Disclosures: The authors report no relevant financial disclosures.
January 21, 2022
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Cumulative high BP exposure drives systolic, diastolic dysfunction in middle age

Disclosures: The authors report no relevant financial disclosures.
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Cumulative exposure to increased BP from early adulthood on may influence right ventricular dysfunction in middle age, according to data from a large population-based study.

In an analysis of more than 2,800 healthy adults, researchers also observed a stronger association between higher cumulative diastolic BP and worse right ventricular (RV) function parameters compared with higher cumulative systolic BP.

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Long-term exposure

“CVD risk prediction algorithms have predominantly focused on BP at a single time measurement, and do not consider the potential effect of long‐term BP exposure,” Zhiwei Zhang, PhD, a research scientist in the department of cardiac pediatrics at Guangdong Cardiovascular Institute, China, and colleagues wrote in the study background. “Cumulative BP exposure, a measure which incorporates both BP level and exposure time, has provided incremental prognostic value and improvement in CVD risk classification. In recent years, with the advent of reliable and reproducible echocardiographic measures of RV function, right ventricular dysfunction is being increasingly recognized in hypertension and found to be an independent predictor of adverse CV outcome.”

Zhang and colleagues analyzed longitudinal data from 2,844 participants from the CARDIA study. The mean age of the cohort was 55 years; 56.8% were women and 53.1% were white. Researchers defined cumulative BP during the 30‐year follow‐up as the sum of the product of mean BP for each pair of consecutive examinations and the time interval between the two consecutive examinations in years. RV structure and function were assessed by echocardiography.

The findings were published in Clinical Cardiology.

Within the cohort, RV systolic dysfunction was observed among 196 participants; diastolic dysfunction was observed among 204 participants. In fully adjusted models, higher cumulative systolic BP was independently associated with lower tricuspid annular plane systolic excursion (beta = –0.21; P < .05), RV peak systolic velocity (beta = –0.26; P < .01), RV early diastolic velocity (beta = –0.32; P < .01) and higher pulmonary arterial systolic pressure (beta = –0.71; P < .01). Higher cumulative diastolic BP was independently associated with smaller RV basal diameter (beta = –0.03; P < .05), lower tricuspid annular plane systolic excursion (beta = –0.48; P < .01), RV peak systolic velocity (beta = –0.36; P < .01) and RV early diastolic velocity (beta = –0.32; P < .05).

In fully adjusted models, researchers found cumulative systolic BP was not related to systolic dysfunction.

Each 1 standard deviation (SD) increase in cumulative systolic BP was associated with a higher risk for diastolic dysfunction (OR = 1.43; 95% CI, 1.14-1.8; P < .01), whereas each 1 SD increase in cumulative diastolic BP was associated with higher risk for systolic dysfunction (OR = 1.36; 95% CI, 1.08-1.7; P < .01) and diastolic dysfunction (OR = 1.51; 95% CI, 1.21-1.88; P < .01).

“These associations were independent of several confounders, including anthropometric relationships, demographic and clinical variables, as well as the corresponding LV parameters,” the researchers wrote.

‘Critical period’

The researchers noted echocardiographic data were available for approximately 50% of CARDIA participants, creating potential for selection bias in the observed associations. However, they added the findings suggest young adulthood is a “critical period in life” when exposure to suboptimal BP is important.

“Our results are notable because myocardial modeling and subclinical RV dysfunction are important precursors of incident‐adverse CV outcomes,” the researchers wrote. “Early detection and early, effective and sustained control of BP may be important to minimize cardiac end‐organ impairments and CVD risk in late life.”