Objective: To explore the association between cumulative blood pressure load from childhood to midlife and the risk of arteriosclerosis in midlife. Methods: This study was based on the Hanzhong Children's Hypertension Cohort in Shaanxi Province. Using 36-year longitudinal follow-up data of 4 623 children and adolescents aged 6-18 years enrolled at baseline in 1987, the study period spanned from 1989 to 2023 with 7 follow-up assessments. A total of 1 845 participants were ultimately included in the analysis. Subjects were divided into the arteriosclerosis group and the non-arteriosclerosis group based on whether arteriosclerosis was detected at the final follow-up. Cumulative blood pressure load, including cumulative systolic blood pressure, diastolic blood pressure, and mean arterial pressure loads, was defined as the ratio of the area under the curve of blood pressure exceeding the standard threshold to the total area under the curve. Using the no-load group (cumulative blood pressure load=0) as the reference, participants were further divided into low-, medium-, and high-load groups based on tertiles. Multivariate logistic regression models were used to analyze the association between cumulative blood pressure load and arteriosclerosis. Restricted cubic spline models were applied to fit the dose-response relationship. Stratified analyses were performed by sex, age, smoking status, alcohol consumption, body mass index, and medication history. Results: The enrolled participants aged 49.00 (46.00, 51.00) years, with 1 016 males (55.1%). There were 506 cases (27.4%) in the arteriosclerosis group and 1 339 cases (72.6%) in the non-arteriosclerosis group. Compared with the non-arteriosclerosis group, the arteriosclerosis group had a higher proportion of males (328 (64.8%) vs. 688 (51.4%)), and higher levels of body mass index (25.72 (23.70, 27.78) kg/m2vs. 24.12 (22.26, 26.13) kg/m2), systolic blood pressure (138.17 (127.67, 150.00) mmHg vs. 121.33 (112.33, 132.00) mmHg, 1 mmHg=0.133 kPa), diastolic blood pressure (91.33 (83.67, 99.00) mmHg vs. 80.33 (73.67, 88.00) mmHg), and mean arterial pressure (107.34 (98.44, 115.89) mmHg vs. 94.00 (86.56, 102.11) mmHg) at the final follow-up (all P0.05). Multivariate logistic regression analysis, using the no-load group as the reference, showed that the risk of arteriosclerosis increased sequentially across the low-(OR=1.44, 95%CI: 0.99-2.11), medium-(OR=1.72, 95%CI: 1.15-2.57), and high-load groups of cumulative systolic blood pressure load. The association was stronger for cumulative diastolic blood pressure load (low-load: OR=2.98, 95%CI: 1.82-4.87; medium-load: OR=4.96, 95%CI: 3.05-8.06; high-load: OR=15.39, 95%CI: 9.34-25.37). Cumulative mean arterial pressure load showed a similar increasing trend (low-load: OR=2.31, 95%CI: 1.54-3.47; medium-load: OR=3.90, 95%CI: 2.63-5.80; high-load: OR=12.55, 95%CI: 8.28-19.02). Restricted cubic spline analysis revealed a non-linear positive correlation between all three cumulative blood pressure loads and the risk of midlife arteriosclerosis (all P0.05). Stratified analysis indicated that these associations were consistent across subgroups defined by sex, age, smoking status, alcohol consumption, body mass index, and medication use, with no interaction effects (all Pfor interaction0.05). Conclusion: Cumulative blood pressure load from childhood to midlife is a risk factor for midlife arteriosclerosis, with a clear dose-response relationship. The association is most pronounced for cumulative diastolic blood pressure load. 目的： 探讨儿童期至中年期的累积血压负荷与中年期动脉硬化发生风险的关联。 方法： 本研究依托陕西汉中儿童高血压研究队列，利用1987年（基线）纳入的4 623名6~18岁儿童青少年历时36年的纵向随访数据，研究时段覆盖1989至2023年，期间开展7次随访，最终纳入1 845名研究对象进行分析。根据末次随访是否检出动脉硬化，将受试者分为动脉硬化组和非动脉硬化组。累积血压负荷包括累积收缩压、舒张压及平均动脉压负荷，定义为个体血压超出标准界值的曲线下面积占总曲线下面积的比值。以血压累积负荷值为0的无负荷组为参照，结合三分位数进一步将研究对象分为低负荷组、中负荷组、高负荷组。采用多因素logistic回归模型分析累积血压负荷与动脉硬化的关联，采用限制性立方样条拟合二者剂量-反应关系；按性别、年龄、吸烟史、饮酒史、体重及药物使用史进行分层分析。 结果： 纳入分析的研究对象年龄为49.00（46.00，51.00）岁，男性1 016人（55.1%），动脉硬化组506例（27.4%），无动脉硬化组1 339人（72.6%）。与无动脉硬化组相比，动脉硬化组男性比例较高［328例（64.8%）比688例（51.4%）］，末次随访时的体重指数［25.72（23.70，27.78）kg/m2比24.12（22.26，26.13）kg/m2］、收缩压［138.17（127.67，150.00）mmHg比121.33（112.33，132.00）mmHg，1 mmHg=0.133 kPa］、舒张压［91.33（83.67，99.00）mmHg比80.33（73.67，88.00）mmHg］及平均动脉压［107.34（98.44，115.89）mmHg比94.00（86.56，102.11）mmHg］均较高（P均0.05）。多因素logistic回归模型分析显示，以无血压负荷组为参照：累积收缩压负荷低（OR=1.44，95%CI 0.99~2.11）、中（OR=1.72，95%CI 1.15~2.57）、高（OR=3.17，95%CI 1.98~5.05）负荷组患动脉硬化的风险依次升高；累积舒张压负荷的关联强度更高（低负荷组：OR=2.98，95%CI 1.82~4.87；中负荷组：OR=4.96，95%CI 3.05~8.06；高负荷组：OR=15.39，95%CI 9.34~25.37）；累积平均动脉压负荷呈现相似升高趋势（低负荷组：OR=2.31，95%CI 1.54~3.47；中负荷组：OR=3.90，95%CI 2.63~5.80；高负荷组：OR=12.55，95%CI 8.28~19.02）。限制性立方样条分析显示，三种累积血压负荷均与中年期动脉硬化风险呈非线性正相关（P均0.05）。分层分析提示，上述关联在不同性别、年龄、吸烟史、饮酒史、体重、用药情况等人群中均稳定存在，且组间交互作用差异无统计学意义（P交互均0.05）。 结论： 儿童期至中年期的累积血压负荷是中年期发生动脉硬化的危险因素，二者存在明显的剂量-反应关系，其中累积舒张压负荷的关联效应最为显著。.