Maintaining Normal Blood Pressure Across the Life Course

Abstract

Although mean blood pressure (BP) increases with age, there may be a subset of individuals whose BP does not increase with age. Characterizing the population that maintains normal BP could inform hypertension prevention efforts. We determined the proportion of Jackson Heart Study participants that maintained normal BP at 3 visits over a median of 8 years. Normal BP was defined as systolic BP <120 mm Hg and diastolic BP <80 mm Hg without antihypertensive medication. We identified lifestyle and psychosocial factors associated with maintaining normal BP and calculated the incidence rate for cardiovascular disease (CVD). Overall, 757 of 3432 participants (22.1%) had normal BP at baseline, and 262 of these participants (34.6%) maintained normal BP. Among participants with normal BP at baseline, normal body mass index (risk ratio [RR] 1.37 [95% CI, 1.08–1.75]), ideal physical activity (RR, 1.28 [95% CI, 0.99–1.65]), and never smoking (RR, 1.48 [95% CI, 0.99–2.20]) at baseline were associated with maintaining normal BP. Maintaining normal body mass index (RR, 1.42 [95% CI, 1.10–1.84]) and ideal physical activity (RR, 1.51 [95% CI, 1.18–1.94]) at all study visits were associated with maintaining normal BP. The cardiovascular disease incidence rate was 4.5, 6.3, and 16.4 per 1000 person-years among participants who maintained normal BP, had normal BP at baseline but did not maintain normal BP, and had elevated BP or hypertension at baseline, respectively, over 5.9 years of follow-up. These data suggest that maintaining normal body mass index and ideal physical activity are potential approaches for African American adults to maintain normal BP.