Blood Pressure and Left Ventricular Geometric Changes: A Directionality Analysis
Miaoying Yun, Shengxu Li, Yinkun Yan, Dianjianyi Sun, Yajun Guo, Camilo Fernandez, Lydia Bazzano, Jiang He, Tao Zhang, Wei Chen
Abstract
This study assessed the temporal relationship of elevated blood pressure (BP) with left ventricular hypertrophy (LVH) and geometric changes in a longitudinal cohort of adults. Left ventricular mass index (LVMI), relative wall thickness (RWT), and BP were measured at 2 time points 4.1 to 14.9 years apart between 2000 and 2016 among 984 adults (677 White and 307 Black people; 41.1% men; age range, 24.2–56.7 years) in the Bogalusa Heart Study cohort. Cross-lagged path analysis models were used to examine the temporal relationship of BP with LVMI and RWT in subjects who did not take antihypertensive medications (n=693). The cross-lagged path coefficients did not differ significantly between race and sex groups. In the combined sample, the path coefficients from baseline systolic BP to follow-up LVMI/RWT were significantly greater than the path coefficients from baseline LVMI/RWT to follow-up systolic BP (0.111 versus −0.005 for LVMI, P =0.010 for difference; 0.146 versus 0.004 for RWT, P =0.002 for difference). Hypertensive subjects at baseline had a significantly higher incidence rate of concentric LVH at follow-up compared with normotensive subjects (19.4% versus 9.7%, P <0.001 for difference), but incident eccentric LVH did not show such a difference between hypertensive and normotensive subjects (5.4% versus 4.4%, P =0.503 for difference). Diastolic BP showed similar results to those of systolic BP. In conclusion, the findings on these one-directional paths provide strong and fresh evidence that elevated BP precedes the development of LVH, especially concentric LVH, during the young-to-midlife adult age period.