Long-term Blood Pressure Variability in Young Adulthood and Coronary Artery Calcium and Carotid Intima-Media Thickness in Mid-Life: The CARDIA Study

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 76; no. 2; pp. 404 - 409
• Main Authors: Nwabuo, Chike C., Yano, Yuichiro, Moreira, Henrique T., Appiah, Duke, Vasconcellos, Henrique D., Aghaji, Queen N., Viera, Anthony J., Rana, Jamal S., Shah, Ravi V., Murthy, Venkatesh L., Allen, Norrina B., Schreiner, Pamela J., Lloyd-Jones, Donald M., Lima, João A.C.
• Format: Journal Article
• Language: English
• Published: 29.06.2020
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.120.15394

Recent evidence links long-term (visit-to-visit) blood pressure (BP) variability to the risk of cardiovascular disease, independent mean BP levels. Potential associations between long-term BP variability and cardiovascular disease risk may be reflected in early life course alterations in coronary artery calcium (CAC) and carotid intima-media thickness. We evaluated 2482 Coronary Artery Risk Development in Young Adults study participants (mean [SD] age at the year-20 exam [2005–2006] was 45.4 [3.6] years, 43.2% men, and 41.3% African-American). We included participants with BP assessments across 20-years (year 0, 2, 5, 7, 10, 15, 20 exams) and carotid intima-media thickness and CAC data at the year-20 exam. BP variability was assessed using variability independent of the mean and SD). Adjusted multivariable linear or logistic regression models (as appropriate) were used to assess associations between long-term BP variability measures and carotid intima-media thickness. and CAC (ln [CAC+1] and prevalent CAC). Long-term systolic BP variability independent of the mean (per 1-SD) was positively associated with carotid intima-media thickness. (β=10 μm, standard error (SE)=3, p =0.002. Similarly, long-term diastolic BP variability independent of the mean was associated with carotid intima-media thickness (β=10μm, SE (3), p =0.001). Long-term BP variability was not associated with either ln [CAC+1] or prevalent CAC. Long-term variability independent of the mean systolic and diastolic across early adulthood was positively associated with modest adverse mid-life alterations in carotid intima-media thickness but not to CAC. Our findings provide further insights into pathophysiologic mechanisms that link long-term BP variability to cardiovascular disease.