Abstract 15869: Blood Pressure Trajectories Across the Life Course and Midlife Ventricular Systolic Function: The Bogalusa Heart Study

Abstract

Introduction: Markers of adverse cardiac remodeling such as left ventricular (LV) hypertrophy and diastolic dysfunction have been associated with higher blood pressure (BP) during early and mid-life. Mid to late life hypertension is a well-known risk factor for left LV systolic dysfunction and progression to clinical heart failure (HF). We explore the association between BP in early to mid-life and LV systolic dysfunction measured by left ventricular ejection fraction (LVEF) in mid-life. Hypothesis: Higher BP in early to mid-life is associated with LV dysfunction as measured by LVEF. Methods: This complete-case analysis considered 1,140 participants of the Bogalusa Heart Study (57.5% female, 34.4% Black) with at least 3 traditional cardiometabolic risk factor (CMRF) observations since childhood (mean age 9.6±3.2 years) and transthoracic echocardiography-based LVEF estimations in midlife (48.9±5). Mean follow-up time was 38.6±3.8 years. A latent class trajectory modeling framework was employed to define trajectories of SBP. LVEF was divided into quartiles, and multivariable logistic regression models were utilized to estimate the association between life-course SBP trajectories and the lower quartile (Q1) of LVEF, controlling for traditional CMRF. Race, sex, and SBP trajectories interactions were tested to explore effect modification. Results: The prevalence of Q1 LVEF was higher among Black (32.1%, p<0.01) and male (31.3%, p<0.01) participants, compared to their counterparts. Four distinct trajectories were identified: stable-increasing (SI, 82.3%), moderate-increasing (MI, 5.2%), high-increasing (HI, 3.2%), and increasing-decreasing (D, 9.3%). Using SI as a reference, the following independent associations with the lower quartile of LEVF were identified: MI (OR: 1.4, 95%CI: 0.8 - 2.6, p=0.18), HI (OR: 0.72, 95%CI: 0.23-1.9, p=0.18), D (OR: 1.68, 95%CI: 1.1-2.6, p=0.02) Conclusion: Elevated systolic BP during early to mid-life (particularly 15-40 years of age) is associated with lower LEVF in midlife. These findings suggest the possibility of cardiac remodeling starting early in life. Increased awareness of elevated BP in childhood might be an avenue to prevent the progression to systolic dysfunction in late life.