Blood Pressure Trajectories in Early Adulthood and Subclinical Atherosclerosis in Middle Age

Study Questions:

Is there a correlation between common blood pressure (BP) trajectories throughout early adulthood and the presence of coronary artery calcification (CAC) during middle age?

Methods:

Prospective cohort data were used from 4,681 participants in the CARDIA study, who were black and white men and women ages 18-30 years at baseline with 25 years of follow-up. The authors examined systolic BP, diastolic BP, and mid-BP (calculated as [SBP + DBP] / 2, an important marker of coronary heart disease risk among younger populations) at baseline and years 2, 5, 7, 10, 15, 20, and 25. Latent mixture modeling was used to identify trajectories in systolic, diastolic, and mid-BP over time.

Results:

Five distinct mid-BP trajectories were identified: low-stable (21.8%; 95% confidence interval [CI], 19.9%-23.7%), moderate-stable (42.3%; 40.3%-44.3%), moderate-increasing (12.2%; 10.4%-14.0%), elevated-stable (19.0%; 17.1%-20.0%), and elevated-increasing (4.8%; 4.0%-5.5%). Compared with the low-stable group, trajectories with elevated BP levels had greater odds of having a CAC score of ≥100 Hounsfield units (HU). Adjusted odds ratios were 1.44 (95% CI, 0.83-2.49) for moderate-stable, 1.86 (95% CI, 0.91-3.82) for moderate-increasing, 2.28 (95% CI, 1.24-4.18) for elevated-stable, and 3.70 (95% CI, 1.66-8.20) for elevated-increasing groups. The adjusted prevalence of a CAC score of 100 HU or higher was 5.8% in the low-stable group. These odds ratios represent an absolute increase of 2.7%, 5%, 6.3%, and 12.9% for the prevalence of a CAC score of 100 HU or higher for the moderate-stable, moderate-increasing, elevated-stable, and elevated-increasing groups, respectively, compared with the low-stable group. Associations were not altered after adjustment for baseline and year 25 BP. Findings were similar for trajectories of isolated systolic BP trajectories, but were attenuated for diastolic BP trajectories.

Conclusions:

BP trajectories throughout young adulthood vary, and higher BP trajectories were associated with an increased risk of CAC in middle age. Long-term trajectories in BP may assist in more accurate identification of individuals with subclinical atherosclerosis.

Perspective:

This is an interesting study and probably valid, but one cannot be sure because of the confusion between an Agatston CAC score of at least 100, which is associated with increased event rates, and their use of CAC score of 100 HU.

Clinical Topics: Atherosclerotic Disease (CAD/PAD)

Keywords: Coronary Artery Disease, Hydroquinones, Follow-Up Studies, Atherosclerosis, Confusion, Mutagens, Middle Aged, Blood Pressure


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