Midlife blood pressure predicts future diastolic dysfunction independently of blood pressure

Abstract

Objectives: High blood pressure (BP) is associated with diastolic dysfunction, but the consequence of elevated BP over the adult life course on diastolic function is unknown. We hypothesised that high BP in earlier adulthood would be associated with impaired diastolic function independent of current BP.

Methods: Participants in the Medical Research Council National Survey of Health and Development birth cohort (n=1653) underwent investigations including echocardiography at age 60-64 years. The relationships between adult BP, antihypertensive treatment (HTT) and echocardiographic measures of diastolic function were assessed using adjusted regression models.

Results: Increased systolic BP (SBP) at ages 36, 43 and 53 years was predictive of increased E/e' and increased left atrial volume. These effects were only partially explained by SBP at 60-64 years and increased left ventricular mass. HTT was also associated with poorer diastolic function after adjustment for SBP at 60-64 years. Faster rates of increase in SBP in midlife were also associated with increased poorer diastolic function.

Conclusions: High SBP in midlife is associated with poorer diastolic function at age 60-64 years. Early identification of individuals with high BP or rapid rises in BP may be important for prevention of impaired cardiac function in later life.

Figure 1

Association between standardised residuals of change in systolic blood pressure (SBP) over three time periods (36–43 years), (43–53 years) and (53–60 to 64 years) conditional on the earlier measure(s) and markers of diastolic function at age 60–64 years. The residuals can be interpreted as the standardised rate of change in SBP in an individual above or below that expected on average in the sample given their earlier SBP. (A) e′ at age 60–64 years (n=1172). (B) E/A at age 60–64 years (n=1190). (C) E/e′ at age 60–64 years (n=1120). (D) Left atrial volume indexed to body surface area at age 60–64 years (n=1054). Data points are β coefficients and the bars represent 95% CIs. Model 1 (•): adjusted for age, sex and clinical research facility attended. Model 2 (○): model 1+diabetes mellitus+body mass index+smoking status+physical activity status+current antihypertensive treatment. p Values were calculated using Wald tests and p<0.05 indicates a significant association between the rate of change in SBP in the specified period and the measure of diastolic function.