Abstract Body: Introduction: While non-optimal blood pressure (BP) is the most common modifiable risk factor preceding cardiovascular disease (CVD), the cumulative impact of early-life elevated BP on premature CVD and particularly kidney outcomes remains less understood. We hypothesized that higher cumulative BP through young adulthood was associated with higher risks of CVD and kidney events in midlife.

Methods: From the Korean National Health Insurance Service database, we included adults aged 40 years without prior CVD or CKD who had ≥3 health examination records with BP measurement: at age 30 (2002–2004), age 40 (2012–2014), and ≥1 in between (median, 8 visits total). For each participant, cumulative BP was calculated as the area under the serial BP-time curve from age 30 to 40 (mm Hg × years) and analyzed in quintiles or as a continuous variable using linear or restricted cubic spline terms. Outcomes were incident CVD (myocardial infarction, ischemic stroke, heart failure, or cardiovascular death) events, kidney events (incident CKD, kidney replacement therapy, or kidney-related death), and the composite of CVD or kidney events after age 40.

Results: Among the 291,887 participants included, 3,894 CVD events, 2,902 kidney events, and 6,698 composite CVD or kidney events occurred over a median follow-up of 10.2 years after age 40. Cumulative incidence and multivariable-adjusted HRs of all outcomes increased monotonically toward higher quintiles of cumulative SBP and DBP from age 30 to 40 (Figure 1). Each 100 mm Hg × year higher cumulative SBP (e.g., 10 mm Hg higher × 10 years) was associated with 27% (HR, 1.27; 95% CI, 1.23–1.32) higher hazard of CVD events and 22% (HR, 1.22; 95% CI, 1.17-1.28) higher hazard of kidney events. Each 50 mm Hg × year higher cumulative DBP (e.g., 5 mm Hg higher × 10 years) was associated with 20% (HR, 1.20; 95% CI, 1.17–1.23) higher hazard of CVD events and 16% (HR, 1.16; 95% CI, 1.13-1.20) higher hazard of kidney events. All associations showed a log-linear, dose-dependent pattern (Figure 2). The associations were similar by sex and for composite CVD or kidney events and subtypes and remained significant after adjustment for single-visit BP at age 40.

Conclusions: Higher cumulative BP in young adulthood was associated with increased risks of CVD and kidney events in midlife, highlighting the importance of maintaining optimal BP throughout early life.