Supplementary information files for "Higher life-course blood pressure associates with reduced myocardial perfusion in older age: Insights from MyoFit46"

Supplementary files for article "Higher life-course blood pressure associates with reduced myocardial perfusion in older age: Insights from MyoFit46"<br><br><b>BACKGROUND:</b> 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 (sMBFN) and perfusion reserve by cardiovascular magnetic resonance.<br><b>METHODS:</b> MyoFit46 (URL: https://www.clinicaltrials.gov; Unique identifier: NCT05455125) prospectively recruited ≈500 National Survey of Health and Development 1946 birth cohort participants aged ≈77 years to undergo stress perfusion and late gadolinium enhancement cardiovascular magnetic resonance. Systolic (SBPs) and diastolic BPs (DBPs) were recorded at 36, 43, 53, 63, 69, and 77 years. For each participant, annual rates of BP change (steepness) and area under the BP trajectory curve (cumulative burden) were derived using mixed-effects models. BP cardiovascular magnetic resonance perfusion associations were tested using generalized models, adjusted for antihypertensive use, demographics, lifestyle, and comorbidities. Cross-sectional associations between major adverse cardiovascular events (myocardial infarction, stroke, and heart failure) were also tested. Mediation analyses explored mechanistic pathways.<b>RESULTS</b>: Among 459 participants, each 10 mm Hg higher SBP at 36 to 69 years was associated with 3% to 6% lower sMBFN at 77 years. At 43 to 63 years, as SBPs rose from 120 to 140 mm Hg, sMBFN was 18% to 24% lower. Having a sustained higher SBP by 10 mm Hg from 36 to 77 years was associated with 11% (95% CI, 8–14) lower sMBFN. Each 1 mm Hg/y steeper SBP rise during age intervals 36 to 43, 43 to 53, 53 to 63, and 63 to 69 is associated with 2% to 5% lower sMBFN at 77 years, association not conditional on baseline or final BPs in each interval. Associations may be clinically relevant as each 1% lower sMBFN is associated with 3% higher major adverse cardiovascular event odds. sMBFN mediated 20% to 40% of the life-course SBPs late gadolinium enhancement associations. Results were similar for diastolic BP, myocardial perfusion reserve, or sMBF.<b>CONCLUSIONS:</b> Higher life-course BPs, steeper increases, and greater cumulative burden associate with lower myocardial perfusion at 77 years, which can be linked with higher major adverse cardiovascular event odds and fibrosis burden. This underscores the importance of early life screening and guiding treatment based on BP trajectories.© The Author(s), CC BY 4.0