Abstract Body: Introduction Cardiovascular disease (CVD) risk differs across Asian subgroups possibly due to differences in hypertension burden. We characterized lifetime blood pressure (BP) trajectories for East and South Asian individuals and compared their age-specific associations with lifetime CVD risk.

Methods Using UK Biobank primary care data, we identified 148,872 individuals with BP measurements since age 18 years. For each sex and self-identified ethnicity, life course BP trajectories were fitted as a function of age. We determined associations of time-averaged young adulthood (age 18-39), middle-age (age 40-64), and later-life (age ≥65) systolic BP (SBP) and diastolic BP (DBP) with incident atherosclerotic CVD risk using sex and antihypertensive-adjusted logistic regression.

Results Of 148,872 UK adults (54% women), 376 (0.3%) identified as East Asian, 3077 (2.1%) as South Asian, 143,575 (96.4%) as White European, and 1844 (1.2%) as African or Black. The predicted SBP/DBP [95% CI] at age 30 years was 108 [103-114] / 68 [65-71] mmHg for East Asian and 114 [110-118] / 72 [71-73] mmHg for South Asian individuals. By age 40, South Asian individuals were projected to reach SBP of 130.0 mmHg, whereas East Asian individuals reached the equivalent SBP by age 49. Among South Asian individuals, each standard deviation increase in young adulthood SBP associated with a higher atherosclerotic CVD risk with an odds ratio (OR) [95% CI] of 1.41 [1.12-1.75] but not among East Asians (P_interaction=0.01). Midlife SBP associated with peripheral artery disease among South Asian individuals (OR [95% CI]: 2.08 [1.51-2.88]), and with ischemic stroke among East Asian individuals (3.84 [1.08-5.07]). Later-life SBP associated with myocardial infarction risk by 1.52 [1.15-1.92]-fold among South Asian and ischemic stroke by 2.50 [1.06-3.80]-fold among East Asian individuals.

Conclusions East and South Asian individuals exhibit distinct BP trajectories that age-differentially associate with incident CVD. Disaggregating Asian subgroups may inform tailored hypertension screening and management.