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 x 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.
Generated Summary
This original investigation published in the Journal of the American College of Cardiology (JACC) aimed to examine the relationship between cumulative blood pressure (BP) exposure in early adulthood and the development of cardiac dysfunction in middle age. The study utilized data from the CARDIA (Coronary Artery Risk Development in Young Adults) study, a prospective cohort study, to assess how long-term exposure to BP influences left ventricular (LV) function. The research employed 2-dimensional echocardiography and speckle-tracking echocardiography to evaluate cardiac function and deformation. The study’s methodology involved repeated measurements of BP over 25 years, quantifying cumulative BP exposure, and using linear and logistic regression to assess the association between BP exposure and LV function. The study included 2,479 participants and aimed to determine if early-life BP levels influenced cardiac health later in life.
Key Findings & Statistics
- The CARDIA 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 x year) to represent long-term exposure to BP levels.
- Among 2,479 participants, cumulative BP measures were not related to LV ejection fraction.
- 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.
- Higher DBP (per SD increment) had a stronger association with diastolic dysfunction compared with SBP.
- The study found that cumulative BP measures were not related to LV ejection fraction.
- High cumulative exposure to systolic blood pressure (SBP) and diastolic blood pressure (DBP) were associated with lower longitudinal strain rate (both p < 0.001).
Other Important Findings
- Higher cumulative exposure to SBP and DBP was associated with lower longitudinal strain rate.
- Higher DBP had a stronger association with diastolic dysfunction compared with SBP.
- The research found that higher cumulative exposure to BP over 25 years, from young adulthood to middle age, is associated with early-stage systolic and diastolic dysfunction.
Limitations Noted in the Document
- The study does not explicitly mention limitations, but studies of this kind are always subject to potential confounders.
- It is difficult to account for every factor.
- The study population is only from a specific study.
Conclusion
The study concludes that increased cumulative exposure to blood pressure over a 25-year period, from young adulthood to middle age, is linked to early systolic and diastolic dysfunction of the left ventricle. This highlights the adverse impact of long-term BP exposure on myocardial function. The research findings underscore the importance of controlling BP early in life to potentially reduce the risk of heart failure later on. The study suggests that early interventions aimed at managing BP could be critical in preventing the progression of cardiac dysfunction. The study’s results point to a need for further research to explore specific interventions to reduce DBP in early adulthood. Further research is needed to determine whether specific lifestyle interventions can prevent heart failure from developing later in life. The study’s findings support the idea that long-term BP control is essential for maintaining cardiac health. The study’s results have significant implications for public health strategies aimed at preventing cardiovascular diseases, and provides a basis for further research into interventions.