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J Am Coll Cardiol. 2015 Jun 30;65(25):2679-87. doi: 10.1016/j.jacc.2015.04.042.

Cumulative Blood Pressure in Early Adulthood and Cardiac Dysfunction in Middle Age: The CARDIA Study.

Author information

Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
Department of Cardiology, Hospital Vall d'Hebron, Barcelona, Spain.
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.
Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware.
Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. Electronic address:



Cumulative blood pressure (BP) exposure may adversely influence myocardial function, predisposing individuals to heart failure later in life.


This study sought to investigate how cumulative exposure to higher BP influences left ventricular (LV) function during young to middle adulthood.


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).


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.


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.


echocardiography; hypertension; left ventricular function; speckle tracking

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