Decision Tree-Based Classification for Maintaining Normal Blood Pressure Throughout Early Adulthood and Middle Age: Findings From the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Related Experiment Video
Updated: Nov 1, 2025
Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis
Published on: September 26, 2018
Orna Reges1, Amy E Krefman1, Shakia T Hardy2
1Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
Insights
Maintaining normal blood pressure (BP) into midlife is linked to early systolic BP and body mass index (BMI). White women with lower baseline BMI and systolic BP have the best chance of maintaining normal BP.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Blood pressure (BP) is influenced by multiple risk factors.
- Identifying these factors is crucial for long-term health.
- Early intervention can prevent hypertension.
Purpose of the Study:
- To identify key risk factors and interactions for maintaining normal BP over 30 years.
- To pinpoint population segments with a high likelihood of normal BP.
- To understand early predictors of midlife hypertension.
Main Methods:
- Decision tree analysis was used.
- Data from the Coronary Artery Risk Development in Young Adults (CARDIA) study was analyzed.
- Participants aged 18-30 with normal baseline BP were followed for 30 years.
Main Results:
- 35.9% maintained normal BP; 64.1% developed higher BP.
- Systolic BP (SBP), race, and BMI were the most significant discriminators.
- Lowest risk: baseline SBP ≤92 mm Hg (69.2%) and White women with BMI < 23 kg/m2 (59.9%).
- Highest risk: Black participants >26.5 years with BMI > 27 kg/m2 (5.4% maintained normal BP).
Conclusions:
- Early life factors significantly impact midlife SBP.
- Maintaining ideal risk factor levels in young adulthood is vital for preventing hypertension.
- Future research should explore policies for maintaining lower BMI and SBP thresholds.
Background:
For most individuals, blood pressure (BP) is related to multiple risk factors. By utilizing the decision tree analysis technique, this study aimed to identify the best discriminative risk factors and interactions that are associated with maintaining normal BP over 30 years and to reveal segments of a population with a high probability of maintaining normal BP.
Methods:
Participants from the Coronary Artery Risk Development in Young Adults study aged 18-30 years with normal BP level at baseline visit (Y0, 1985-1986) were included in this study.
Results:
Of 3,156 participants, 1,132 (35.9%) maintained normal BP during the follow-up period and 2,024 (64.1%) developed higher BP. Systolic BP (SBP) within the normal range, race, and body mass index (BMI) were the most discriminative factors between participants who maintained normal BP throughout midlife and those who developed higher BP. Participants with a baseline SBP level ≤92 mm Hg and White women with baseline BMI < 23 kg/m2 were the two segments of the population with the highest probability for maintaining normal BP throughout midlife (69.2% and 59.9%, respectively). Among Black participants aged >26.5 years with BMI > 27 kg/m2, only 5.4% of participants maintained normal BP throughout midlife.
Conclusions:
This study emphasizes the importance of early life factors to later life SBP and support efforts to maintain ideal levels of risk factors for hypertension at young ages. Whether policies to maintain lower BMI and SBP well below the clinical thresholds throughout young adulthood and middle age can reduce later age hypertension should be examined in future studies.
Related Concept Videos
01:26Coronary Artery Disease IV: Preventive Measures
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:28Factors affecting Blood pressure
Physiological Factors:
01:23Assessment of blood pressure in brachial artery(two-step method)
01:18Hypertension and Regulation of Blood Pressure
01:30Coronary Artery Disease I: Introduction