Childhood High Blood Pressure Linked to Increased Risk of Early Cardiovascular Death in Adulthood

Children with higher blood pressure at age 7 may face a significantly increased risk of dying from cardiovascular disease by their mid-50s, according to preliminary research presented at the American Heart Association’s Hypertension Scientific Sessions 2025. The study, simultaneously published in JAMA, found that both elevated blood pressure (90-94th percentile) and hypertension (≥95th percentile) were associated with approximately 40% to 50% higher risk of early cardiovascular death in adulthood.

The research analyzed data from approximately 38,000 children who had their blood pressure measured at age 7 as part of the Collaborative Perinatal Project, the largest U.S. study documenting the influence of pregnancy and postnatal factors on children's health. Blood pressure measurements were converted to age-, sex-, and height-specific percentiles according to the American Academy of Pediatrics clinical practice guidelines available here. The analysis accounted for demographic factors and childhood body mass index to ensure findings specifically related to blood pressure rather than weight-related factors.

By 2016, after follow-up through an average age of 54 years, 2,837 participants had died, with 504 deaths attributed to cardiovascular disease. The risk was highest for children whose blood pressure measurements were in the top 10% for their age, sex, and height. Even moderate elevations in blood pressure within the normal range were significant, with children having moderately higher than average blood pressure showing a 13-18% increased risk of premature cardiovascular death.

Dr. Alexa Freedman, lead author of the study and assistant professor at Northwestern University's Feinberg School of Medicine, stated, "We were surprised to find that high blood pressure in childhood was linked to serious health conditions many years later. Our results highlight the importance of screening for blood pressure in childhood and focusing on strategies to promote optimal cardiovascular health beginning in childhood."

The study's sibling analysis involving 150 clusters of siblings found that children with higher blood pressure at age 7 had similar increases in cardiovascular death risk compared to their siblings with lower readings, indicating that shared family and early childhood environment could not fully explain the impact of blood pressure. This suggests that blood pressure itself, rather than familial factors alone, contributes significantly to long-term cardiovascular risk.

Dr. Bonita Falkner, an American Heart Association volunteer expert not involved in the study, emphasized that "the results of this study support monitoring blood pressure as an important metric of cardiovascular health in childhood. Moreover, the results of this study and other older child cohort studies with potential follow-up in adulthood will contribute to a more accurate definition of abnormal blood pressure and hypertension in childhood."

The findings have significant implications for pediatric healthcare practices and public health policies. They underscore the importance of regular blood pressure monitoring starting in early childhood, as recommended by clinical practice guidelines that suggest checking blood pressure at annual well-child pediatric appointments beginning at age 3. The research also highlights the need for early intervention strategies and education about heart-healthy habits that can help lower cardiovascular risk throughout life.

While the study provides compelling evidence, researchers note several limitations, including that the analysis relied on a single blood pressure measurement at age 7, which may not capture variability or long-term patterns. Additionally, participants were primarily Black or white, so findings may not be generalizable to children of other racial or ethnic groups. The study also involved children from the 1960s and 1970s, who likely had different lifestyles and environmental exposures than children today.