Cumulative blood pressure in early adulthood and cardiac dysfunction in middle age: The CARDIA study

Satoru Kishi, Gisela Teixido-Tura, Hongyan Ning, Bharath Ambale Venkatesh, Colin Wu, Andre Almeida, Eui Young Choi, Ola Gjesdal, David R. Jacobs, Pamela J. Schreiner, Samuel S. Gidding, Kiang Liu, João A.C. Lima

Research output: Contribution to journalArticlepeer-review

84 Scopus citations


Background Cumulative blood pressure (BP) exposure may adversely influence myocardial function, predisposing individuals to heart failure later in life. Objectives This study sought to investigate how cumulative exposure to higher BP influences left ventricular (LV) function during young to middle adulthood. Methods The CARDIA (Coronary Artery Risk Development in Young Adults) study prospectively enrolled 5,115 healthy African Americans and whites in 1985 and 1986 (baseline). At the year 25 examination, LV function was measured by 2-dimensional echocardiography; cardiac deformation was assessed in detail by speckle-tracking echocardiography. We used cumulative exposure of BP through baseline and up to the year 25 examination (millimeters of mercury × year) to represent long-term exposure to BP levels. Linear regression and logistic regression were used to quantify the association of BP measured repeatedly through early adulthood (18 to 30 years of age) up to middle age (43 to 55 years). Results Among 2,479 participants, cumulative BP measures were not related to LV ejection fraction; however, high cumulative exposure to systolic blood pressure (SBP) and diastolic blood pressure (DBP) were associated with lower longitudinal strain rate (both p < 0.001). For diastolic function, higher cumulative exposures to SBP and DBP were associated with low early diastolic longitudinal peak strain rate. Of note, higher DBP (per SD increment) had a stronger association with diastolic dysfunction compared with SBP. Conclusions Higher cumulative exposure to BP over 25 years from young adulthood to middle age is associated with incipient LV systolic and diastolic dysfunction in middle age.

Original languageEnglish (US)
Pages (from-to)2679-2687
Number of pages9
JournalJournal of the American College of Cardiology
Issue number25
StatePublished - Jun 30 2015

Bibliographical note

Funding Information:
The CARDIA Study is supported by Contracts HHSN268201300025C, HHSN268201300026C, HHSN268201300027C, HHSN268201300028C, HHSN268201300029C, and HHSN268200900041C from the National Heart, Lung, and Blood Institute , the Intramural Research Program of the National Institute on Aging, and an intra-agency agreement between the National Institute on Aging and the National Heart, Lung, and Blood Institute (AG0005). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2015 American College of Cardiology Foundation.


  • echocardiography
  • hypertension
  • left ventricular function
  • speckle tracking


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