Life-course blood pressure linked to myocardial fibrosis in older age

The prospective MyoFit46 study recruited participants from a 1946 birth cohort for cardiovascular magnetic resonance imaging at age 77. Among 472 participants (54% male), investigators assessed left ventricular late gadolinium enhancement (LGE), a measure of focal myocardial fibrosis, and analyzed systolic and diastolic blood pressure recorded at ages 36, 43, 53, 63, 69, and 77. Models accounted for antihypertensive treatment, demographics, lifestyle, and comorbidities.

Using the 3-SD method to quantify LGE, each 10 mm Hg higher systolic pressure at ages 36 to 69 was associated with 6% to 11% greater LGE. A sustained 10 mm Hg higher systolic pressure across age intervals from 36 to 69 was associated with 16% to 24% greater LGE, independently of systolic pressure at age 77. Steeper systolic pressure increases from ages 36 to 63 were also associated with greater LGE. LGE presence was associated with incident major adverse cardiovascular events (hazard ratio 2.5; 95% CI, 1.2–5.2); 29 events were recorded.

The findings link earlier-adult blood pressure patterns with later-life cardiac imaging findings, but do not establish causation or show that trajectory-based management improves outcomes. The single birth cohort and small number of cardiovascular events limit interpretation; the authors say these measures warrant further investigation as tools for guiding blood pressure management.