Blood Pressure Trajectories in Early Adulthood and Subclinical Atherosclerosis in Middle Age

Abstract

IMPORTANCE Single measures of blood pressure (BP) levels are associated with the development of atherosclerosis; however, long-term patterns in BP and their effect on cardiovascular disease risk are poorly characterized.OBJECTIVES To identify common BP trajectories throughout early adulthood and to determine their association with presence of coronary artery calcification (CAC) during middle age. DESIGN, SETTING, AND PARTICIPANTSProspective cohort data from 4681 participants in the CARDIA study, who were black and white men and women aged 18 to 30 years at baseline in 1985-1986 at 4 urban US sites, collected through 25 years of follow-up (2010-2011). We examined systolic BP, diastolic BP, and mid-BP (calculated as [SBP+DBP]/2, an important marker of coronary heart disease risk among younger populations) at baseline and years 2, 5, 7, 10, 15, 20, and 25. Latent mixture modeling was used to identify trajectories in systolic, diastolic, and mid-BP over time. MAIN OUTCOMES AND MEASURES Coronary artery calcification greater than or equal toAgatston score of 100 Hounsfield units (HU) at year 25. RESULTSWe identified 5 distinct mid-BP trajectories: low-stable (21.8%; 95% CI, 19.9%-23.7%; n=987), moderate-stable (42.3%; 40.3%-44.3%; n=2085), moderateincreasing (12.2%; 10.4%-14.0%; n=489), elevated-stable (19.0%; 17.1%-20.0%; n=903), and elevated-increasing (4.8%; 4.0%-5.5%; n=217). Compared with the low-stable group, trajectories with elevated BP levels had greater odds of having a CAC score of 100 HU or greater. Adjusted odds ratios were 1.44 (95% CI, 0.83-2.49) for moderate-stable, 1.86 (95% CI, 0.91-3.82) for moderate-increasing, 2.28 (95% CI, 1.24-4.18), for elevated-stable, and 3.70 (95% CI, 1.66-8.20) for elevated-increasing groups. The adjusted prevalence of a CAC score of 100 HU or higher was 5.8% in the low-stable group. These odds ratios represent an absolute increase of 2.7%, 5%, 6.3%, and 12.9% for the prevalence of a CAC score of 100 HU or higher for the moderate-stable, moderate-increasing, elevated-stable and elevated-increasing groups, respectively, compared with the low-stable group. Associations were not altered after adjustment for baseline and year 25 BP. Findings were similar for trajectories of isolated systolic BP trajectories but were attenuated for diastolic BP trajectories.CONCLUSIONS AND RELEVANCE Blood pressure trajectories throughout young adulthood vary, and higher BP trajectories were associated with an increased risk of CAC in middle age. Long-term trajectories in BP may assist in more accurate identification of individuals with subclinical atherosclerosis.

Mid- to Late-Life Trajectories of Blood Pressure and the Risk of Stroke

“…Those studies identified 4 to 5 parallel trajectories in which trajectories with long-term higher blood pressure related to more cardiovascular pathology. [12][13][14] In our older population, we also observed that the class with a high midlife blood pressure had the highest risk of stroke and death compared with the class with the lowest blood pressure. However, a novel finding of our study is that the slope of increase was associated with an increasing risk of stroke and competing causes of death.…”

“…Studies in young-and middle-aged adults showed that increases in blood pressure over long periods (10-30 years) are related to an increased risk of stroke and cardiovascular disease, [11][12][13] and that trajectories of higher blood pressure relate to a higher risk of subclinical atherosclerosis. 14 Trajectories in older people may vary even more because it is particularly in later ages that arterial stiffness increases, which is associated with increases in blood pressure and blood pressure variability. [15][16][17] Furthermore, studies suggest that lower blood pressures might also be harmful in this population, leading to an increased risk of myocardial infarction or death.…”

Ideal Cardiovascular Health and the Prevalence and Severity of Aortic Stenosis in Elderly Patients

“…We assessed the relationship between pattern of CVHS attainment through midlife to late life and AV disease in late life. As previously published,18 we identified trajectories of ideal cardiovascular health attainment through midlife to late life on the basis of CVHS at the 5 study visits using trajectory analysis22 with the use of the STATA macro TRAJ. We used the bayesian information criterion to decide the number of trajectories (2–5 trajectories assessed).…”

Prehypertension During Normotensive Pregnancy and Postpartum Clustering of Cardiometabolic Risk Factors

“…The BP indices used for the modeling included DBP, SBP, mean arterial pressure (MAP), and mean mid-BP (calculated as [SBP+DBP]/2, a marker of coronary heart disease risk among younger populations). 29,30 The following criteria were used to determine the number of BP trajectory groups and the trajectory shapes for each BP index 31,32 : (1) an a priori …”

“…In recent years, the emerging application of multiple BP measurement-derived trajectories across the lifespan has provided insights for identifying novel means of preventing future cardiovascular risk. 30,32,38 Therefore, considering the dynamic nature of BP during pregnancy and the impact of seasonality on pregnancy BP levels, 39 BP trajectories that are an entire pregnancy course-dependent systemic approach have potential advantages over the fragmented, single BP measurement in terms of accuracy and reproducibility. Because all pregnant women should have at least 4 antenatal care assessments according to the new World Health Organization antenatal care model, 40 full utilization of these serial BP data would thus provide additional information for future risk stratification.…”