Sex-specific associations between blood pressure in early midlife and arterial stiffness 27 years later: The Hordaland Health Study

Ester Kringeland; Helga Midtbø; Annabel Eide Ohldieck; Arleen Aune; Eva Gerdts

doi:10.1093/eurjpc/zwaf379

Sex-specific associations between blood pressure in early midlife and arterial stiffness 27 years later: The Hordaland Health Study

Eur J Prev Cardiol. 2025 Jun 28:zwaf379. doi: 10.1093/eurjpc/zwaf379. Online ahead of print.

Authors

Ester Kringeland¹, Helga Midtbø^{1

2}, Annabel Eide Ohldieck^{1

2}, Arleen Aune³, Eva Gerdts^{2

1}

Affiliations

¹ Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
² Department of Clinical Science, University of Bergen, Bergen, Norway.
³ Department of Medicine, Haukeland University Hospital, Bergen, Norway.

PMID: 40578832
DOI: 10.1093/eurjpc/zwaf379

Abstract

Background and aims: Little is known about sex-specific associations between elevated blood pressure (BP) in early midlife and presence of increased arterial stiffness later in life.

Methods: BP was measured in 1,127 women and 938 men, mean age 42 years (baseline), and categorized as non-elevated BP (<120/70mmHg), elevated BP (120-139/70-89mmHg) and hypertension (≥140/90mmHg). Increased arterial stiffness was identified as carotid-femoral pulse wave velocity (cf-PWV) >10 m/s. Associations between BP at baseline with increased arterial stiffness 27 years later were assessed in logistic regression analysis adjusted for baseline body mass index, diabetes, smoking, heart rate, lipids, age and education, and reported as odds ratios (OR) and 95% confidence intervals (CI).

Results: At baseline, 62% of women and 67% of men had elevated BP and 9% of women vs 26% of men had hypertension (p<0.001). At follow-up, 17% of women and 31% of men had increased arterial stiffness (p<0.001). In adjusted analysis, having elevated BP or hypertension at baseline as compared to non-elevated BP were both associated with increased arterial stiffness 27 years later in women (OR 2.78 [95% CI 1.74-4.42] and OR 4.62 [95% CI 2.48-8.58]), but not in men (OR 1.10 [95% CI 0.58-2.10] and OR 1.33 [95% CI 0.67-2.66]), p for sex-interaction 0.01.

Conclusions: In the Hordaland Health Study, having elevated BP or hypertension in early midlife were associated with increased arterial stiffness 27 years later in women, but not in men. These findings underscore the importance of managing BP in early midlife for optimal CVD prevention in women.

Keywords: Hypertension; arterial stiffness; blood pressure; cardiovascular disease; organ damage; women.

Plain language summary

This study tested whether the association of blood pressure (BP) in early midlife with arterial stiffening at older age differ between women and men.We tested sex-specific associations between BP categories (non-elevated if BP<120/70 mmHg, elevated if BP 120-139/70-89 mmHg, hypertension if BP≥140/90 mmHg) in early midlife and presence of increased arterial stiffness 27 years later.Women with elevated BP in midlife had twice the risk, and those with hypertension had four times the risk of increased arterial stiffness compared to women with non-elevated BP, while this association was not found in men.