title: Longitudinal Patterns of Change in Systolic Blood Pressure and Incidence of Cardiovascular Disease: The Atherosclerosis Risk in Communities Study.
abstract: Elevated blood pressure in midlife contributes significantly to the risk of cardiovascular disease. However, patterns of blood pressure increase may differ among individuals and may result in differential risk. Our goal was to examine the contribution of longitudinal patterns of blood pressure change to incidence of heart failure, coronary heart disease, stroke, and cardiovascular disease mortality. Latent class growth models were used to identify patterns of change in blood pressure across 4 clinical examinations (1987-1998) among 9845 Atherosclerosis Risk in Communities (ARIC) cohort participants (mean age, 53.7 [SD 5.7] years). Patterns of change in systolic blood pressure included slowly and steeply increasing, a decreasing and a sustained elevated blood pressure. Changes in diastolic and mid-blood pressure (½ systolic+½ diastolic) were less pronounced. The association of blood pressure pattern group membership with incidence of clinical outcomes was examined in follow-up from the fourth clinical examination (1996-1998) to December 31, 2011, using Poisson regression models adjusted for demographic and metabolic characteristics, and hypertension medication use. A gradient of rates of all events was observed across the identified patterns. Associations were attenuated after adjustment for covariates. Cumulative systolic blood pressure load, rather than the temporal pattern of change in systolic blood pressure itself, plays a role in determining the risk of cardiovascular disease, in particular, of heart failure and cardiovascular disease mortality, independent of blood pressure level measured at one point in time.
authors.affiliation: From the Department of Epidemiology (N.P.-I., C.L.A.), Department of Family Medicine and Hypertension Research Program (A.J.V.), Department of Biostatistics (D.C.), and Cecil G. Sheps Center for Health Services Research (A.K.-N.), University of North Carolina, Chapel Hill; Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (D.S.); Department of Epidemiology, University of Alabama Birmingham, Birmingham (P.M.); and Departments of Neurology and Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.L.C.S.). petruski@email.unc.edu.
authors.forename: Natalia
authors.initials: N
authors.lastname: Petruski-Ivleva
authors.affiliation: From the Department of Epidemiology (N.P.-I., C.L.A.), Department of Family Medicine and Hypertension Research Program (A.J.V.), Department of Biostatistics (D.C.), and Cecil G. Sheps Center for Health Services Research (A.K.-N.), University of North Carolina, Chapel Hill; Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (D.S.); Department of Epidemiology, University of Alabama Birmingham, Birmingham (P.M.); and Departments of Neurology and Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.L.C.S.).
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Viera
authors.affiliation: From the Department of Epidemiology (N.P.-I., C.L.A.), Department of Family Medicine and Hypertension Research Program (A.J.V.), Department of Biostatistics (D.C.), and Cecil G. Sheps Center for Health Services Research (A.K.-N.), University of North Carolina, Chapel Hill; Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (D.S.); Department of Epidemiology, University of Alabama Birmingham, Birmingham (P.M.); and Departments of Neurology and Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.L.C.S.).
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.affiliation: From the Department of Epidemiology (N.P.-I., C.L.A.), Department of Family Medicine and Hypertension Research Program (A.J.V.), Department of Biostatistics (D.C.), and Cecil G. Sheps Center for Health Services Research (A.K.-N.), University of North Carolina, Chapel Hill; Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (D.S.); Department of Epidemiology, University of Alabama Birmingham, Birmingham (P.M.); and Departments of Neurology and Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.L.C.S.).
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: From the Department of Epidemiology (N.P.-I., C.L.A.), Department of Family Medicine and Hypertension Research Program (A.J.V.), Department of Biostatistics (D.C.), and Cecil G. Sheps Center for Health Services Research (A.K.-N.), University of North Carolina, Chapel Hill; Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (D.S.); Department of Epidemiology, University of Alabama Birmingham, Birmingham (P.M.); and Departments of Neurology and Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.L.C.S.).
authors.forename: Christy L
authors.initials: CL
authors.lastname: Avery
authors.affiliation: From the Department of Epidemiology (N.P.-I., C.L.A.), Department of Family Medicine and Hypertension Research Program (A.J.V.), Department of Biostatistics (D.C.), and Cecil G. Sheps Center for Health Services Research (A.K.-N.), University of North Carolina, Chapel Hill; Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (D.S.); Department of Epidemiology, University of Alabama Birmingham, Birmingham (P.M.); and Departments of Neurology and Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.L.C.S.).
authors.forename: Andrea L C
authors.initials: AL
authors.lastname: Schneider
authors.affiliation: From the Department of Epidemiology (N.P.-I., C.L.A.), Department of Family Medicine and Hypertension Research Program (A.J.V.), Department of Biostatistics (D.C.), and Cecil G. Sheps Center for Health Services Research (A.K.-N.), University of North Carolina, Chapel Hill; Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (D.S.); Department of Epidemiology, University of Alabama Birmingham, Birmingham (P.M.); and Departments of Neurology and Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.L.C.S.).
authors.forename: David
authors.initials: D
authors.lastname: Couper
authors.affiliation: From the Department of Epidemiology (N.P.-I., C.L.A.), Department of Family Medicine and Hypertension Research Program (A.J.V.), Department of Biostatistics (D.C.), and Cecil G. Sheps Center for Health Services Research (A.K.-N.), University of North Carolina, Chapel Hill; Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (D.S.); Department of Epidemiology, University of Alabama Birmingham, Birmingham (P.M.); and Departments of Neurology and Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.L.C.S.).
authors.forename: Anna
authors.initials: A
authors.lastname: Kucharska-Newton
mesh_terms: D017677:Age Distribution; D001795:Blood Pressure Determination / Q000379:methods; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate; D013599:Systole / Q000502:physiology*; D013997:Time Factors
keywords: blood pressure; cardiovascular diseases; coronary disease; heart failure; hypertension; stroke