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Association Between Visit-to-Visit Blood Pressure Variability in Early Adulthood and Myocardial Structure and
Chike C Nwabuo1, Yuichiro Yano2, Henrique T Moreira1
1Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
Insights
High blood pressure variability in early adulthood is linked to adverse changes in heart structure and function by middle age. This highlights the importance of monitoring blood pressure fluctuations for long-term cardiovascular health.
Area of Science:
- Cardiovascular Research
- Hypertension Studies
- Cardiac Imaging
Background:
- Long-term blood pressure (BP) variability is a significant predictor of heart failure, independent of average BP levels.
- Visit-to-visit BP variability in early life may indicate subclinical cardiac alterations.
- Understanding this association can inform early interventions for cardiovascular disease prevention.
Purpose of the Study:
- To investigate the association between visit-to-visit blood pressure variability in early adulthood and myocardial structure and function in middle age.
- To determine if BP variability predicts changes in cardiac dimensions and performance over time.
Main Methods:
- Utilized data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a 30-year longitudinal cohort.
- Analyzed BP measurements from 8 visits over 25 years in 2400 participants (aged 18-30 at baseline).
- Assessed cardiac structure and function using echocardiography at year 25, focusing on left-ventricular mass, systolic, and diastolic function.
Main Results:
- Greater visit-to-visit systolic BP variability, independent of mean BP, was associated with increased left-ventricular mass index and impaired diastolic function (reduced é, increased E/é).
- Higher visit-to-visit diastolic BP variability also correlated with increased left-ventricular mass index, worse diastolic function, and reduced global longitudinal strain.
- These associations remained consistent across different measures of BP variability (SD, average real variability).
Conclusions:
- Visit-to-visit blood pressure variability in early adulthood is significantly associated with adverse cardiac structural and functional changes by middle age.
- These findings underscore the clinical relevance of BP variability, beyond average BP, in predicting long-term cardiovascular health.
- Monitoring BP variability may offer a valuable tool for identifying individuals at higher risk for heart disease.
Importance:
Long-term blood pressure (BP) variability has emerged as a reproducible measure that is associated with heart failure independent of systemic BP. Visit-to-visit BP variability may be associated with the risk of heart failure early in the life course and thus may be reflected in subclinical alterations in cardiac structure and function.
Objective:
To evaluate the association between visit-to-visit BP variability in early adulthood and myocardial structure and function in middle age.
Design, Setting, And Participants:
This cohort study used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a community-based cohort study of 5115 participants aged 18 to 30 years at baseline (year 0; March 25, 1985, to June 7, 1986) and followed up over a 30-year interval. A total of 2400 CARDIA study participants underwent evaluation at 4 field sites (Birmingham, Alabama; Oakland, California; Chicago, Illinois; and Minneapolis, Minnesota). Blood pressure was measured at 8 visits over a 25-year interval and participants received echocardiograms at year 25 (June 1, 2010, to August 31, 2011). Data analysis was conducted from June 7, 1986, to August 31, 2011.
Exposures:
Visit-to-visit systolic and diastolic BP variability measures included SD, average real variability, and variability independent of the mean.
Main Outcomes And Measures:
Echocardiographic indices of myocardial structure, systolic function, and diastolic function at the year 25 examination.
Results:
Of the 2400 participants, 1024 were men (42.7%) and 976 were African American (40.7%); mean (SD) age at the year 25 examination was 50.4 (3.6) years. Per 1-SD increment, greater visit-to-visit systolic BP variability independent of the mean was associated with higher left-ventricular (LV) mass index (β [SE], 2.66 [0.4] g/m2, P < .001), worse diastolic function (early peak diastolic mitral annular velocity [é]) (β [SE], -0.40 [0.1] cm/s, P < .001), higher LV filling pressures (mitral inflow velocity to early diastolic mitral annular velocity [E/é]) β [SE], 0.37 [0.1] cm/s, P < .001), and worse global longitudinal strain (β [SE], 0.17 [0.1], P = .002). Similarly, greater visit-to-visit diastolic BP variability was associated with higher LV mass index (β [SE], 3.21 [0.5] g/m2, P < .001), worse diastolic function (é: β [SE], -0.24 [0.1] cm/s [P < .001]; E/é: β [SE], 0.23 [0.1] cm/s [P < .001]), and worse global longitudinal strain (β [SE], 0.13 [0.1], P = .02). The findings remained consistent when other BP variability measures were used (SD and average real variability).
Conclusions And Relevance:
In this cohort study using data from the CARDIA study, greater visit-to-visit systolic and diastolic BP variability have been associated with adverse alterations in cardiac structure as well as systolic and diastolic function independent of mean BP levels.
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