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Cumulative Blood Pressure in Early Adulthood and Cardiac Dysfunction in Middle Age: The CARDIA Study
Satoru Kishi1, Gisela Teixido-Tura2, Hongyan Ning3
1Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
Insights
Long-term high blood pressure (BP) exposure damages heart function over time. Even in young to middle adulthood, cumulative BP is linked to early signs of left ventricular (LV) systolic and diastolic dysfunction.
Area of Science:
- Cardiology
- Cardiovascular Health
- Hypertension Research
Background:
- Cumulative blood pressure (BP) exposure is a potential risk factor for myocardial dysfunction and future heart failure.
- Understanding the long-term impact of BP on cardiac function is crucial for preventative strategies.
Purpose of the Study:
- To investigate the influence of cumulative high BP exposure on left ventricular (LV) function.
- To assess cardiac deformation and diastolic function in relation to long-term BP levels during young to middle adulthood.
Main Methods:
- Utilized data from the Coronary Artery Risk Development in Young Adults (CARDIA) study.
- Measured LV function and cardiac deformation using echocardiography and speckle-tracking at year 25.
- Quantified cumulative BP exposure (mm Hg × year) and analyzed associations with LV function using regression models.
Main Results:
- Cumulative BP exposure was not associated with LV ejection fraction.
- Higher cumulative systolic blood pressure (SBP) and diastolic blood pressure (DBP) were linked to reduced longitudinal strain rate (p < 0.001).
- Elevated cumulative SBP and DBP correlated with impaired early diastolic longitudinal peak strain rate, with DBP showing a stronger association.
Conclusions:
- Sustained exposure to elevated BP from young adulthood to middle age is associated with early signs of LV systolic and diastolic dysfunction.
- These findings highlight the detrimental effects of long-term hypertension on cardiac mechanics, even before clinical manifestation of heart failure.
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.
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Physiological Factors:
01:24Blood Pressure
01:30Blood Pressure
The average BP in an adult is typically around 120/80 mmHg (millimeters of mercury). In this measurement, the numerator (120) indicates the systolic pressure, which is the pressure in the arteries during the contraction of the heart's ventricles as blood is expelled. The denominator (80) represents the...