Background: Central SBP purports to aid hypertension management. This concept is founded on cross-sectional studies; however, findings are mixed and few report longitudinal relationships between changes in blood pressure (BP) and outcomes. This study aimed to determine associations of changes in brachial BP and central BP with changes in left ventricular mass index (LVMi), as an important hypertension-related clinical outcome. Methods: Standard brachial BP and central BP (Vicorder, Skidmore Medical, UK; a type 1 device, using SBP/DBP calibration) were measured at the same time as cardiac MRI for LVMi among adults from the UK Biobank Cohort Study assessed prospectively at two time points (2014+ and 2019+). Analysis was by linear regression adjusted for demographic and clinical characteristics. Results: Data were evaluable for 681 participants (aged 50.1 ± 7.1 years, 54% women) followed over 3.2 ± 1.6 years [mean ± standard deviation (SD)]. Cross-sectional analysis showed the association of brachial SBP with LVMi [ β ± standard error (SE) 3.47 × 10 −2 ± 6.39 × 10 −3 g/m 2.7 /mmHg] and central SBP with LVMi ( β ± SE = 3.52 × 10 −2 ± 6.40 × 10 −3 g/m 2.7 /mmHg) were comparable ( P < 0.001 both). In longitudinal analysis, associations between the changes in BP and changes in LVMi were identical for both central and brachial SBP ( β ± SE = 0.011 ± 0.003 g/m 2.7 /mmHg; P < 0.001 both). Findings were unchanged if participants were stratified by age, LVMi quartile, BP category or central BP phenotype. Conclusion: Changes over time in standard brachial BP provide similar information to central BP on changes over time in LVMi. Whether these findings are generalizable must be further investigated in other cohorts and by other types of central BP devices.

BACKGROUND:Automated blood pressure (BP) devices may be less accurate in females than males, but this requires further investigation. This study aimed to determine sex differences in automated BP, measured with a single brand and model of device, compared with manual BP, with a focus on cuff sizes and associations with measures of adiposity. METHODS:Automated (Omron HEM-907XL) and manual BP were taken sequentially in a random order among a subsample of participants attending the US National Health and Nutrition Examination Survey, 2017 to 2018. Anthropometry and dual-energy x-ray absorptiometry were used to record body size and composition. Analyses, including multivariable regression to determine sex differences in BP, by cuff size, followed complex survey statistical principles. RESULTS:A total of 3735 participants (49.0% female [95% CI, 46.4-51.6], 45 years [43-46]) were included. In females, automated systolic BP (SBP) incrementally underestimated manual SBP across larger cuffs up to extra-large (-6.4 mm Hg [-8.0 to -4.9]). In males, automated SBP underestimated manual SBP only with extra-large cuffs (-2.4 mm Hg [95% CI-3.9 to -0.9]). Underestimation by automated SBP with extra-large cuffs was independently associated with all measures of body size indicative of increased adiposity in both females and males. Hypertension classification from automated and manual SBP had moderate agreement for adult/large cuffs (weighted kappa range 0.66-0.79) but weak agreement for extra-large cuffs (0.55-0.58) for females and males. CONCLUSIONS:The automated device used in this study underestimated manual SBP at larger cuff sizes, which was associated with indices of adiposity. Poorer accuracy of automated BP in larger cuff sizes could contribute to inequitable BP-related health care for females and males and requires further investigation.

Differences between automated cuff oscillometric blood pressure (BP) and invasive measurements are well described, but the causes are not fully understood. Automated BP devices record cuff oscillometric mean arterial pressure (MAP) as a key measurement step that is presumed to be accurate, but if not, could create error in cuff systolic (SBP) and diastolic BP (DBP) estimations. This has never been determined and was the aim of the study. Data from five studies with similar protocols were analysed (N = 262 patients undergoing coronary angiography, 61 ± 11 years, 65% male). Cuff oscillometric MAP was measured using five different models of automated cuff BP devices simultaneous to invasively measured MAP (fluid-filled or solid-state catheters). Cuff SBP and DBP were estimated by device-specific algorithms. Differences (∆) were calculated as cuff–invasive aortic BP. There were significant associations between ∆MAP and ∆SBP in four out of five devices (unstandardised β range = 0.42–1.04). The ∆MAP explained 6–52% of the variance in ∆SBP. In the same four devices, there were significant associations between ∆MAP and ∆DBP (unstandardised β range = 0.57–0.97) and ∆MAP explained 35–52% of the variance in ∆DBP. In conclusion, there are differences between cuff oscillometric MAP and invasive MAP which are associated with ∆SBP and ∆DBP. Further research is required to improve cuff oscillometric BP and greater transparency needed to understand algorithms used in these devices.

