[Correlation analysis between cumulative blood pressure load and arterial stiffness in midlife: a 36-year follow-up...

Objective: To explore the association between cumulative blood pressure load from childhood to midlife and the risk of arteriosclerosis in midlife. Methods: This study was based on the Hanzhong Children's Hypertension Cohort in Shaanxi Province. Using 36-year longitudinal follow-up data of 4 623 children and adolescents aged 6-18 years enrolled at baseline in 1987, the study period spanned from 1989 to 2023 with 7 follow-up assessments. A total of 1 845 participants were ultimately included in the analysis. Subjects were divided into the arteriosclerosis group and the non-arteriosclerosis group based on whether arteriosclerosis was detected at the final follow-up. Cumulative blood pressure load, including cumulative systolic blood pressure, diastolic blood pressure, and mean arterial pressure loads, was defined as the ratio of the area under the curve of blood pressure exceeding the standard threshold to the total area under the curve. Using the no-load group (cumulative blood pressure load=0) as the reference, participants were further divided into low-, medium-, and high-load groups based on tertiles. Multivariate logistic regression models were used to analyze the association between cumulative blood pressure load and arteriosclerosis. Restricted cubic spline models were applied to fit the dose-response relationship. Stratified analyses were performed by sex, age, smoking status, alcohol consumption, body mass index, and medication history. Results: The enrolled participants aged 49.00 (46.00, 51.00) years, with 1 016 males (55.1%). There were 506 cases (27.4%) in the arteriosclerosis group and 1 339 cases (72.6%) in the non-arteriosclerosis group. Compared with the non-arteriosclerosis group, the arteriosclerosis group had a higher proportion of males (328 (64.8%) vs. 688 (51.4%)), and higher levels of body mass index (25.72 (23.70, 27.78) kg/m²vs. 24.12 (22.26, 26.13) kg/m²), systolic blood pressure (138.17 (127.67, 150.00) mmHg vs. 121.33 (112.33, 132.00) mmHg, 1 mmHg=0.133 kPa), diastolic blood pressure (91.33 (83.67, 99.00) mmHg vs. 80.33 (73.67, 88.00) mmHg), and mean arterial pressure (107.34 (98.44, 115.89) mmHg vs. 94.00 (86.56, 102.11) mmHg) at the final follow-up (all P0.05). Multivariate logistic regression analysis, using the no-load group as the reference, showed that the risk of arteriosclerosis increased sequentially across the low-(OR=1.44, 95%CI: 0.99-2.11), medium-(OR=1.72, 95%CI: 1.15-2.57), and high-load groups of cumulative systolic blood pressure load. The association was stronger for cumulative diastolic blood pressure load (low-load: OR=2.98, 95%CI: 1.82-4.87; medium-load: OR=4.96, 95%CI: 3.05-8.06; high-load: OR=15.39, 95%CI: 9.34-25.37). Cumulative mean arterial pressure load showed a similar increasing trend (low-load: OR=2.31, 95%CI: 1.54-3.47; medium-load: OR=3.90, 95%CI: 2.63-5.80; high-load: OR=12.55, 95%CI: 8.28-19.02). Restricted cubic spline analysis revealed a non-linear positive correlation between all three cumulative blood pressure loads and the risk of midlife arteriosclerosis (all P0.05). Stratified analysis indicated that these associations were consistent across subgroups defined by sex, age, smoking status, alcohol consumption, body mass index, and medication use, with no interaction effects (all P_{for interaction}0.05). Conclusion: Cumulative blood pressure load from childhood to midlife is a risk factor for midlife arteriosclerosis, with a clear dose-response relationship. The association is most pronounced for cumulative diastolic blood pressure load.