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Original Investigation
April 15, 2020

Association Between Visit-to-Visit Blood Pressure Variability in Early Adulthood and Myocardial Structure and Function in Later Life

Author Affiliations
  • 1Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
  • 2Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
  • 3Department of Public Health, Texas Tech University Health Sciences Center, Lubbock
  • 4Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
  • 5Kaiser Permanente Northern California, Division of Research, Oakland
  • 6Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
  • 7Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
  • 8Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 9University of Minnesota School of Public Health, Minneapolis
JAMA Cardiol. Published online April 15, 2020. doi:10.1001/jamacardio.2020.0799
Key Points

Question  Is there an association between visit-to-visit blood pressure variability in early adulthood and myocardial structure and function in middle age?

Findings  In this cohort study including 2400 participants, greater visit-to-visit variability in systolic and diastolic blood pressure in young adulthood was associated with higher left-ventricular mass, higher left-ventricular filling pressures, impaired left-ventricular relaxation, and greater global longitudinal strain.

Meaning  Greater visit-to-visit systolic and diastolic blood pressure variability in early adulthood appears to be associated with adverse alterations in cardiac structure as well as systolic and diastolic function in middle age.

Abstract

Importance  Long-term blood pressure (BP) variability has emerged as a reproducible measure that is associated with heart failure independent of systemic BP. Visit-to-visit BP variability may be associated with the risk of heart failure early in the life course and thus may be reflected in subclinical alterations in cardiac structure and function.

Objective  To evaluate the association between visit-to-visit BP variability in early adulthood and myocardial structure and function in middle age.

Design, Setting, and Participants  This cohort study used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a community-based cohort study of 5115 participants aged 18 to 30 years at baseline (year 0; March 25, 1985, to June 7, 1986) and followed up over a 30-year interval. A total of 2400 CARDIA study participants underwent evaluation at 4 field sites (Birmingham, Alabama; Oakland, California; Chicago, Illinois; and Minneapolis, Minnesota). Blood pressure was measured at 8 visits over a 25-year interval and participants received echocardiograms at year 25 (June 1, 2010, to August 31, 2011). Data analysis was conducted from June 7, 1986, to August 31, 2011.

Exposures  Visit-to-visit systolic and diastolic BP variability measures included SD, average real variability, and variability independent of the mean.

Main Outcomes and Measures  Echocardiographic indices of myocardial structure, systolic function, and diastolic function at the year 25 examination.

Results  Of the 2400 participants, 1024 were men (42.7%) and 976 were African American (40.7%); mean (SD) age at the year 25 examination was 50.4 (3.6) years. Per 1-SD increment, greater visit-to-visit systolic BP variability independent of the mean was associated with higher left-ventricular (LV) mass index (β [SE], 2.66 [0.4] g/m2, P < .001), worse diastolic function (early peak diastolic mitral annular velocity [é]) (β [SE], −0.40 [0.1] cm/s, P < .001), higher LV filling pressures (mitral inflow velocity to early diastolic mitral annular velocity [E/é]) β [SE], 0.37 [0.1] cm/s, P < .001), and worse global longitudinal strain (β [SE], 0.17 [0.1], P = .002). Similarly, greater visit-to-visit diastolic BP variability was associated with higher LV mass index (β [SE], 3.21 [0.5] g/m2, P < .001), worse diastolic function (é: β [SE], −0.24 [0.1] cm/s [P < .001]; E/é: β [SE], 0.23 [0.1] cm/s [P < .001]), and worse global longitudinal strain (β [SE], 0.13 [0.1], P = .02). The findings remained consistent when other BP variability measures were used (SD and average real variability).

Conclusions and Relevance  In this cohort study using data from the CARDIA study, greater visit-to-visit systolic and diastolic BP variability have been associated with adverse alterations in cardiac structure as well as systolic and diastolic function independent of mean BP levels.

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