High blood pressure (BP) affects >1 billion adults worldwide, with many cases undiagnosed and/or ineffectively controlled. There is a need for complementary approaches to that of in-clinic BP measurement at rest to identify uncontrolled high BP (≥140/90 mmHg). A hypertensive response to exercise (HRE) is associated with increased cardiovascular risk and likely represents poor BP control not detected via standard in-clinic BP at rest. Many clinical exercise professionals measure exercise BP as part of standard practice and are therefore uniquely placed to identify uncontrolled high BP from exercise BP. This statement was developed with the aim of providing exercise professionals with consensus and practical guidance to support best-practice BP management via the measurement of exercise BP. Exercise and Sports Science Australia (ESSA) consensus statement. An international authorship team with research and clinical expertise covering exercise physiology, cardiology, blood pressure, and general practice was assembled to review evidence and develop a series of consensus recommendations. Exercise BP measurement has significant potential to identify individuals with uncontrolled high BP. Exercise BP should be measured using best-practice technique during fixed workload exercise that elicits up to a moderate intensity (e.g., 64 < 76 % maximal heart rate). If an HRE is recorded (exercise systolic BP ≥170 mmHg), uncontrolled high BP should be assumed and trigger: 1) correspondence with a primary care physician (PCP) encouraging follow-up testing to ascertain BP status; 2) guidance for the patient to complete home BP measurement as part of ascertaining BP status and encouragement to report their findings to a PCP; and 3) with PCP confirmation of raised BP, ongoing exercise and lifestyle intervention to lower high BP. This consensus statement provides a recommended clinical pathway for clinical exercise professionals to utilise exercise BP measurement in practice and take a complementary role in the identification and management of high BP.

OBJECTIVE:Uscom BP+ is a cuff-based blood pressure (BP) device designed to noninvasively estimate central BP as distinct from conventional brachial BP. This study aimed to assess the accuracy of the Uscom BP+ device compared with invasively measured BP. METHODS:Automated noninvasive cuff central BP (using the Uscom BP+ device) and invasive central aortic BP were recorded simultaneously in 191 participants (65% male, aged 66 ± 11 years) receiving coronary angiography at three independent research sites in Australia, Poland, and Italy. Validation procedures were undertaken according to the Artery Society recommendations and with a minimally acceptable error (mean ± SD) of ≤5 ± ≤8 mmHg as pass criteria. RESULTS:Using the device default calibration technique [brachial cuff systolic blood pressure (SBP) and diastolic blood pressure (DBP)], cuff central SBP underestimated invasive central SBP [mean (SD) difference: -10.2 (11.2) mmHg] and cuff central DBP overestimated invasive central DBP [mean (SD) difference: 9.8 (8.5) mmHg]. When calibrating by brachial cuff mean arterial pressure and DBP, SBP accuracy was improved, but variability remained high [mean (SD) difference: -6.3 (14.4) mmHg, P  = 0.004 vs. default calibration, whereas DBP accuracy and variability remained similar [mean (SD) difference: 10.9 (8.5) mmHg, P  = 0.19 vs. default calibration]. CONCLUSION:The Uscom BP+ cuff device does not pass the Artery Society accuracy criteria compared with invasively measured central BP.

