Key result
Midlife diastolic blood pressure strongly predicted arterial stiffness progression, while baseline arterial stiffness predicted isolated systolic hypertension development (OR 1.30; 95% CI 1.22–1.39).
Why the study?
Long-term interactions between SBP, DBP, and arterial stiffness in the development of late-life hypertensive phenotypes remain unclear.
Cohort (n=169,742)
Yes
Odds Ratio: 1.3 (95% CI 1.22–1.39)
Midlife diastolic blood pressure is a strong predictor of arterial stiffness progression, which in turn predicts the development of isolated systolic hypertension in late life.
Midlife DBP may mark arterial stiffness progression toward ISH; leaves open whether intervention alters trajectories in observational data.
Background Hypertension‐associated cardiovascular events are particularly associated with elevated systolic blood pressure ( SBP ) in late life, yet long‐term interactions between SBP , diastolic BP ( DBP ) and arterial stiffness in development of late‐life hypertensive phenotypes remain unclear. Methods and Results In the UK Biobank, we determined associations between arterial stiffness index ( ASI ), SBP , DBP , and their progression, and transition from normotension (<140/90 mm Hg) to hypertension or elevated ASI (>10 m/s). Associations were determined by general linear and logistic regression, adjusted for cardiovascular risk factors and variability of measurements across follow‐ups. Mean values of baseline SBP , DBP , and ASI were determined stratified by deciles of age, blood pressure, and ASI , with CIs determined by bootstrapping. In 169 742 participants at baseline, ASI was more strongly associated with DBP than SBP , before and after adjustment for risk factors (β: SBP , −0.01 [ P <0.001]; DBP , 0.06 [ P <0.001]), while DBP was more strongly associated with progression of ASI (n=13 761; β: SBP, 0.013 [ P =0.01]; DBP , 0.038 [ P <0.001]). Baseline ASI was associated with increasing SBP during follow‐up (β=0.02, P <0.001) but not DBP (β=0.0004, P =0.39), but was associated with a younger age of transition from rising to falling DBP (highest versus lowest quartile: 51.2; 95% CI, 49.9–52.3 versus 60.4; 95% CI, 59.6–61.3 [ P <0.001]). ASI predicted the development of isolated systolic hypertension (odds ratio, 1.30; 95% CI, 1.22–1.39), particularly after adjustment for measurement variability (odds ratio, 2.29). Conclusions Midlife DBP was the strongest predictor of progression of arterial stiffness, while arterial stiffness was associated with earlier transition to a falling DBP . Prevention of long‐term harms associated with arterial stiffness may require more intensive control of midlife DBP .
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Alastair J.S. Webb (2020) conducted a cohort in Hypertension and Arterial Stiffness (n=169,742). Arterial stiffness index (ASI) and Diastolic blood pressure (DBP) was evaluated on Development of isolated systolic hypertension (OR 1.30, 95% CI 1.22-1.39). Midlife diastolic blood pressure strongly predicted arterial stiffness progression, while baseline arterial stiffness predicted isolated systolic hypertension development (OR 1.30; 95% CI 1.22–1.39).
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