Munakata Masanori, Nunokawa Tohru, Yoshinaga Kaoru, Toyota Takayoshi
Preventive Medical Center, Tohoku Rosai Hospital, Sendai, Japan.
Hypertens Res. 2006 Jul;29(7):515-21. doi: 10.1291/hypres.29.515.
Brachial-ankle pulse wave velocity is a new measure of arterial stiffness. The clinical significance of brachial-ankle pulse wave velocity as a measure of early vascular damage remains unclear. We examined the hypothesis that higher brachial-ankle pulse wave velocity is associated with a much greater risk of albuminuria by employing a cohort of 718 never-treated hypertensive patients registered in a prospective study. The 718 patients consisted of 500 patients with normoalbuminuria (69.6%), 191 patients with microalbuminuria (26.6%) and 27 patients with macroalbuminuria (3.8%). The prevalence of microalbuminuria increased with a graded increase in brachial-ankle pulse wave velocity (17.6, 22.8, 28.2 and 39.6%, p < 0.0001). The prevalence of macroalbuminuria remained constant until the third grade group of the brachial-ankle pulse wave velocity but increased significantly in the highest grade group compared with the lower grade groups (2.3, 3.2, 2.3, 9.9%, p < 0.0001). Age, systolic and diastolic blood pressure, pulse pressure, heart rate, and fasting glucose concentration were also significantly increased with an increase in brachial-ankle pulse wave velocity (p < 0.0001 for all). Multiple logistic regression analysis has shown that systolic blood-pressure, fasting blood glucose, and brachial-ankle pulse wave velocity are significant risk factors for microalbuminuria. After adjusting for other risk factors, the odds ratio for an increase of 200 cm/s in brachial-ankle pulse wave velocity was 1.192 (95% confidence interval: 1.022-1.365; p < 0.05). These data suggest that brachial-ankle pulse wave velocity is an independent risk factor for microalbuminuria and could be used as a marker for early vascular damage in never-treated hypertensive patients.
臂踝脉搏波速度是一种新的动脉僵硬度测量指标。臂踝脉搏波速度作为早期血管损伤测量指标的临床意义仍不明确。我们通过一项前瞻性研究中登记的718例未经治疗的高血压患者队列，检验了较高的臂踝脉搏波速度与蛋白尿风险显著增加相关的假设。这718例患者包括500例正常白蛋白尿患者（69.6%）、191例微量白蛋白尿患者（26.6%）和27例大量白蛋白尿患者（3.8%）。微量白蛋白尿的患病率随臂踝脉搏波速度分级增加而升高（分别为17.6%、22.8%、28.2%和39.6%，p<0.0001）。大量白蛋白尿的患病率在臂踝脉搏波速度的三级分组之前保持稳定，但在最高分组中与较低分组相比显著升高（分别为2.3%、3.2%、2.3%、9.9%，p<0.0001）。年龄、收缩压和舒张压、脉压、心率以及空腹血糖浓度也随臂踝脉搏波速度增加而显著升高（所有p<0.0001）。多因素逻辑回归分析显示，收缩压、空腹血糖和臂踝脉搏波速度是微量白蛋白尿的显著危险因素。在调整其他危险因素后，臂踝脉搏波速度增加200 cm/s的比值比为1.192（95%置信区间：1.022-1.365；p<0.05）。这些数据表明，臂踝脉搏波速度是微量白蛋白尿的独立危险因素，可作为未经治疗的高血压患者早期血管损伤的标志物。