ImportanceDespite its relevance for pediatric blood pressure (BP) screening, the long-term predictive utility and natural progression of pediatric BP classification remain understudied.ObjectiveTo evaluate BP tracking from childhood to midadulthood using the American Academy of Pediatrics (AAP) thresholds and estimate transition probabilities among BP classifications over time considering multiple time points.Design, Setting, and ParticipantsThe analyses were performed in 2023 using data gathered from September 1980 to August 2018 within the longitudinal Cardiovascular Risk in Young Finns Study. Participants had BP examined 9 times over 38 years, from childhood (aged 6-12 years) or adolescence (15-18 years) to young adulthood (21-27 years), late young adulthood (30-37 years), and midadulthood (39-56 years).ExposuresBP classifications (normal, elevated, hypertension) were based on AAP guidelines for children and adolescents and the 2017 American College of Cardiology/American Heart Association guidelines for adults.Main Outcomes and MeasuresOutcomes were BP classifications at follow-up visits. Tracking coefficients were calculated using generalized estimated equations. Transition probabilities among BP classifications were estimated using multistate Markov models.ResultsThis study included 2918 participants (mean [SD] baseline age, 10.7 [5.0] years; 1553 female [53.2%]). Over 38 years, the tracking coefficient (odds ratio [OR]) for maintaining elevated BP/hypertension was 2.16 (95% CI, 1.95-2.39). Males had a higher probability than females of progressing to and maintaining hypertension and a lower probability of reverting to normal BP from childhood to midadulthood (transition probability: from normal BP to stage 2 hypertension, 0.20; 95% CI, 0.17-0.22 vs 0.08; 95% CI, 0.07-0.10; maintaining stage 2 BP, 0.32; 95% CI, 0.27-0.39 vs 0.14; 95% CI, 0.09-0.21; from stage 2 hypertension to normal BP, 0.23; 95% CI, 0.19-0.26 vs 0.58; 95% CI, 0.52-0.62. For both sexes, the probability of transitioning from adolescent hypertension to normal BP in midadulthood was lower (transition probability, ranging from 0.16; 95% CI, 0.14-0.19 to 0.44; 95% CI, 0.39-0.48) compared with childhood hypertension (transition probability, ranging from 0.23; 95% CI, 0.19-0.26 to 0.63; 95% CI, 0.61-0.66). The probability of maintaining normal BP sharply decreased in the first 5 to 10 years, stabilizing thereafter. Children with normal BP generally maintained this status into adolescence (male: transition probability, 0.64; 95% CI, 0.60-0.67; female: transition probability, 0.81; 95% CI, 0.79-0.84) but decreased by young adulthood (male: transition probability, 0.41; 95% CI, 0.39-0.44; female: transition probability, 0.69; 95% CI, 0.67-0.71).Conclusion and RelevanceResults of this cohort study reveal an enduring association of childhood and adolescent BP (AAP thresholds) with later BP. Although childhood normal BP tends to be maintained into adolescence, the probability of reverting to and sustaining normal BP decreases notably from adolescence to young adulthood. The findings of this study underscore the importance of prevention to maintain normal BP starting in childhood, suggesting adolescence as a potential critical period. The results suggest the potential for less frequent screenings for children with initially normal BP.

Hypertension is the most common problem managed in Australian general practice, yet most adults with hypertension do not have their blood pressure (BP) treated to target. Hypertension diagnosis and management rely upon accurate BP measurements performed using a standardised protocol. However, health system barriers prevent doctors from following measurement protocols, leading to inaccurate BP assessments. A practical BP measurement protocol that can be widely implemented is urgently warranted. Automated office BP (AOBP) is the recommended measurement standard for the diagnosis and management of hypertension. AOBP involves using a validated automated upper-arm cuff BP device programmed to record multiple BP readings at set intervals starting after a rest period. It is done by a trained operator using a standardised protocol in a quiet setting with the correct patient setup, no distractions, and in the absence of a doctor. The device automatically calculates the average of the AOBP recordings and this is comparable to the 24-h ambulatory BP daytime mean. The hypertension threshold based on AOBP is 135/85 mmHg. AOBP can also be applied in other community settings (e.g. pharmacies), provided all the above criteria are met along with communication of results to the person's usual general practitioner. In Australia, nation-wide systematic implementation of evidence based AOBP measurement is strongly recommended. This standardised approach will support healthcare professionals, especially general practitioners, in obtaining high-quality BP values with increasing confidence in clinical decision-making. Policy and practice changes, to address barriers and provide enabling mechanisms for sustained implementation of AOBP, are required.

