Pattern of higher blood pressure in early adulthood helps predict risk of atherosclerosis in middle-age

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A study published recently in the Journal of the American Medical Association, reports that in an analysis of blood pressure patterns over a 25-year span from young adulthood to middle age, individuals who exhibited elevated and increasing blood pressure levels throughout this time period had greater odds of having higher measures of coronary artery calcification.

According to a press release, Norrina B Allen, of the Feinberg School of Medicine, Northwestern University, Chicago, USA, and colleagues identified common blood pressure trajectories throughout early adulthood and sought to determine their association with the presence of coronary artery calcification during middle age among 4,681 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

The participants were black and white men and women, 18 to 30 years of age at the beginning of the study in 1985-1986. Data were collected through 25 years of follow-up on systolic blood pressure, diastolic blood pressure, and mid-blood pressure (calculated as [SBP+DBP]/2, an important marker of coronary heart disease risk among younger populations). The primary measured outcome for the study was a higher level of coronary artery calcification detected by computed tomography scan.

The researchers identified five distinct trajectories in mid-blood pressure from young adulthood to middle age: 22% of participants maintained low blood pressure throughout follow-up (low-stable group); 42% had moderate blood pressure levels (moderate-stable group); 12% started with moderate blood pressure levels which increased at an average age of 35 years (moderate-increasing group); 19% had relatively elevated blood pressure levels throughout (elevated-stable group); and 5% started with elevated blood pressure which increased during follow-up (elevated-
increasing group).

The prevalence of a high coronary artery calcification score varied from 4% in the low-stable blood pressure trajectory group to 25% in the elevated-increasing blood pressure trajectory group. Participants who exhibited elevated blood pressure levels throughout the study period and those who had increases in blood pressure levels over this time had larger odds of having a high coronary artery calcification score.

“Although blood pressure has been a well-known risk factor for cardiovascular disease for decades, these findings suggest that an individual’s long-term patterns of change in blood pressure starting in early adulthood may provide additional information about his or her risk of development of coronary calcium,” the authors write. “Additional research is needed to examine the utility of specific blood pressure trajectories in risk prediction for clinical cardiovascular disease events and to explore the effect of lifestyle modification, treatment, and timing of intervention on lifetime trajectories in blood pressure and outcomes.”