Greater variability in systolic blood pressure (SBP) measurements across visits in young adults may be associated with elevated risks for cardiovascular disease (CVD) and all-cause mortality in midlife, according to a study published in JAMA Cardiology.
Although BP variability from visit to visit is observed, little is known about the clinical relevance or prognostic implications of specific BP patterns in early adulthood.
In this subanalysis of the Coronary Artery Risk Development in Young Adults (CARDIA) study in which black and white individuals aged 18 to 30 years were enrolled between 1985 and 1986 and followed for 30 years, the data of 3394 participants with complete BP information were examined. Participants had SBP measured at baseline and at the 2-, 5-, 7-, and 10-year follow-up visits. The BP variability independent of the mean (VIM) was used to estimate visit-to-visit SBP variability.
The primary outcome was a CVD composite of coronary heart disease, stroke, heart failure hospitalization, peripheral artery disease intervention, and transient ischemic attack. The secondary outcome was all-cause mortality. Outcomes were assessed through August 2015.
At the 10-year visit, the mean age of the cohort was 35.1 years, with 1892 women (55.7%) and 1557 blacks (45.9%), and 103 patients (3.0%) receiving antihypertensive pharmacotherapy. Median follow-up time was 20.0 years. During this period, there were 162 (2.49 per 1,000 person-years) and 181 (2.74 per 1,000 person-years) CVD events and fatalities, respectively.
A multivariable-adjusted regression model included all SBP pattern measurements from baseline through year 7 and a single SBP measurement from the 10-year visit. For every increase in SBP by 1-standard deviation, the hazard ratios (HRs) for CVD were: 1.25 (95% CI, 0.90-1.74) for mean SBP, 0.99 (95% CI, 0.81-1.26) for annual SBP change, and 1.23 (95% CI, 1.07-1.43) for SBP VIM. SBP VIM was the sole variable found to be associated with all-cause mortality (HR, 1.24; 95% CI, 1.09-1.41).
Study strengths include a large sample size, high retention rate, detailed evaluation criteria, stringent quality control, and standardized data collection. Study limitations include unclear applicability to typical clinic settings, uncertain impact of BP measurement interval variations, and potential nongeneralizability to racial and ethnic groups other than those included in the cohort.
“The results of this study suggest that the assessment of visit-to-visit SBP variability may help identify young adults at increased risk for CVD and all-cause mortality later in life,” noted the authors.
Yano Y, Reis JP, Lewis CE, et al. Association of blood pressure patterns in young adulthood with cardiovascular disease and mortality in middle age. JAMA Cardiol. 2020:E1-E8. doi: 10.1001/jamacardio.2019.5682