累积血压暴露可能对心肌功能产生不良影响，继而引起之后的心力衰竭(简称心衰)。近期，美国和西班牙学者们对年轻至中年期间的成人较高水平血压是如何影响左心室功能进行了研究，结果表明，青年至中年期间25年以上的长期高血压累积暴露与中年时左心室收缩和舒张功能障碍有关性。论文在线发表于《美国心脏病学学会杂志》(简称JACC)。

该研究名为年轻人冠状动脉风险进展研究(CARDIA研究)，基线时前瞻性纳入5115例健康非裔美国人和白人。在25年的评估中，通过二维超声心动检查评估其左心室功能，以斑点超声追踪成像技术详细评估心脏变形情况。以基线至随访25年时的累积血压暴露代表长期血压暴露水平。研究者利用线性和Logistic 回归分析评估受试者自青年至中年期间高血压累积暴露对其左心室功能的影响。

结果显示，在最终的2479例受试者中，血压累积与左心室射血分数无关。然而，收缩压和舒张压的高累积暴露与左心室纵向应变率较低具有相关性(P<0.001)。对于舒张功能，收缩压和舒张压高累积暴露与左心室早期舒张纵向峰值应变率较低具有相关性。值得注意的是，高舒张压与舒张功能障碍的相关性强于高收缩压。

参考文献：Satoru Kishi,et al. J Am Coll Cardiol. 2015;65(25):2679-2687. doi:10.1016/j.jacc.2015.04.042

Original Investigation | June 2015
Cumulative Blood Pressure in Early Adulthood and Cardiac Dysfunction in Middle AgeThe CARDIA Study
Satoru Kishi, MD∗; Gisela Teixido-Tura, MD, PhD†; Hongyan Ning, MD‡; Bharath Ambale Venkatesh, PhD∗; Colin Wu, PhD§; Andre Almeida, MD∗; Eui-Young Choi, MD∗; Ola Gjesdal, MD∗; David R. Jacobs, Jr., PhD‖; Pamela J. Schreiner, PhD‖; Samuel S. Gidding, MD¶; Kiang Liu, PhD‡; João A.C. Lima, MD∗
[+] Author Information
∗ Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
† Department of Cardiology, Hospital Vall d’Hebron, Barcelona, Spain
‡ Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
§ Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
‖ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
¶ Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
J Am Coll Cardiol. 2015;65(25):2679-2687. doi:10.1016/j.jacc.2015.04.042

Abstract
Background Cumulative blood pressure (BP) exposure may adversely influence myocardial function, predisposing individuals to heart failure later in life.
Objectives This study sought to investigate how cumulative exposure to higher BP influences left ventricular (LV) function during young to middle adulthood.
Methods The CARDIA (Coronary Artery Risk Development in Young Adults) study prospectively enrolled 5,115 healthy African Americans and whites in 1985 and 1986 (baseline). At the year 25 examination, LV function was measured by 2-dimensional echocardiography; cardiac deformation was assessed in detail by speckle-tracking echocardiography. We used cumulative exposure of BP through baseline and up to the year 25 examination (millimeters of mercury × year) to represent long-term exposure to BP levels. Linear regression and logistic regression were used to quantify the association of BP measured repeatedly through early adulthood (18 to 30 years of age) up to middle age (43 to 55 years).
Results Among 2,479 participants, cumulative BP measures were not related to LV ejection fraction; however, high cumulative exposure to systolic blood pressure (SBP) and diastolic blood pressure (DBP) were associated with lower longitudinal strain rate (both p < 0.001). For diastolic function, higher cumulative exposures to SBP and DBP were associated with low early diastolic longitudinal peak strain rate. Of note, higher DBP (per SD increment) had a stronger association with diastolic dysfunction compared with SBP.
Conclusions Higher cumulative exposure to BP over 25 years from young adulthood to middle age is associated with incipient LV systolic and diastolic dysfunction in middle age.