Mid- to Late-Life Time-Averaged Cumulative Blood Pressure and Late-Life Cardiac Structure, Function, and Heart Failure.
Mid- to Late-Life Time-Averaged Cumulative Blood Pressure and Late-Life Cardiac Structure, Function, and Heart Failure.
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DOI：
10.1161/hypertensionaha.120.14833
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发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Shah AM
中科院分区：
文献类型：
--
作者：
Teramoto K;Nadruz Junior W;Matsushita K;Claggett B;John JE;Skali H;Solomon S;Cheng S;Shah AM
Limited data exist regarding systolic blood pressure (SBP) through mid- to late-life and late-life cardiac function and heart failure (HF) risk. Among 4,578 HF-free participants in the Atherosclerosis Risk in Communities study attending the 5th Visit (2011-2013; age 75±5 years), time-averaged cumulative SBP was calculated as the sum of averaged SBPs from adjacent consecutive visits (Visits 1-5) indexed to total observation time (24±1 years). Calculations were performed using measured SBPs and also incorporating antihypertensive medication specific effect constants (‘underlying’ SBP). Outcomes included comprehensive echocardiography at Visit 5 and post-Visit 5 incident HF, HF with preserved ejection fraction (HFpEF), and reduced ejection fraction (HFrEF). Higher cumulative SBP was associated with greater LV mass and worse diastolic measures (all p <0.001), associations that were stronger with underlying compared to cumulative SBP (all p<0.05). At 5.6±1.2 years follow-up post-Visit 5, higher cumulative measured and underlying SBP were associated with incident HF (HR per 10 mmHg for measured: 1.12 [1.01-1.24]; underlying: 1.19 [95%CI 1.10-1.30]) and HFpEF (measured: 1.15 [1.00-1.33]; underlying: 1.28 [1.14-1.45]), but not HFrEF (measured: 1.11 [0.94-1.32]; underlying: 1.11 [0.96-1.24]). Associations with HF and HFpEF were more robust with cumulative underlying compared to measured SBP (all p <0.05). Time-averaged cumulative SBP in mid- to late-life is associated with worse cardiac function and risk of incident HF, especially HFpEF, in late-life. These associations were stronger considering underlying as opposed to measured SBP, highlighting the importance of prevention and effective treatment of hypertension to prevent late-life cardiac dysfunction and HF.
