Long-term Blood Pressure Exposure Impacts Cardiac Structure and Function

Overview

This study from the MESA cohort demonstrates that decade-long cumulative exposure to elevated blood pressure (BP), particularly systolic BP, is associated with adverse changes in cardiac structure and function independent of current BP levels. These changes include increased left ventricular mass, impaired myocardial strain, and greater risk of myocardial scar, even among non-hypertensive individuals.

Background

Blood pressure fluctuates over time, and cumulative BP exposure reflects the integrated burden of BP over years. Prior research has linked cumulative BP to cardiovascular disease risk, but its relationship with detailed cardiac structure and function independent of current BP is less clear. Cardiac magnetic resonance imaging (CMR) provides precise assessment of myocardial structure, function, fibrosis, and scar. This study leverages CMR data from the Multi-Ethnic Study of Atherosclerosis (MESA) to explore how long-term BP exposure affects myocardial health.

Data Highlights

Key Findings

• Higher cumulative systolic BP over 10 years is independently associated with increased left ventricular mass index.
• Cumulative systolic BP correlates with worse global and regional myocardial circumferential strain, indicating impaired systolic function.
• Greater cumulative systolic BP is linked to higher risk of myocardial scar detected by late gadolinium enhancement.
• Cumulative diastolic BP shows a nearly J-shaped relationship with myocardial strain after adjusting for current BP.
• Even in individuals without hypertension, cumulative systolic BP remains significantly associated with adverse cardiac remodeling and impaired function.

Clinical Implications

These findings highlight the importance of considering long-term BP exposure rather than relying solely on single BP measurements when assessing cardiovascular risk. Early and sustained BP control may prevent adverse myocardial remodeling and fibrosis, potentially reducing heart failure risk. Cardiac imaging, especially CMR, can provide valuable insights into subclinical myocardial changes related to cumulative BP burden.

Conclusion

Long-term cumulative exposure to elevated blood pressure significantly impacts myocardial structure and function independent of current BP levels, underscoring the need for sustained BP management to mitigate cardiac remodeling and fibrosis.

References

1. MESA Study Group 2024 -- Long-term Blood Pressure Exposure and Its Impact on Cardiac Structure and Function