BACKGROUND:Rapid access chest pain clinics (RACPCs) are outpatient cardiac services designed to promptly assess and manage patients experiencing chest pain. Despite the establishment of 25 RACPCs across Australia, a standardised implementation framework has yet to be developed. This study aimed to identify the core components of successful delivery of an existing RACPC. METHOD:A qualitative process assessment study was conducted at an RACPC in a metropolitan, tertiary hospital in Tasmania, Australia from November 2022 to July 2023. Clinical observations and semi-structured interviews were conducted with seven RACPC clinicians. Deductive data analysis was undertaken according to a Context-Mechanism-Outcome framework. RESULTS:Core components of successful RACPC delivery included (1) a multidisciplinary team-based approach to care with discreet clinical roles, (2) timely patient review by RACPC clinicians within 30 days of referral, (3) embedded patient education, (4) ongoing clinical team training and education, and (5) a shared understanding of the RACPC service's identity and purpose. Challenges to RACPC delivery were also identified and included resource constraints and administrative burdens. CONCLUSIONS:Successful delivery of an RACPC model of care relies on a range of interrelated factors. These findings align with the broader theme of ongoing health service assessment as a driver for continuous quality improvement and care standards within RACPCs. Further research aimed at developing and implementing effective strategies to enhance service delivery is needed to determine a national model of care.

Kiosk devices for unsupervised self-measurement of blood pressure (BP) are being used in public spaces and healthcare settings in several countries. This statement by the European Society of Hypertension (ESH) Working Group on BP Monitoring and Cardiovascular Variability provides a review of the published evidence on kiosk BP devices and consensus recommendations for their requirements and clinical use. A systematic literature search identified 54 relevant studies. Kiosk BP measurements appeared to be close to office BP [mean difference systolic 0.2 mmHg (95% confidence intervals -1.3 to 1.8); diastolic -0.4 mmHg (-3.5 to 2.7)], and higher than daytime ambulatory and home BP [mean difference 6.0 mmHg (1.6-10.4)/5.0 (2-8) and 8.1 mmHg (-2.6 to 18.9)/0.2 (-9.6 to 10.0), respectively]. Randomized or observational studies using kiosk BP measurements for hypertension screening or for assessing hypertension control were also included, as well as studies investigating users' and healthcare professionals' opinions, acceptability, and perspectives regarding kiosk BP measurements, and validation studies of kiosk BP devices. These studies had considerable heterogeneity in design, setting, methodology, measurement protocol, and sample size. Thus, at present, the clinical utility of kiosk BP measurements is uncertain. This ESH consensus statement acknowledges the potential of kiosk BP measurement as an emerging method for unsupervised self-measurement in the context of opportunistic screening for hypertension in apparently healthy people and the long-term monitoring of people with diagnosed hypertension. Requirements for the design, validation, function, and use of kiosk BP monitors are provided, together with the pending research questions on their optimal implementation in clinical practice.

Abstract Objective To evaluate the impact of absolute cardiovascular risk counselling on quality-of-life indices within a chest pain clinic. Data sources and study setting Primary data was collected at the Royal Hobart Hospital, Australia, between 2014 and 2020. Study design Patients attending an Australian chest pain clinic were randomised into a prospective, open-label, blinded-endpoint study over a minimum 12-months follow-up. Data collection / extraction methods The SF-36 questionnaire was completed at baseline/follow-up and SF-6D multi-attribute utility instrument’s health state utilities (HSU) were generated using SF-36 responses and the SF-6D’s Australian tariff. SF-6D minimal important difference was 0.04 points. Absolute cardiovascular risk was also stratified into high/intermediate/low-risk categories for exploratory analysis of summary HSUs and dimensional scores. ANZCTR registration number 12617000615381 (registered 28/4/17). Principal findings Of n = 189 patients enrolled, HSUs were generated for 96% at baseline (intervention n = 93, usual care n = 88) and 61% at follow-up. There were no statistical differences in age, sex, absolute cardiovascular risk or mean HSU between groups at baseline. Summary HSUs improved more for the intervention group and the median between-group difference exceeded the minimal important difference threshold (intervention 0.16 utility points, control 0.10 utility points). For Intervention patients with high absolute risk (≥ 15%), HSU did not significantly change. Conclusions Absolute cardiovascular risk counselling in a chest pain clinic yielded clinically meaningful improvement in health-related quality of life.

