Special Issues in Hypertension

In clinical practice, HNBP is usually detected in the third or fourth decade of a patient’s
life. However, adults with prehypertension have higher than normal BP already as
children and young adults. Thistracking phenomenon has been verified in a systematic
meta-regression analysis of 50 cohort studies [18]. In the Tecumseh study, we used
records of earlier medical exams [13] to reconstruct previous BP trends in subjects
who, at 32 years of age, were normotensive or prehypertensive. Adult subjects with
prehypertension had significantly elevated BP levels already at 6 and 21 years of age.
There was little or no BP increase between the ages of 6 and 21. However, this pattern
dramatically changed from 21 to 31 years of age. In the third decade of life, the average
BP increased in both cohorts but the increase in the prehypertension group was nearly
three times as steep as in normotensive subjects (Fig. 1.1).