Pattern of higher blood pressure in early adulthood helps predict risk of heart disease

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The JAMA Network Journals
Pattern of higher blood pressure in early adulthood helps predict risk of heart disease 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 (a measure of coronary artery atherosclerosis), according to a study in the February 5 issue of JAMA.

"Blood pressure (BP) represents a major modifiable risk factor for cardiovascular disease (CVD). Current risk prediction models take into account BP level only at the time of risk prediction, usually in middle or older age, and do not consider the potential effect of BP levels earlier in life or the changes in BP levels over time," according to background information in the article.

Norrina B. Allen, Ph.D., M.P.H., of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues identified common BP trajectories (patterns) throughout early adulthood and sought to determine their association with the presence of coronary artery calcification (CAC) 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 BP, diastolic BP, and mid-BP (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 5 distinct trajectories in mid-BP from young adulthood to middle age: 22 percent of participants maintained low BP throughout follow-up (low-stable group); 42 percent had moderate BP levels (moderate-stable group); 12 percent started with moderate BP levels which increased at an average age of 35 years (moderate-increasing group); 19 percent had relatively elevated BP levels throughout (elevated-stable group); and 5 percent started with elevated BP's which increased during follow-up (elevated-increasing group).

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

"Although BP has been a well-known risk factor for CVD for decades, these findings suggest that an individual's long-term patterns of change in BP 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 BP trajectories in risk prediction for clinical CVD events and to explore the effect of lifestyle modification, treatment, and timing of intervention on lifetime trajectories in BP and outcomes." (doi:10.1001/jama.2013.285122; Available pre-embargo to the media at http://media.jamanetwork.com)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

There will also be a digital news release available for this study, including the JAMA Report video, embedded and downloadable video, audio files, text, documents, and related links. This content will be available at 3 p.m. CT Tuesday, February 4 at this link.

Editorial: Early Patterns of Blood Pressure Change and Future Coronary Atherosclerosis

Pantelis A. Sarafidis, M.D., M.Sc., Ph.D., of Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece, and George L. Bakris, M.D., of University of Chicago Medicine, comment on the findings of this study in an accompanying editorial.

"The study by Allen and colleagues presents a novel approach for assessing coronary heart disease and CVD risk, and the data offer an important perspective to support a preventive approach to reduce coronary heart disease risk by demonstrating the existence of widely different BP trajectories ranging from young adulthood through middle age … Further research is warranted to explore the associations of BP trajectories with development of advancing chronic kidney disease and heart failure and to provide novel tools for risk prediction to guide interventions for BP lowering in everyday practice." (doi:10.1001/jama.2013.285123; Available pre-embargo to the media at http://media.jamanetwork.com)

Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc. ### END