EARLY LIFE BLOOD PRESSURE TRAJECTORIES AND SUBCLINICAL VASCULAR DAMAGE IN MIDLIFE: A 30-YEAR PROSPECTIVE COHORT STUDY

Abstract

Objective: To describe the trajectory of BP across a 30-year span and evaluate its association with carotid intima–media thickness (CIMT) and brachial-ankle pulse wave velocity (baPWV) by middle age. Design and method: 4623 participants aged 6–18 years, recruited from the ongoing cohort of Hanzhong Adolescent Hypertension study, a total of 2780 subjects were followed up for 6 visits over 30 years, and 1925 participants with complete CIMT and baPWV data were used for final analyses. Systolic and diastolic BP trajectories were identified by latent mixture modeling. Results: We identified 5 distinct systolic BP (SBP) trajectories as: “low-stable” (n = 512, 26.6%), “moderate-stable” (n = 993, 51.6%), “high-stable” (n = 229, 11.9%), “moderate-increasing” (n = 152, 7.9%) and “high-increasing” (n = 39, 2.0%). The levels of CIMT and baPWV were linearly increased from low stable- to high-increasing SBP trajectories. A total of 85 individuals and 425 participants developed high CIMT and high baPWV by 2017, respectively. Compared with the low-stable SBP trajectory group, the high-increasing group had increasingly greater odds of high CIMT by middle age in the full adjustment [OR = 5.04(1.76–14.44)]. Such association was observed in diastolic BP trajectories [OR = 3.61(1.11–11.70)]. Conclusions: BP trajectories derived from childhood to middle age vary, and higher BP trajectories were associated with an increased risk of subclinical vascular damage in middle age. Monitoring trajectories of BP from childhood may help identify a high cardiovascular risk population in early life.