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Professor Mou Jianjun’s Team from Shaanxi Medical Promotion Association Highlights Multiple Researches on the International Stage, Showcasing Advances in Hypertension Management

Recently, the 33rd European Society of Hypertension (ESH 2024) Annual Meeting was grandly held at the Estrel Congress Center in Berlin, Germany. The conference focused on hypertension management, prevention, and the latest research advancements. During the meeting, several recent research results from Professor Mou, Jianjun's team, Vice President of the Shaanxi Medical Promotion Association and from the First Affiliated Hospital of Xi’an Jiaotong University, were presented, showcasing the latest progress in hypertension in China. Below are three highlighted studies.

1. Time in the Target Range for Systolic Blood Pressure from Childhood to Adulthood and Its Independent Association with Midlife Arteriosclerosis

Previous studies have shown that elevated blood pressure in childhood is associated with adult hypertension and arteriosclerosis. However, the correlation between time in the target range for systolic blood pressure (SBP-TTR) from childhood to midlife and midlife arteriosclerosis remains unclear. Professor Mou's team investigated this using a 36-year follow-up study of the Hanzhong Youth Hypertension Cohort.

Study Design

Data from the ongoing Hanzhong Youth Hypertension Cohort were used. At baseline, 1956 children and adolescents aged 6-18 were included in the study. The study assessed participants' SBP-TTR from childhood to adulthood over 36 years. Childhood SBP targets were defined as the 90th-95th percentile of normal SBP for age, sex, and height, and adult SBP targets were 110-130 mmHg.

Results

After 36 years of follow-up, arteriosclerosis risk decreased with increasing SBP-TTR. After adjusting for traditional risk factors, the risk of midlife arteriosclerosis was compared between the highest and lowest quartiles of SBP-TTR, showing an odds ratio (OR) of 0.642 (95% CI: 0.452-0.911). Even after adjusting for average SBP or SBP variability, TTR remained significantly associated with arteriosclerosis.

Additionally, among men, the highest quartile of SBP-TTR was significantly associated with reduced arteriosclerosis risk (OR=0.432; 95% CI: 0.262-0.710), whereas no significant difference was found in women.

Conclusion

The study indicates that a higher long-term SBP-TTR from childhood to adulthood is associated with a reduced risk of midlife arteriosclerosis, independent of average blood pressure or blood pressure variability. Thus, childhood SBP-TTR could be a modifiable risk factor for subsequent cardiovascular diseases.

2. Higher Blood Pressure Variability from Childhood to Adulthood and Increased Risk of Midlife Vascular Aging

Vascular aging, assessed through arterial structure and function, is an independent predictor of cardiovascular outcomes. This 30-year follow-up study comprehensively explored the potential relationship between long-term blood pressure variability and midlife carotid thickening, carotid plaques, and arteriosclerosis.

Study Design

The study utilized data from the ongoing Hanzhong Youth Hypertension Cohort, including 2065 children and adolescents aged 6-18 at baseline, with a 30-year follow-up (7 visits). Long-term blood pressure variability was defined as the standard deviation (SD) and average real variability (ARV) of blood pressure over 30 years. Vascular aging included midlife carotid thickening, carotid plaques, and arteriosclerosis.

Results

The 30-year follow-up showed that 444 out of 2065 participants developed arteriosclerosis. Higher systolic blood pressure standard deviation (SDSBP), ARV of SBP, diastolic blood pressure standard deviation (SDDBP), and ARV of DBP from childhood to midlife were significantly associated with midlife arteriosclerosis. Higher SDDBP was also related to the risk of carotid thickening. Higher SDDBP and ARVDBP were significantly associated with the risk of midlife carotid plaques. Similar results were obtained after adjusting for cumulative blood pressure exposure rather than average blood pressure.

Additionally, long-term blood pressure variability from youth to adulthood was significantly associated with arteriosclerosis, and from childhood to adolescence, it was associated with carotid plaque risk.

Conclusion

The study indicates that increased blood pressure variability from childhood to adulthood may increase the risk of midlife vascular aging, independent of average blood pressure or cumulative blood pressure exposure. Thus, early long-term blood pressure variability could be a predictor of late cardiovascular diseases, which is significant for understanding the relationship between hypertension and vascular aging and for exploring early prevention measures.

3. Cardiovascular Risk Factors in Childhood and Their Association with Increased Midlife Vascular Aging Risk

Vascular aging, assessed through arterial structure and function, is an independent predictor of cardiovascular outcomes. This study aimed to explore the relationship between cardiovascular risk factors from childhood to midlife and their association with midlife vascular aging.

Study Design

The study used data from the ongoing Hanzhong Youth Hypertension Cohort, following 2180 participants aged 6-18 at baseline for 30 years. The researchers used trajectory models based on this cohort to determine different trajectories of SBP, body mass index (BMI), and heart rate from childhood to midlife and assessed vascular aging using carotid intima-media thickness (cIMT) or ankle-brachial pulse wave velocity (baPWV).

Results

After 30 years of follow-up, four different SBP trajectories, three BMI trajectories, and two heart rate trajectories were identified. Continuously increasing SBP, high BMI growth, and stable high heart rate were positively correlated with midlife baPWV. Similar correlations were observed with cIMT for continuously increasing SBP and high BMI. The correlation between cardiovascular risk factor trajectories and baPWV and cIMT remained after adjusting for SBP, BMI, and heart rate.

Conclusion

Longitudinal exposure to cardiovascular risk factors from childhood to midlife and the accumulation of these risk factors are associated with increased midlife vascular aging risk. This research supports early identification of cardiovascular risk factors to prevent cardiovascular diseases in adulthood.