# Impact of Blood Pressure Across the Life Course on Arterial Stiffness in Midlife: The Mediating Role of Metabolic Factors

## TL;DR

High blood pressure from childhood to adulthood increases arterial stiffness in midlife, with adult BP having the strongest impact, partly explained by metabolic factors like insulin resistance.

## Contribution

This study identifies the long-term impact of blood pressure across life stages on arterial stiffness and reveals the mediating role of metabolic factors, particularly in males.

## Key findings

- Elevated blood pressure in adulthood shows the strongest association with arterial stiffness in midlife.
- The triglyceride–glucose index partially mediates the relationship between adult BP and arterial stiffness.
- The detrimental effects of BP on arterial stiffness begin in childhood and intensify over time.

## Abstract

Childhood blood pressure (BP) is associated with increased arterial stiffness later in life. This study aimed to investigate the contributions of BP across different life stages to midlife arterial stiffness and the mediating role of metabolic factors. Using data from the Hanzhong Adolescent Hypertension Study, 1448 participants aged 6–18 years at baseline were prospectively followed for 30 years into adulthood. We used linear regression models to examine the associations between BP at different life stages and brachial‐ankle pulse wave velocity (baPWV). In addition, parallel multiple mediation analyses were conducted to evaluate the mediating roles of blood glucose and lipid metabolism in these associations. Significant associations between BP and adult baPWV were observed across childhood, adulthood, and cumulative long‐term BP burden, with BP in adulthood showing the strongest association. Additionally, the triglyceride–glucose index was identified as a mediator in the relationship between adult BP and midlife baPWV, with the mediation effects more pronounced among males. Our findings suggest that the detrimental impact of elevated BP on arterial stiffness begins early in life and intensifies over the lifespan, particularly during adulthood. Furthermore, the association between adult BP and arterial stiffness appears to be partially mediated by insulin resistance.

This 30‐year cohort study demonstrates that elevated blood pressure (BP) since childhood contributes to arterial stiffness in midlife, with adult BP showing the strongest association. The triglyceride–glucose index partially mediates this relationship, especially in males. These findings highlight the importance of early BP control and metabolic health management to reduce the long‐term burden of arterial stiffness and associated cardiovascular risk.