20 年来年轻人血压的一致性及其对心血管结构的影响。

Consistency of blood pressure and impact on cardiovascular structure over 20 years in young men.

机构信息

Clinical Experimental Research Laboratory, Sahlgrenska University Hospital Ostra and Institute of Medicine, University of Gothenburg, Sweden.

出版信息

J Intern Med. 2010 Mar;267(3):295-304. doi: 10.1111/j.1365-2796.2009.02142.x. Epub 2009 Jun 11.

DOI:10.1111/j.1365-2796.2009.02142.x

PMID:19572922

Abstract

OBJECTIVE

To identify, in a prospective study, how blood pressure levels at the age of twenty predict hypertension and cardiovascular remodelling 20 years later.

METHODS

Twenty-year-old men with blood pressure (BP) elevation [systolic blood pressure (SBP) 140-160 and/or diastolic blood pressure (DBP) 85-95 mmHg; blood pressure elevation (BPE) group] or normal BP [SBP 110-130 and DBP 60-80 mmHg; normal controls (NC) group] entered the study in 1987. In 2007, follow-up was conducted including ambulatory BP, echocardiography, anthropometric and intima media thickness (IMT) measurements.

RESULTS

Assessed with 24-h ambulatory BP, the prevalence of hypertension was 35/47 (74.5%) and 1/17 (5.9%) in the BPE and NC group at follow-up respectively. Twenty-four hour mean arterial pressure (MAP) increased from 86.6 (0.8) to 97.2 (1.2) (P < 0.0001), and from 83.1 (1.5) to 88.1 (1.2) mmHg (P < 0.01) from baseline to follow-up in the BPE and NC group respectively. At follow-up, left ventricular mass index (LVMI) was 122 (4) and 106 (4) g m(-1) in the BPE and NC group (unpaired t-test; P < 0.01) respectively, whilst IMT was 0.61 (0.01) and 0.57 (0.01) mm in the BPE and NC group (P < 0.05) respectively. In a logistic regression model, prevalence of hypertension was best explained by office MAP and 24-h DBP at baseline (R(2) 0.333; P < 0.05). A combined model of office MAP, body mass index and insulin levels at baseline explained 56% of LVMI at follow-up.

CONCLUSIONS

BP elevation in young age predicts hypertension and adverse cardiovascular remodelling at the age of 40 years. Baseline office MAP is the best predictor of hypertension, 24-h MAP and LVMI.

摘要

目的

前瞻性研究 20 岁时的血压水平如何预测 20 年后的高血压和心血管重构。

方法

1987 年，血压升高的 20 岁男性（收缩压 140-160 且/或舒张压 85-95mmHg；血压升高组）或血压正常的 20 岁男性（收缩压 110-130 且舒张压 60-80mmHg；正常对照组）进入研究。2007 年，进行了随访，包括动态血压、超声心动图、人体测量和内膜中层厚度（IMT）测量。

结果

用 24 小时动态血压评估，血压升高组在随访时高血压的患病率为 35/47（74.5%），正常对照组为 1/17（5.9%）。24 小时平均动脉压（MAP）从基线时的 86.6（0.8）mmHg 增加到随访时的 97.2（1.2）mmHg（P<0.0001），从 83.1（1.5）mmHg 增加到 88.1（1.2）mmHg（P<0.01），分别在血压升高组和正常对照组。在随访时，血压升高组的左心室质量指数（LVMI）为 122（4）g/m²，正常对照组为 106（4）g/m²（未配对 t 检验；P<0.01），而内膜中层厚度（IMT）分别为 0.61（0.01）mm 和 0.57（0.01）mm（P<0.05）在血压升高组和正常对照组中。在逻辑回归模型中，高血压的患病率最好由基线时的诊室 MAP 和 24 小时舒张压解释（R² 0.333；P<0.05）。基线时的诊室 MAP、体重指数和胰岛素水平的综合模型解释了随访时 LVMI 的 56%。