BACKGROUND:Systolic blood pressure (SBP) amplification is a physiological phenomenon related to the level of pressure difference between the aorta and brachial artery and is associated with cuff blood pressure (BP) measurement inaccuracy. However, knowledge on the invasively measured level of aortic-to-brachial SBP amplification is limited. This study aimed to explore this, as well as anticipated effects on hypertension classification. METHODS:A systematic review and individual participant data meta-analysis identified invasive brachial and aortic BP recorded in 1151 participants (62±12 years, 72% male). SBP amplification was calculated as brachial SBP minus aortic SBP. Hypertension classification (defined according to previously described thresholds for brachial and aortic BP) was compared between the aortic and brachial BP measures. RESULTS:There was a wide range of SBP amplification, which was similar between male and female (mean±SD, 8±9 mm Hg and 7±10 mm Hg, respectively) and decreased with increasing age. High SBP amplification (>15 mm Hg) was observed in 17.4% (male, 16.8% versus female, 19.5%; P=0.44), and low SBP amplification (<5 mm Hg) in 37.3% of participants (male, 37.2% versus female, 37.4%; P=0.95). The overall level of agreement between hypertension classification based on brachial and aortic BP was moderate (κ, 0.67; P<0.001; agreement, 87.4%). Agreement in hypertension classification was 65.0%, 38.1%, and 92.7% across classifications of optimal, prehypertension, and hypertension, respectively. CONCLUSIONS:In males and females there is wide variability in aortic-to-brachial SBP amplification. There were major theoretical differences in hypertension classification based on brachial versus aortic BP. This knowledge may help toward innovations for improving cuff BP measurement accuracy.

Exaggerated systolic blood pressure (SBP) during submaximal exercise is associated with increased cardiovascular (CV) risk. However, findings are mixed and new evidence indicates that cardiorespiratory fitness should be considered for proper clinical interpretation of exercise SBP responses. This study aimed to determine the relationship between exercise SBP during submaximal effort corrected and uncorrected for fitness, as well as at peak effort and abnormalities of cardiac structure and function. Each of 231 participants with controlled BP (with or without previously diagnosed hypertension), no evidence for ischemic or valvular heart disease, or heart failure underwent cardiopulmonary exercise testing and resting and exercise echocardiography. Submaximal exercise SBP (measured at the 2nd stage of Bruce protocol) and peak exercise SBP was corrected for peak VO2. Associations with TOD – target organ damage (left ventricular [LV] mass, relative wall thickness, diastolic function, LV exercise reserve) were stronger for fitness-corrected than uncorrected exercise SBP. There was a progressive deterioration of cardiac function and structure parameters across the submaximal exercise SBP/peak VO2 tertiles. Multivariable models demonstrated that fitness-corrected SBP was more closely associated with LV hypertrophy and diastolic dysfunction than uncorrected SBP, and ROC analysis revealed better performance of fitness-corrected SBP than uncorrected SBP (AUC 0.792 vs. 0.627, and 0.808 vs. 0.662, both p < 0.001, for LV hypertrophy and diastolic dysfunction, respectively). Fitness-corrected SBP responses to submaximal exercise can identify more profound target organ damage with respect to cardiac function and structure even among patients with controlled clinic BP. Exaggerated BP response to exercise must be considered relative to fitness for proper clinical interpretation of BP responses to exercise testing.

