title: Cumulative Blood Pressure in Early Adulthood and Cardiac Dysfunction in Middle Age: The CARDIA Study.
abstract: BACKGROUND
  Cumulative blood pressure (BP) exposure may adversely influence myocardial function, predisposing individuals to heart failure later in life.
  
  
  OBJECTIVE
  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.
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Satoru
authors.initials: S
authors.lastname: Kishi
authors.affiliation: Department of Cardiology, Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Gisela
authors.initials: G
authors.lastname: Teixido-Tura
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Ning
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Bharath Ambale
authors.initials: BA
authors.lastname: Venkatesh
authors.affiliation: Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Colin
authors.initials: C
authors.lastname: Wu
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Andre
authors.initials: A
authors.lastname: Almeida
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Eui-Young
authors.initials: EY
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ola
authors.initials: O
authors.lastname: Gjesdal
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Schreiner
authors.affiliation: Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Gidding
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. Electronic address: jlima@jhmi.edu.
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018487:Ventricular Dysfunction, Left / Q000209:etiology; D055815:Young Adult
keywords: echocardiography; hypertension; left ventricular function; speckle tracking