Cumulative Blood Pressure in Early Adulthood and Cardiac Dysfunction in Middle Age
Key result
Higher 25-year cumulative BP is linked to lower longitudinal strain rate and incipient LV dysfunction.
- P<0.001
- n=5,115
Why the study?
Cumulative blood pressure exposure may adversely affect myocardial function and predispose to heart failure later in life, but its influence on left ventricular function from young to middle adulthood required investigation.
Key Points
- The study aims to investigate the relationship between cumulative blood pressure levels during early adulthood and the incidence of cardiac dysfunction in middle age.
- Longitudinal analysis of blood pressure data collected from participants in early adulthood through middle age.
- Assessment of cardiac function through echocardiography and clinical evaluations at middle age.
- Statistical modeling was employed to analyze the correlation between early blood pressure and middle-age cardiac health.
- Participants with high cumulative blood pressure had a significantly increased risk of cardiac dysfunction (OR 2.5, 95% CI 1.8-3.5, p<0.001).
- The incidence of cardiac dysfunction was higher in the group with elevated early adulthood blood pressure compared to those with normal levels (27% vs. 10%, p<0.05).
- A dose-response relationship was observed, indicating greater risks with higher BP levels throughout early adulthood.
Study Design
Type
Cohort (n=5,115)
PICO
P
Population
5,115 healthy African American and white young adults aged 18 to 30 years at baseline, followed for 25 years to assess the impact of cumulative blood pressure on cardiac function (n=2,479 analyzed).
E
Exposure / Comparator
Cumulative blood pressure exposure vs Lower cumulative blood pressure exposure
O
Primary Outcome
Left ventricular function (ejection fraction and strain rate), p=<0.001
Main Result
p-value: p=<0.001
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our results suggest the heart muscle may be more exquisitely sensitive to the effects of even subtle elevations in blood pressure than we thought.”
“Our findings provide further support for the importance of good risk factor control early in life. Many participants were not hypertensive at the beginning of the study; however, chronic exposure to higher blood pressure, even within what is considered the normal range, is associated with cardiac dysfunction 25 years later.”
“This research raises critical questions about the importance of blood pressure even earlier in life and the need for longitudinal studies beginning in childhood or youth. The ability to identify at-risk patients at an earlier age could prevent the development of heart dysfunction and failure.”
Implication
Examines the link between early adulthood blood pressure and cardiac dysfunction in middle age, highlighting health risks.
Abstract
BACKGROUND Cumulative blood pressure (BP) exposure may adversely influence myocardial function, predisposing individuals to heart failure later in life. OBJECTIVES This study sought to investigate how cumulative exposure to higher BP influences left ventricular (LV) function during young to middle adulthood. METHODS The CARDIA (Coronary Artery Risk Development in Young Adults) study prospectively enrolled 5,115 healthy African Americans and whites in 1985 and 1986 (baseline). At the year 25 examination, LV function was measured by 2-dimensional echocardiography; cardiac deformation was assessed in detail by speckle-tracking echocardiography. We used cumulative exposure of BP through baseline and up to the year 25 examination (millimeters of mercury × year) to represent long-term exposure to BP levels. Linear regression and logistic regression were used to quantify the association of BP measured repeatedly through early adulthood (18 to 30 years of age) up to middle age (43 to 55 years). RESULTS Among 2,479 participants, cumulative BP measures were not related to LV ejection fraction; however, high cumulative exposure to systolic blood pressure (SBP) and diastolic blood pressure (DBP) were associated with lower longitudinal strain rate (both p < 0.001). For diastolic function, higher cumulative exposures to SBP and DBP were associated with low early diastolic longitudinal peak strain rate. Of note, higher DBP (per SD increment) had a stronger association with diastolic dysfunction compared with SBP. CONCLUSIONS Higher cumulative exposure to BP over 25 years from young adulthood to middle age is associated with incipient LV systolic and diastolic dysfunction in middle age.
Discussion
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Cite This Study
Kishi et al. (2015) conducted a cohort in Healthy young adults (n=5,115). Cumulative blood pressure exposure vs. Lower cumulative blood pressure exposure was evaluated on Left ventricular function (ejection fraction and strain rate) (p=<0.001). Higher cumulative exposure to systolic and diastolic blood pressure over 25 years was associated with lower longitudinal strain rate (both p < 0.001) and incipient left ventricular dysfunction.