Original Investigation
Cumulative Blood Pressure in Early Adulthood and Cardiac Dysfunction in Middle Age: The CARDIA Study

https://doi.org/10.1016/j.jacc.2015.04.042Get rights and content
Under an Elsevier user license
open archive

Abstract

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.

Key Words

echocardiography
hypertension
left ventricular function
speckle tracking

Abbreviations and Acronyms

BP
blood pressure
CI
confidence interval
DBP
diastolic blood pressure
Ecc
circumferential peak systolic strain
Ecc_SRe
circumferential peak early diastolic strain rate
Ecc_SRs
circumferential peak systolic strain rate
Ell
4-chamber longitudinal peak strain
Ell_SRe
4-chamber longitudinal peak early diastolic strain rate
Ell_SRs
4-chamber longitudinal peak systolic strain rate
Err
radial peak strain
Err_SRs
radial peak systolic strain rate
HF
heart failure
LV
left ventricular
LVEF
left ventricular ejection fraction
LVMI
left ventricular mass index
MAP
mean arterial pressure
OR
odds ratio
PP
pulse pressure
SBP
systolic blood pressure
STE
speckle-tracking echocardiography

Cited by (0)

The CARDIA Study is supported by Contracts HHSN268201300025C, HHSN268201300026C, HHSN268201300027C, HHSN268201300028C, HHSN268201300029C, and HHSN268200900041C from the National Heart, Lung, and Blood Institute, the Intramural Research Program of the National Institute on Aging, and an intra-agency agreement between the National Institute on Aging and the National Heart, Lung, and Blood Institute (AG0005). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.