Higher Life-Course Blood Pressure Associates With Reduced Myocardial Perfusion in Older Age: Insights From MyoFit46

作者：Constantin‐Cristian Topriceanu, Matthew Webber, Hunain Shiwani, Fiona T.S. Chan, Emma Martin, Debbie Falconer, Matthew A Stanley, Jonathan Bennett, Pablo González, Haytham Shah, Swades De, Andrew Wong, Iain Pierce, Rhodri Davies, Pier D. Lambiase, Nish Chaturvedi, Peter Kellman, Rebecca Hardy, James Moon, Alun D. Hughes, Gabriella Captur · 发表于：Circulation Cardiovascular Imaging · 年份：2025 · DOI：10.1161/circimaging.125.019105 · 被引用次数：2 · 研究领域：Blood Pressure and Hypertension Studies、Cardiac Imaging and Diagnostics、Heart rate and cardiovascular health

BACKGROUND: Elevated blood pressure (BP) is a major contributor to coronary artery disease. We explored the impact of life-course BP on later-life normalized stress myocardial blood flow (sMBF N ) and myocardial perfusion reserve by cardiovascular magnetic resonance (CMR). METHODS: MyoFit46 prospectively recruited ≈500 National Survey of Health and Development 1946 birth cohort participants, aged ≈77 years, to undergo stress perfusion and late gadolinium enhancement CMR. Systolic (SBPs) and diastolic BPs were recorded at 36, 43, 53, 63, 69, and 77 years. For each participant, the annual rates of BP change (steepness of BP increase) and area under the BP trajectory curve (cumulative life-course BP burden) were derived using mixed-effects models. The associations between BP measures and CMR metrics were tested using generalized linear and additive models, adjusted for antihypertensive use, demographics, lifestyle choices, and comorbidities. Cross-sectional associations between CMR metrics and major adverse cardiovascular events (myocardial infarction, stroke, and heart failure) were also tested. Mediation analyses explored the mechanistic pathways linking life-course BPs, myocardial perfusion, and myocardial fibrosis. RESULTS: Among 459 included MyoFit46 participants, each 10 mm Hg higher SBP at 36 to 69 years was associated with 3% to 6% lower sMBF N by CMR at 77 years. At 43 to 63 years, as SBPs rose from 120 to 140 mm Hg, sMBF N was 18% to 24% lower. Having a sustained highe...