Abstract 07: Longitudinal Patterns of Change in Systolic Blood Pressure (SBP) and Incidence of Cardiovascular Disease. The Atherosclerosis Risk in Communities (ARIC) Study
Background: Increasing SBP throughout the life course is associated with an increased risk of cardiovascular disease (CVD); however, patterns of SBP increase may differ among individuals. We sought to examine the association of longitudinal change in SBP with CVD outcomes among middle-aged adults.
Methods: We used latent class growth models (STATA, traj) to identify patterns of longitudinal change in SBP among 11,565 ARIC cohort participants with non-missing SBP measurements at 4 clinical examinations (1987-1998) Model adequacy was assessed using BIC criteria, average posterior probabilities of group assignment, and odds of correct classification. The association of SBP pattern with incidence of CVD and mortality was examined in follow-up from the fourth clinical examination (1998) through Dec 31, 2011, using Poisson regression models adjusted for age and use of hypertension medication.
Results: We identified six distinct patterns of SBP change, of which three showed a sustained increase within the normal range (<140 mm Hg), with the remaining ones showing an increase in SBP from normal to elevated, a decrease from elevated SBP to normal, and elevated stable SBP (Figure). Distinct longitudinal SBP patterns were associated with different rates of incident heart failure (HF), coronary heart disease (CHD), stroke, and death. During median 14.0 years of follow-up, lowest rates for all events were observed among study participants with lowest SBP who remained <140 mm Hg at all examinations. A gradient of event rates was observed across SBP patterns, with an increase observed even among study participants whose SBP remained within the normal range. The pattern characterized by a change from elevated to normal SBP was not associated with a decrease in rate of CHD.
Conclusions: Increase in SBP during midlife is associated with long-term risk of CVD, regardless of baseline SBP. Having an elevated SBP in mid-life increases the risk of CVD events and mortality. Our observations highlight the value of hypertension prevention efforts.
Author Disclosures: N. Petruski-Ivleva: None. A. Viera: None. D. Couper: None. D. Schimbo: None. P. Muntner: None. C. Avery: None. A. Schneider: None. A. Kucharska-Newton: None.
- © 2015 by American Heart Association, Inc.