Ingelsson Erik, Pencina Michael J, Levy Daniel, Aragam Jayashri, Mitchell Gary F, Benjamin Emelia J, Vasan Ramachandran S
Framingham Heart Study, Boston University School of Medicine, Framingham, Massachusetts 01702-5803, USA.
Hypertension. 2008 Sep;52(3):473-7. doi: 10.1161/HYPERTENSIONAHA.108.114157. Epub 2008 Jul 28.
Proximal aortic diameter, including aortic root (AoR) diameter, has been inversely related to pulse pressure in cross-sectional studies. So, investigators have hypothesized that a smaller AoR diameter may increase the risk of developing hypertension. Prospective studies are lacking to test this hypothesis. We measured AoR diameter in 3195 Framingham Study participants (mean age: 49 years; 57% women; 8460 person-examinations) free from hypertension and previous cardiovascular disease who underwent routine echocardiography. We related AoR to hypertension incidence and blood pressure (BP) progression (increment of >or=1 category, as defined by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure). On follow-up (median: 4 years), 1267 individuals (15%; 661 women) developed hypertension, and 2978 participants experienced BP progression (35%; 1588 women). In logistic regression models adjusted for age, sex, and height, AoR was positively associated with hypertension incidence (odds ratio: 1.15; 95% CI: 1.08 to 1.23) and BP progression (odds ratio: 1.09; 95% CI: 1.04 to 1.14) on follow-up. However, adjustment for other factors known to influence BP tracking (baseline systolic and diastolic BP, smoking, diabetes, and weight) rendered these relations statistically nonsignificant (odds ratio: 1.03; 95% CI: 0.96 to 1.11 for hypertension incidence; odds ratio: 1.03; 95% CI: 0.97 to 1.08 for BP progression). In our large community-based sample of nonhypertensive individuals, AoR diameter was not associated with hypertension incidence or BP progression prospectively after adjustment for potential confounders. Our prospective study does not support the notion that a smaller AoR predisposes to hypertension.
在横断面研究中，包括主动脉根部（AoR）直径在内的近端主动脉直径与脉压呈负相关。因此，研究人员推测较小的AoR直径可能会增加患高血压的风险。目前缺乏前瞻性研究来验证这一假设。我们对3195名弗雷明汉心脏研究参与者（平均年龄：49岁；57%为女性；共进行了8460人次检查）进行了AoR直径测量，这些参与者均无高血压病史且既往无心血管疾病，他们接受了常规超声心动图检查。我们将AoR与高血压发病率及血压（BP）进展情况（按照美国预防、检测、评估与治疗高血压联合委员会的定义，血压升高≥1个等级）进行关联分析。在随访（中位数：4年）期间，1267人（15%；661名女性）患上了高血压，2978名参与者出现了血压进展（35%；1588名女性）。在对年龄、性别和身高进行校正的逻辑回归模型中，随访时AoR与高血压发病率（比值比：1.15；95%置信区间：1.08至1.23）及血压进展（比值比：1.09；95%置信区间：1.04至1.14）呈正相关。然而，在对其他已知会影响血压追踪的因素（基线收缩压和舒张压、吸烟、糖尿病和体重）进行校正后，这些关联在统计学上不再显著（高血压发病率的比值比：1.03；95%置信区间：0.96至1.11；血压进展的比值比：1.03；95%置信区间：0.97至1.08）。在我们这个以社区为基础的大型非高血压个体样本中，在对潜在混杂因素进行校正后，前瞻性分析显示AoR直径与高血压发病率或血压进展无关。我们的前瞻性研究不支持较小的AoR易导致高血压这一观点。
