Aims: This study examined the associations between decade-long cumulative blood pressure (BP) exposure and global/regional myocardial structure and function independent of current BP levels.
Methods and results: We analysed 3015 adults (aged 69.0 ± 9.2 years) from the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent cardiac magnetic resonance (CMR) imaging at Year 10 (Exam 5, 2010-12). Measures included left ventricular (LV) parameters, global/regional myocardial function via tagged CMR, interstitial myocardial fibrosis via T1-mapping measures (native T1 and extracellular volume fraction), and myocardial scar via late gadolinium enhancement. We used cumulative exposure to BP through baseline and up to Exam 5 (millimetres of mercury × year) to represent long-term exposure to BP levels. Linear regression, logistic regression, and generalized additive models were used to quantify the association of cumulative BP parameters with measures of cardiac structure and function. Higher cumulative systolic BP (SBP), independent of current SBP, correlated with increased LV mass index [1.93 g/m2 per standard deviation (SD)], worse global/regional circumferential strain (0.24-0.38% lower absolute values per SD), and greater myocardial scar risk [odds ratio (OR): 1.36, 95% confidence interval (CI): 1.02-1.82 per SD]. Cumulative diastolic BP (DBP) was associated with circumferential strain, showing nearly J-shaped relationships after adjusting for current DBP (all P < 0.05). In non-hypertensive individuals with BP consistently below the hypertension threshold, cumulative SBP remained significantly associated with LV mass index and strain but not myocardial scar (OR: 1.53, 95% CI: 0.82-2.87, P = 0.19).
Conclusion: Higher cumulative BP was associated with worse global and regional cardiac structure/function and myocardial scar, independent of a single BP at the time of imaging, and was still observed to some extent in non-hypertensive individuals who consistently maintained BP levels below the hypertension threshold.
Keywords: Blood pressure; Cardiac magnetic resonance imaging; Cardiac structure and function; Multi-Ethnic Study of Atherosclerosis.
We provided a detailed description of the relationship between decade-long cumulative blood pressure (BP) exposure and cardiac magnetic resonance (CMR)-measured global and regional cardiac structure and function. The research included 3015 adults with a mean age of 69 years from the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent CMR imaging in 2010–12.Greater 10-year exposure to systolic BP (SBP) was linearly associated with increased left ventricular mass index, worse global and regional circumferential strain (ECC), and replacement fibrosis as assessed with late gadolinium enhancement. Even in non-hypertensive participants, cumulative SBP remained significantly linked to adverse cardiac remodelling and impaired systolic function.Higher cumulative diastolic BP was linked to worse ECC measures, showing nearly J-shaped relationships after adjusting for current BP levels. In conclusion, long-term cumulative exposure to elevated BP has a significant impact on myocardial structure and function, independent of current BP levels.
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.