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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\u201318 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\u2010ankle 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\u2010term BP burden, with BP in adulthood showing the strongest association. Additionally, the triglyceride\u2013glucose 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.<\/jats:p>","DOI":"10.1002\/mco2.70440","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T06:58:43Z","timestamp":1761202723000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of Blood Pressure Across the Life Course on Arterial Stiffness in Midlife: The Mediating Role of Metabolic Factors"],"prefix":"10.1002","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7717-5031","authenticated-orcid":false,"given":"Yang","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine First Affiliated Hospital of Xi'an Jiaotong University  Xi'an China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shi\u2010Qi","family":"Liu","sequence":"additional","affiliation":[{"name":"Clinical Research Center the Third Xiangya Hospital, Central South University  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