Key result
25-year SBP rises ~13 mm Hg, with greater increases in Black adults, DM, and BMI ≥25.
Why the study?
It is unknown to what extent out-of-office blood pressure derived via ambulatory monitoring increases over time, and which participant characteristics and risk factors contribute to these increases.
Cohort
Mean Difference: 12.8 (95% CI 7.6–17.9)
Office and ambulatory blood pressure increase significantly from early to middle adulthood, with more pronounced increases observed among black adults and those with diabetes or a BMI ≥25 kg/m2.
Supports intensified early BP monitoring in Black adults with DM or BMI ≥25; leaves open whether risk-factor modification alters trajectories.
BACKGROUND: Blood pressure (BP) measured in the office setting increases from early through later adulthood. However, it is unknown to what extent out-of-office BP derived via ambulatory BP monitoring (ABPM) increases over time, and which participant characteristics and risk factors might contribute to these increases. METHODS: We assessed 25-year change in office- and ABPM-derived BP across sex, race, diabetes mellitus (DM), and body mass index (BMI) subgroups in the Coronary Artery Risk Development in Young Adults study using multivariable-adjusted linear mixed effects models. RESULTS: We included 288 participants who underwent ABPM at the Year 5 Exam (mean [SD] age, 25.1 [3.7]; 45.8% men) and 455 participants who underwent ABPM at the Year 30 Exam (mean [SD] age, 49.5 [3.7]; 42.0% men). Office, daytime, and nighttime systolic BP (SBP) increased 12.8 (95% confidence interval [CI], 7.6-17.9), 14.7 (95% CI, 9.7-19.8), and 16.6 (95% CI, 11.4-21.8) mm Hg, respectively, over 25 years. Office SBP increased 6.5 (95% CI, 2.3-10.6) mm Hg more among black compared with white participants. Daytime SBP increased 6.3 (95% CI, 0.2-12.4) mm Hg more among participants with a BMI ≥25 vs. <25 kg/m2. Nighttime SBP increased 4.7 (95% CI, 0.5-8.9) mm Hg more among black compared with white participants, and 17.3 (95% CI, 7.2-27.4) mm Hg more among participants with vs. without DM. CONCLUSIONS: Office- and ABPM-derived BP increased more from early through middle adulthood among black adults and participants with DM and BMI ≥25 kg/m2.
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Bundy et al. (2020) conducted a cohort in Blood pressure increase. 25-year follow-up vs. Baseline was evaluated on 25-year change in office systolic blood pressure (MD 12.8 mm Hg, 95% CI 7.6-17.9). Over 25 years, office, daytime, and nighttime systolic blood pressure increased by 12.8, 14.7, and 16.6 mm Hg, respectively, with greater increases among Black adults and those with DM or BMI ≥25.
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