Blood pressure in childhood, young- and mid-adulthood: association with carotid plaque severity.

Abstract

Background and aims: Blood pressure (BP) is a key modifiable risk factor for atherosclerosis. How BP across different life stages associates with carotid plaque in mid-adulthood remains unclear, which is the aim of this study.

Methods: The sample included 1889 participants from the Cardiovascular Risk in Young Finns Study who had their BP measured in childhood (6-18 years), young adulthood (21-39 years), and mid-adulthood (40-56 years). Outcomes were the carotid plaque presence and area in mid-adulthood. A Bayesian relevant life-course exposure model was used to estimate the life-course association of BP with carotid plaque and determine the relative contributions attributed to each life stage.

Results: After a 38-year follow-up, 745 participants (39.4%) developed carotid plaques. Cumulative systolic BP (SBP) from childhood, young-, and mid-adulthood was associated with carotid plaque presence in mid-adulthood [for each 1-SD increase (∼12 mm Hg), relative risk (95% credible intervals (CrIs)): 1.22 (1.10-1.36)], with SBP at each life stage contributing approximately equally (relative weights: childhood, 39.4%; young adulthood, 37.9%; mid-adulthood, 22.7%). Cumulative SBP was associated with carotid plaque areas [β (95% CrIs), 0.16 (0.08-0.23)] square millimetre, with mid-adulthood SBP showing a higher contribution (relative weights: childhood, 12.5%; young adulthood, 25.0%; mid-adulthood, 62.5%). Similar patterns were observed for diastolic BP, pulse pressure, and mean arterial pressure.

Conclusions: Blood pressure at each life stage contributes equally to carotid plaque presence, with mid-adulthood BP associated with a greater contribution to plaque area. These findings underscore the importance of maintaining normal BP throughout life to reduce atherosclerosis risk and suggest that intensive BP management in mid-adulthood may help slow plaque progression.