BACKGROUND:Familial hypercholesterolemia (FH) is an under-recognised but common genetic condition resulting in elevated levels of low-density lipoprotein cholesterol (LDL-C) and a high risk of premature coronary disease. The prevalence of FH among younger patients undergoing coronary bypass surgery is unknown, as is their post-surgical prognosis. METHOD:This was a retrospective analysis of younger patients (aged <60 years) undergoing coronary bypass surgery at an Australian tertiary hospital between 2008 and 2022. A Dutch Lipid Clinical Network Score was calculated to determine the presence of underlying FH for each patient. Outcomes were FH prevalence, pre-surgical attainment of guideline-based secondary prevention LDL-C targets and post-surgical major adverse cardiovascular events. RESULTS:Overall, 590 eligible patients (mean age 53.7 years, 85.6% male) were followed over a median of 7.9 years (interquartile range 4.7-12.1). Eighty (80; 13.6%) patients were categorised as 'FH', 249 (42.2%) 'possible FH' and 261 (44.2%) 'non-FH'. Compared to the non-FH group, patients with FH were less likely to achieve target LDL-C <1.8 mmol/L (15 [18.8%] vs 119 [45.6%]; p<0.001) and had higher rates of adverse cardiovascular events in the years following surgery (adjusted odds ratio 2.52; 95% confidence interval 1.0-6.4; p<0.001). CONCLUSIONS:FH is highly prevalent among younger patients undergoing coronary bypass surgery. These patients are less likely to achieve adequate LDL reduction and are at higher risk of further adverse events. Detection and appropriate treatment of FH prior to bypass surgery should be a clinical priority.

Background:HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative, aimed at helping countries enhance hypertension and cardiovascular disease (CVD) risk management in primary care settings. Its core implementation tool, the HEARTS Clinical Pathway, has been adopted by 28 countries. To improve the care of hypertension, diabetes, and chronic kidney disease (CKD), HEARTS 2.0 was developed as a three-phase process to integrate evidence-based interventions into a unified care pathway, ensuring consistency across fragmented guidelines. This paper focuses on Phase 1, highlighting targeted interventions to improve and update the HEARTS Clinical Pathway. Methods:First, the coordinating group defined the project's scope, objectives, principles, methodological framework, and tools. Second, international experts from different disciplines proposed interventions to enhance the HEARTS Clinical Pathway. Third, the coordinating group harmonized these proposals into unique interventions. Fourth, experts appraised the appropriateness of the proposed interventions on a 1-to-9 scale using the adapted RAND/UCLA Appropriateness Method. Finally, interventions with a median score above 6 were deemed appropriate and selected as candidates to enhance the HEARTS Clinical Pathway. Results:Building on the existing HEARTS Clinical Pathway, 45 unique interventions were selected, including community-based screening, early detection and management of risk factors, lower blood pressure thresholds for diagnosing hypertension in high-CVD-risk patients, reinforcement of single-pill combination therapy, inclusion of sodium-glucose cotransporter-2 inhibitors for patients with diabetes, CKD, or heart failure, expanded roles for non-physician health workers in team-based care, and strengthened clinical documentation, monitoring, and evaluation. Conclusion:HEARTS 2.0 Phase 1 identifies key interventions to integrate and improve hypertension and cardiovascular-kidney-metabolic care within primary care, enabling their seamless incorporation into a unified and effective clinical pathway. This process will inform an update to the HEARTS Clinical Pathway, optimizing resources, reducing care fragmentation, improving care delivery, and advancing health equity, thereby supporting global efforts to combat the leading causes of death and disability.

