General Internal Medicine Section 111A1, VA Medical Center, 4150 Clement Street, San Francisco, CA 94124, USA.
Am J Epidemiol. 2010 Jan 1;171(1):63-71. doi: 10.1093/aje/kwp319. Epub 2009 Nov 30.
Vascular abnormalities may exist before clinical hypertension. Using Poisson regression, the authors studied the association of coronary artery calcium (CAC), common carotid intima-media thickness (CIMT), aortic distensibility, and large and small arterial elasticity with incident hypertension among 2,512 normotensive US adults free of cardiovascular disease. Incidence rate ratios for incident hypertension (blood pressure > or =140/90 mm Hg or new antihypertensive medication) were calculated. Increased CAC was associated with incident hypertension in demographics-adjusted models (incidence rate ratio (IRR) = 1.35, 95% confidence interval (CI): 1.04, 1.75; IRR = 1.35, 95% CI: 1.02, 1.78; and IRR = 1.59, 95% CI: 1.12, 2.25 for CAC scores of 30-99, 100-399, and > or =400, respectively) but was attenuated after further adjustment. Increased common CIMT was associated with incident hypertension (IRR = 1.77, 95% CI: 1.28, 2.46 for quintile 4; IRR = 1.80, 95% CI: 1.28, 2.53 for quintile 5). Participants with the lowest, compared with the highest, aortic distensibility had an increased risk of hypertension (IRR = 1.75, 95% CI: 1.10, 2.79), as did those with the lowest large arterial elasticity (IRR = 1.49, 95% CI: 1.11, 1.99). Lower small arterial elasticity was incrementally associated with incident hypertension starting at quintile 2 (IRR = 2.01, 95% CI: 1.39, 2.91; IRR = 2.47, 95% CI: 1.71, 3.57; IRR = 2.73, 95% CI: 1.88, 3.95; and IRR = 2.85, 95% CI: 1.95, 4.16). Structural and functional vascular abnormalities are independent predictors of incident hypertension. These findings are important for understanding the pathogenesis of hypertension.
血管异常可能在临床高血压之前就存在。作者使用泊松回归研究了冠状动脉钙（CAC）、颈总动脉内膜中层厚度（CIMT）、主动脉顺应性以及大动脉和小动脉弹性与 2512 名无心血管疾病的美国正常血压成年人中高血压事件的相关性。计算了高血压事件（血压≥140/90mmHg 或新使用降压药物）的发生率比。在调整了人口统计学因素后，CAC 增加与高血压事件相关（发生率比（IRR）=1.35，95%置信区间（CI）：1.04，1.75；IRR=1.35，95%CI：1.02，1.78；IRR=1.59，95%CI：1.12，2.25，分别为 CAC 评分 30-99、100-399 和≥400），但在进一步调整后，这种相关性减弱。增加的 CIMT 与高血压事件相关（五分位 4 为 IRR=1.77，95%CI：1.28，2.46；五分位 5 为 IRR=1.80，95%CI：1.28，2.53）。与最高主动脉顺应性相比，最低主动脉顺应性的参与者高血压风险增加（IRR=1.75，95%CI：1.10，2.79），最低大动脉弹性的参与者也是如此（IRR=1.49，95%CI：1.11，1.99）。较小的动脉弹性逐渐与高血压事件相关，从五分位 2 开始（IRR=2.01，95%CI：1.39，2.91；IRR=2.47，95%CI：1.71，3.57；IRR=2.73，95%CI：1.88，3.95；IRR=2.85，95%CI：1.95，4.16）。结构和功能血管异常是高血压事件的独立预测因子。这些发现对于理解高血压的发病机制很重要。
