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JAMA Cardiol. 2020 Jan 22. doi: 10.1001/jamacardio.2019.5682. [Epub ahead of print]

Association of Blood Pressure Patterns in Young Adulthood With Cardiovascular Disease and Mortality in Middle Age.

Author information

Department of Family Medicine and Community Health, Duke University, Durham, North Carolina.
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
Department of Epidemiology, University of Alabama at Birmingham.
Division of Research, Kaiser Permanente Northern California, Oakland.
Department of Epidemiology and Biostatistics, University of California, San Francisco.
Duke Clinical Research Institute, Durham, North Carolina.
Associate Editor.
Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Genki Plaza Medical Center for Health Care, Tokyo, Japan.
Nemours Cardiac Center, Alfred I. DuPont Hospital for Children, Wilmington, Delaware.
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.



Determining blood pressure (BP) patterns in young adulthood that are associated with cardiovascular disease (CVD) events in later life may help to identify young adults who have an increased risk for CVD.


To determine whether the long-term variability of BP across clinical visits and the rate of change in BP from young adulthood to midlife are associated with CVD and all-cause mortality by middle age, independently of mean BP during young adulthood and a single BP in midlife.

Design, Setting, and Participants:

This prospective cohort study included a community-based sample of 3394 African American and white participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, enrolled from March 1985 through June 1986. Patterns of systolic BP (SBP) were evaluated with measurements at year 0 (baseline) and 2, 5, 7, and 10 years after baseline. Visit-to-visit SBP variability was estimated as BP variability independent of the mean (VIM). Data were collected from March 1985 through August 2015 and analyzed from June through October 2019.

Main Outcomes and Measures:

Cardiovascular disease and all-cause mortality experienced through August 2015 were adjudicated. The associations of each SBP pattern with CVD events and all-cause mortality were determined using Cox proportional hazards regression models.


At year 10, the mean (SD) age of the 3394 participants was 35.1‚ÄČ(3.6) years; 1557 (45.9%) were African American; 1892 (55.7%) were women; and 103 (3.0%) were taking antihypertensive medication. During a median follow-up of 20.0 (interquartile range, 19.4-20.2) years, 162 CVD events and 181 deaths occurred. When all BP pattern measurements were entered into the same model including a single SBP measurement at the year 10 examination, the hazard ratios for CVD events for each 1-SD increase in SBP measures were 1.25 (95% CI, 0.90-1.74) for mean SBP, 1.23 (95% CI, 1.07-1.43) for VIM SBP, and 0.99 (95% CI, 0.81-1.26) for annual change of SBP. The VIM for SBP was the only BP pattern associated with all-cause mortality (hazard ratio, 1.24; 95% CI, 1.09-1.41).

Conclusions and Relevance:

The results of this study suggest that the assessment of visit-to-visit SBP variability may help identify young adults at increased risk for CVD and all-cause mortality later in life.

[Available on 2021-01-22]

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