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.

Central Illustration

Early Adulthood Blood Pressure and Middle-Age Left Ventricular Function

Blood pressure (BP) trends with increasing age. The trajectory slope shows mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) with increasing age for white and black men and women. All BP measurements over 25 years were within guideline acceptable range (A and B). Systolic and diastolic function with increasing cumulative SBP and DBP. (C) For left ventricular (LV) systolic function, there were no differences in left ventricular ejection fraction (LVEF) among cumulative SBP deciles; meanwhile, higher deciles of cumulative SBP produced a lower 4-chamber longitudinal peak systolic strain rate (Ell_SRs) compared with the lowest SBP (0% to 10%) decile. For LV diastolic function, early peak diastolic mitral velocity/peak early diastolic mitral annular velocity (E/e′) ratio increased in higher deciles of cumulative SBP compared with the lowest decile. Higher deciles of cumulative SBP were associated with lower 4-chamber longitudinal peak early diastolic strain rate (Ell_SRe) versus the lowest decile. (D) In considering cumulative DBP deciles, the same trends were seen for LVEF, as well as when comparing the higher deciles with the lowest group for Ell_SRs, E/e′ ratio, and Ell_SRe.

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Perspectives

COMPETENCY IN MEDICAL KNOWLEDGE: BP in early adulthood is related to later systolic and diastolic ventricular dysfunction.

TRANSLATIONAL OUTLOOK: Further studies are needed to determine whether specific lifestyle interventions implemented to reduce DBP in early adulthood prevent HF from developing later in life.