Srinivasan Sathanur R, Myers Leann, Berenson Gerald S
Tulane Center for Cardiovascular Health and Departments of Epidemiology, Tulane University Health Sciences Center, New Orleans, La 70112, USA.
Hypertension. 2006 Jul;48(1):33-9. doi: 10.1161/01.HYP.0000226410.11198.f4. Epub 2006 Jun 12.
That essential hypertension is associated with metabolic syndrome is known. However, information is scant regarding the course of development of adverse levels of blood pressure and other risk variables of metabolic syndrome in youth at risk for developing hypertension. This aspect was studied, retrospectively, in a community-based cohort of normotensive (n=2206), prehypertensive (n=721), and hypertensive (n=328) subjects examined serially during childhood (4 to 11 years), adolescence (12 to 18 years), and adulthood (19 to 42 years). Prehypertensive subjects versus normotensive subjects had significantly higher body mass index and subscapular skinfold, systolic (SBP) and diastolic (DBP) blood pressures, and triglycerides beginning in childhood; higher glucose in adolescence; and higher low-density lipoprotein cholesterol, fasting insulin, and insulin resistance index in adulthood. Hypertensive subjects versus normotensive subjects had higher adiposity measures, SBP and DBP, glucose, and triglycerides beginning in childhood; higher insulin and insulin resistant index in childhood and adulthood; and lower high-density lipoprotein, cholesterol in adulthood. Most of these variables progressed adversely at an increased rate in prehypertensive and hypertensive subjects. In a multivariate analysis, adverse changes in adiposity, SBP, and DBP were independently associated with prehypertensive status; and adverse changes in adiposity, SBP and DBP, insulin resistant index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides with hypertension status. As young adults, prehypertensive and hypertensive subjects showed significantly higher prevalence of obesity, hyperinsulinemia, hyperglycemia, and dyslipidemias. Thus, excess adiposity and blood pressure beginning in childhood and accelerated adverse longitudinal changes in risk variables of metabolic syndrome through young adulthood characterize the early natural history of hypertension.
已知原发性高血压与代谢综合征相关。然而，关于有高血压风险的年轻人中血压不良水平及代谢综合征其他风险变量的发展过程，相关信息却很少。本研究对一个基于社区的队列进行了回顾性分析，该队列包括血压正常（n = 2206）、高血压前期（n = 721）和高血压（n = 328）的受试者，他们在童年期（4至11岁）、青春期（12至18岁）和成年期（19至42岁）接受了连续检查。高血压前期受试者与血压正常受试者相比，从童年期开始就有显著更高的体重指数和肩胛下皮褶厚度、收缩压（SBP）和舒张压（DBP）以及甘油三酯；青春期血糖更高；成年期低密度脂蛋白胆固醇、空腹胰岛素和胰岛素抵抗指数更高。高血压受试者与血压正常受试者相比，从童年期开始就有更高的肥胖指标、SBP和DBP、血糖和甘油三酯；童年期和成年期胰岛素和胰岛素抵抗指数更高；成年期高密度脂蛋白胆固醇更低。在高血压前期和高血压受试者中，这些变量中的大多数以更快的速度出现不良进展。在多变量分析中，肥胖、SBP和DBP的不良变化与高血压前期状态独立相关；而肥胖、SBP和DBP、胰岛素抵抗指数、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和甘油三酯的不良变化与高血压状态相关。作为年轻成年人，高血压前期和高血压受试者的肥胖、高胰岛素血症、高血糖和血脂异常的患病率显著更高。因此，童年期开始的肥胖和血压过高以及直到年轻成年期代谢综合征风险变量的加速不良纵向变化，是高血压早期自然病程的特征。