OBJECTIVES:High blood pressure (BP) affects >1 billion adults worldwide, with many cases undiagnosed and/or ineffectively controlled. There is a need for complementary approaches to that of in-clinic BP measurement at rest to identify uncontrolled high BP (≥140/90 mmHg). A hypertensive response to exercise (HRE) is associated with increased cardiovascular risk and likely represents poor BP control not detected via standard in-clinic BP at rest. Many clinical exercise professionals measure exercise BP as part of standard practice and are therefore uniquely placed to identify uncontrolled high BP from exercise BP. This statement was developed with the aim of providing exercise professionals with consensus and practical guidance to support best-practice BP management via the measurement of exercise BP. DESIGN:Exercise and Sports Science Australia (ESSA) consensus statement. METHODS:An international authorship team with research and clinical expertise covering exercise physiology, cardiology, blood pressure, and general practice was assembled to review evidence and develop a series of consensus recommendations. RESULTS:Exercise BP measurement has significant potential to identify individuals with uncontrolled high BP. Exercise BP should be measured using best-practice technique during fixed workload exercise that elicits up to a moderate intensity (e.g., 64 < 76 % maximal heart rate). If an HRE is recorded (exercise systolic BP ≥170 mmHg), uncontrolled high BP should be assumed and trigger: 1) correspondence with a primary care physician (PCP) encouraging follow-up testing to ascertain BP status; 2) guidance for the patient to complete home BP measurement as part of ascertaining BP status and encouragement to report their findings to a PCP; and 3) with PCP confirmation of raised BP, ongoing exercise and lifestyle intervention to lower high BP. CONCLUSIONS:This consensus statement provides a recommended clinical pathway for clinical exercise professionals to utilise exercise BP measurement in practice and take a complementary role in the identification and management of high BP.

Importance:Although cardiovascular disease (CVD) begins in early life, the extent to which blood pressure (BP) at different life stages contributes to CVD is unclear. Objective:To determine the relative contribution of BP at different life stages across the early-life course from infancy to young adulthood with carotid intima-media thickness (IMT). Design, setting, and participants:The analyses were performed in 2022 using data gathered from July 1989 through January 2018 within the Special Turku Coronary Risk Factor Intervention Project, a randomized, infancy-onset cohort of 534 participants coupled with annual BP (from age 7 months to 20 years), biennial IMT measurements (from ages 13 to 19 years), who were followed up with again at age 26 years. Exposures:BP measured from infancy (aged 7 to 13 months), preschool (2 to 5 years), childhood (6 to 12 years), adolescence (13 to 17 years), and young adulthood (18 to 26 years). Main outcomes and measures:Primary outcomes were carotid IMT measured in young adulthood at age 26 years. Bayesian relevant life-course exposure models assessed the relative contribution of BP at each life stage. Results:Systolic BP at each life stage contributed to the association with young adulthood carotid IMT (infancy: relative weight, 25.3%; 95% credible interval [CrI], 3.6-45.8; preschool childhood: relative weight, 27.0%; 95% CrI, 3.3-57.1; childhood: relative weight, 18.0%; 95% CrI, 0.5-40.0; adolescence: relative weight, 13.5%; 95% CrI, 0.4-37.1; and young adulthood: relative weight, 16.2%; 95% CrI, 1.6-46.1). A 1-SD (at single life-stage) higher systolic BP accumulated across the life course was associated with a higher carotid IMT (0.02 mm; 95% CrI, 0.01-0.03). The findings for carotid IMT were replicated in the Cardiovascular Risk in Young Finns Study that assessed systolic BP from childhood and carotid IMT in adulthood (33 to 45 years). Conclusion and relevance:In this cohort study, a life-course approach indicated that accumulation of risk exposure to BP levels at all life stages contributed to adulthood carotid IMT. Of those, the contribution attributed to each observed life stage was approximately equal. These results support prevention efforts that achieve and maintain normal BP levels across the life course, starting in infancy.

ObjectivesLow health literacy is associated with worse health outcomes, including for cardiovascular disease (CVD). However, general practitioners (GPs) have limited support to identify and address patient health literacy needs in CVD prevention consultations. This study explored GPs’ experiences of patient health literacy needs during CVD risk assessment and management consultations.MethodsSemi-structured interviews with 18 GPs in Tasmania, Australia in 2021. A Framework Analysis approach was used to code transcripts to a thematic framework.ResultsGPs perceptions on patient health literacy informed three themes: 1. Methods of estimating health literacy; 2. GPs’ perceptions about the impact of health literacy on CVD prevention including risk factor knowledge and behaviours; and 3. Strategies for communicating with patients experiencing health literacy challenges. The findings show that while no formal tools were used to assess health literacy in this sample, perceived health literacy can change GPs’ communication and prevention strategies.ConclusionThe findings raise concerns about the equity of choices made available to patients, based on subjective perceptions of their health literacy level.Practice implicationGPs could be better supported to assess and address patient health literacy needs in CVD prevention consultations.