birth weight. , 2003, Pediatrics.

[29]  R. Collins,et al.  Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies , 2002, The Lancet.

[30]  G Parati,et al.  Relation between blood pressure variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis (ELSA) , 2001, Journal of hypertension.

[31]  S. Jacobson,et al.  Increased blood pressure but normal renal function in adult women born preterm , 2000, Pediatric Nephrology.

[32]  F. Mee,et al.  Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society , 2000, BMJ : British Medical Journal.

[33]  P. Verdecchia,et al.  Prognostic value of ambulatory blood pressure : current evidence and clinical implications. , 2000, Hypertension.

[34]  G. Reboldi,et al.  Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. , 1994, Hypertension.

[35]  A. Sadeh,et al.  Activity-based sleep-wake identification: an empirical test of methodological issues. , 1994, Sleep.

[36]  G Mancia,et al.  Prognostic value of 24-hour blood pressure variability , 1993, Journal of hypertension.

[37]  P. Rantakallio,et al.  Labour induction policy in hospitals of different levels of specialisation , 1993, British journal of obstetrics and gynaecology.

[38]  K. Raivio,et al.  [Characteristic of recent fetal growth curves in Finland]. , 1989, Duodecim; laaketieteellinen aikakauskirja.