Associations of Ultra Long-Term Visit-to-Visit Blood Pressure Variability Since Childhood With Vascular Aging in Midlife: A 30-Year Prospective Cohort Study

Objective: Vascular aging, as assessed by structural and functional arterial properties, is an independent predictor of cardiovascular outcomes. In this study, we aimed to investigate the potential associations of ultra long-term blood pressure (BP) variability from childhood to adulthood with vascular aging in midlife. Design and method: Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, 2065 participants aged 6 to 18 years at baseline were followed up with seven visits over 30 years. Long-term BP variability was defined as the standard deviation (SD) and average real variability (ARV) of BP over 30 years (seven visits). Vascular aging included arterial stiffness, carotid hypertrophy, and carotid plaque. Results: Over 30 years of follow-up, 444 of the 2065 participants developed arterial stiffness. After adjusting for demographic variables, clinical characteristics and mean BP over 30 years, higher SDSBP, ARVSBP, SDDBP and ARVDBP from childhood to midlife were significantly associated with arterial stiffness in midlife. Additionally, higher SDDBP was associated with risk of carotid hypertrophy. Greater SDDBP and ARVDBP were significantly associated with the presence of carotid plaque in midlife. When we used cumulative exposure to BP from childhood to adulthood instead of mean BP as adjustment factors, results were similar. Furthermore, we found a significant correlation between long-term BP variability from youth to adulthood and arterial stiffness, while long-term BP variability from childhood to adolescence is associated with the presence of carotid plaques. The subpopulation treatment effect pattern plot methodology demonstrated a progressive divergence in the risk of vascular aging during midlife between the high SDSBP or high ARVSBP group and the low SDSBP or low ARVSBP group as age increases. Notably, this divergence became particularly pronounced in a subpopulation of individuals around the age of 44. Conclusions: Higher BP variability from childhood to adulthood may increase the risk of vascular aging in midlife independently of mean BP or cumulative BP exposure. Therefore, long-term BP variability from an early age may serve as a predictor of cardiovascular diseases in later life.