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Chronically elevated BP in young adulthood linked to cardiac dysfunction in middle age
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Cumulative exposure to high BP from young adulthood through middle age was associated with left ventricular systolic and diastolic dysfunction later in life, according to new data from the CARDIA study.
“Blood pressure at the higher end of the population distribution may represent a chronic exposure that injures the cardiovascular system. Cumulative BP exposure from young adulthood to middle age may adversely influence myocardial function and predispose individuals to heart failure and other cardiovascular disease later in life,” researchers wrote in the Journal of the American College of Cardiology.
Using data from the CARDIA study, researchers evaluated 5,115 healthy black and white individuals who were enrolled from 1985 to 1986 at centers in Birmingham, Alabama; Oakland, California; Chicago; and Minneapolis. The participants were followed for 25 years, starting in early adulthood, and were evaluated with repeat measures of BP and CV risk factors. In total, 3,498 participants received 25-year evaluations in 2010 to 2011, and 3,474 had LV function measured by 2-D echocardiography and cardiac deformation by speckle-tracking echocardiography. After excluding 995 participants with incomplete BP measurements during follow-up, 2,479 participants were included in the analysis. The mean age at 25-year follow-up was 50 years.
In the overall cohort, systolic BP gradually increased after age 35 years; diastolic BP and mean arterial pressure increased from baseline to about age 40 years, then plateaued; and pulse pressure decreased until age 40 years, then increased with age. Compared with white participants, black participants aged older than 25 years had higher levels of systolic BP, diastolic BP and mean arterial pressure. Elevated pulse pressure was more common in men compared with women.
Overall, 135 participants had systolic or diastolic dysfunction: 70 had LV systolic dysfunction (LV ejection fraction < 50%) and 69 had diastolic dysfunction (E/e’ ratio > 15).
The researchers assessed long-term exposure to BP using cumulative exposure of BP over 25 years, from early adulthood (18 to 30 years) to middle age (43 to 55 years), to represent long-term exposure to BP levels.
The results indicated that cumulative exposure to high systolic and diastolic BP levels was associated with a lower longitudinal strain rate (P < .001 for both). The researchers found no correlation between cumulative BP measures and LV ejection fraction.
When diastolic function parameters were evaluated, low early diastolic longitudinal peak strain rate was associated with high cumulative exposure to systolic and diastolic BP. The association with diastolic dysfunction was stronger for higher diastolic BP compared with systolic BP.
“This study shows that the use of speckle-tracking data and LV dysfunction help us better understand the adverse effects of cumulated BP exposure that ejection fraction alone does not identify. … Our findings suggest that the relationship of long-term exposure to higher BP and LV dysfunction is similar to that for subclinical atherosclerosis and provides further support for the importance of good risk factor control early in life,” the researchers wrote. – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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