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Original Investigation |

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

Norrina B. Allen, PhD, MPH1; Juned Siddique, DrPH1; John T. Wilkins, MD, MS1; Christina Shay, PhD2; Cora E. Lewis, MD, MSPH3; David C. Goff, MD, PhD4; David R. Jacobs Jr, PhD5; Kiang Liu, PhD1; Donald Lloyd-Jones, MD, ScM1
[+] Author Affiliations
1Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
2College of Public Health, University of Oklahoma, Oklahoma City
3Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham
4Colorado School of Public Health, University of Colorado, Aurora
5Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
JAMA. 2014;311(5):490-497. doi:10.1001/jama.2013.285122.
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Importance  Single measures of blood pressure (BP) levels are associated with the development of atherosclerosis; however, long-term patterns in BP and their effect on cardiovascular disease risk are poorly characterized.

Objectives  To identify common BP trajectories throughout early adulthood and to determine their association with presence of coronary artery calcification (CAC) during middle age.

Design, Setting, and Participants  Prospective cohort data from 4681 participants in the CARDIA study, who were black and white men and women aged 18 to 30 years at baseline in 1985-1986 at 4 urban US sites, collected through 25 years of follow-up (2010-2011). We 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.

Main Outcomes and Measures  Coronary artery calcification greater than or equal to Agatston score of 100 Agatston units (AU) at year 25.

Results  We identified 5 distinct mid-BP trajectories: low-stable (21.8%; 95% CI, 19.9%-23.7%; n=987), moderate-stable (42.3%; 40.3%-44.3%; n=2085), moderate-increasing (12.2%; 10.4%-14.0%; n=489), elevated-stable (19.0%; 17.1%-20.0%; n=903), and elevated-increasing (4.8%; 4.0%-5.5%; n=217). Compared with the low-stable group, trajectories with elevated BP levels had greater odds of having a CAC score of 100 AU or greater. 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 AU 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 AU 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 and Relevance  Blood pressure 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.

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Figures

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Figure 1.
Trajectories in Mid–Blood Pressure in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Trajectory classes identified for mid–blood pressure, their pattern by age, and number of CARDIA participants in each class.

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Figure 2.
Trajectories in Systolic and Diastolic Blood Pressure in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Trajectory classes identified for systolic and diastolic blood pressure, their pattern by age, and number of CARDIA participants in each class.

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