Abstract

Background: Childhood maltreatment has been associated with chronic stress, systemic inflammation, immune deregulation, and behavioral risk factors, all of which may increase long-term risk for high blood pressure. Prior to this study, no meta-analysis has systematically quantified the relationship between childhood maltreatment and high blood pressure in adulthood.

Objective: To conduct a systematic review and meta-analysis of the relationship between childhood maltreatment and adulthood hypertension risk, and to examine potential moderators including maltreatment subtypes, geographic region, and study characteristics.

Participants and setting: Thirty-three observational studies involving a total of 811,029 participants from community-based, nonclinical populations across diverse global settings.

Methods: Systematic searches were conducted in MEDLINE, Embase, and PsycINFO (up to December 2024), supplemented by manual reference searches. Eligible studies reported quantitative associations between childhood maltreatment (experienced before age 18) and adulthood hypertension outcomes (diagnosis, systolic blood pressure [SBP], or diastolic blood pressure [DBP]). Data extraction and quality assessment followed PRISMA guidelines. Random-effects meta-analyses estimated pooled associations, and subgroup/meta-regression analyses tested moderators.

Results: Childhood maltreatment was associated with significantly higher odds of adulthood hypertension (OR = 1.19, 95 % CI: 1.08-1.31) and elevated DBP (Cohen's d = 0.04, 95 % CI: 0.01-0.07), but not SBP. Associations were strongest for physical abuse and for studies conducted in upper-middle-income countries compared to high-income countries.

Conclusions: Childhood maltreatment is a modest but significant risk factor for hypertension in adulthood. Findings underscore the long-term cardiovascular consequences of early adversity and highlight the importance of early prevention and targeted intervention for individuals with maltreatment histories.