Childhood maltreatment and adult blood pressure-based outcomes: age- and sex-specific associations in the German National Cohort (NAKO)

BACKGROUND: Childhood maltreatment (CM) is associated with adult cardiovascular disease (CVD) risk. Systolic (SBP) and diastolic (DBP) blood pressure (BP), key markers of CVD risk, exhibit age- and sex-dependent variability, which was insufficiently accounted for in previous studies on the CM-BP relationship. This study therefore aimed to assess age- and sex-specific associations between CM and adult BP-based outcomes and hypertension using cross-sectional data from the population based German National Cohort (NAKO). METHODS: Complete data were available for 150,983 participants (49.3% female), who took part in the baseline assessment between 2014 and 2019. CM was assessed via the Childhood Trauma Screener (CTS). Resting BP was assessed using a standardized procedure. Hypertension was defined as either SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or intake of antihypertensive medication. Age- and sex-stratified multivariable regression models estimated age- and sex-specific associations between CM and BP-based markers and sex-stratified logistic regression models were calculated for hypertension as the outcome. RESULTS: A pattern of inverse associations between CTS sum score (CTS) and BP markers emerged. Compared to their non-exposed counterparts, females (OR = 0.87, 95%-CI: 0.80; 0.94) but not males (OR = 1.01, 95%-CI: 0.91; 1.13) with high cumulative CM exposure (i.e., ≥ 3 CM categories) had lower odds of hypertension. Age-dependent inverse associations between CTS and BP markers revealed sex-specific patterns. The age- and sex-dependent inverse associations of CM with BP markers were more consistent for the abuse vs. neglect subscales. CONCLUSIONS: The association between CM and BP revealed age- and sex-dependent patterns, highlighting the complexity of physical consequences in adulthood associated with CM.