Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Hypertension. 2010 Aug;56(2):203-9. doi: 10.1161/HYPERTENSIONAHA.109.146415. Epub 2010 Jun 14.
Although prehypertension at adolescence is accepted to indicate increased future risk of hypertension, large-scale/long follow-up studies are required to better understand how adolescent blood pressure (BP) tracks into young adulthood. We studied 23 191 male and 3789 female adolescents from the Metabolic Lifestyle and Nutrition Assessment in Young Adults cohort (mean age: 17.4 years) with BP <140/90 mm Hg at enrollment or categorized by current criteria for pediatric BP and body mass index (BMI) values. Participants were prospectively followed up with repeated BP measurements between ages 25 and 42 years and retrospectively between ages 17 and 25 years for the incidence of hypertension. We identified 3810 new cases of hypertension between ages 17 and 42 years. In survival analyses, the cumulative risk of hypertension between ages 17 and 42 years was 3 to 4 times higher in men than in women. Using Cox regression models adjusted for age, BMI, and stratified by baseline BP, the hazard ratio of hypertension increased gradually across BP groups within the normotensive range at age 17 years, without a discernible threshold effect, reaching a hazard ratio of 2.50 (95% CI: 1.75 to 3.57) for boys and 2.31 (95% CI: 0.71 to 7.60) for girls in the group with BP at 130 to 139/85 to 89 mm Hg. BMI at age 17 years was strongly associated with future risk of hypertension even when adjusted to BP at age 17 years, particularly in boys. Yet, BMI at age 30 years attenuated this association, more evidently in girls. In conclusion, BP at adolescence, even in the low-normotensive range, linearly predicts progression to hypertension in young adulthood. This progression and the apparent interaction between BP at age 17 years and BMI at adolescence and at adulthood are sex dependent.
虽然青春期前高血压被认为预示着未来患高血压的风险增加，但需要大规模/长期随访研究来更好地了解青少年血压（BP）如何在成年早期跟踪。我们研究了代谢生活方式和营养评估在年轻人中的队列中的 23191 名男性和 3789 名女性青少年，他们在入组时的 BP<140/90mmHg，或根据当前儿科 BP 和体重指数（BMI）标准分类。参与者在 25 至 42 岁之间进行了前瞻性的重复血压测量，并在 17 至 25 岁之间进行了回顾性血压测量，以确定高血压的发生率。我们在 17 至 42 岁之间发现了 3810 例新的高血压病例。在生存分析中，男性在 17 至 42 岁之间患高血压的累积风险是女性的 3 至 4 倍。使用 Cox 回归模型调整年龄、BMI，并根据基线 BP 分层，在 17 岁时的正常血压范围内，高血压的风险比随着 BP 组逐渐增加，没有明显的阈值效应，在 130-139/85-89mmHg 的 BP 组中，男孩的风险比达到 2.50（95%CI：1.75 至 3.57），女孩达到 2.31（95%CI：0.71 至 7.60）。即使在调整到 17 岁时的 BP 时，17 岁时的 BMI 与未来患高血压的风险也密切相关，尤其是在男孩中。然而，30 岁时的 BMI 减弱了这种关联，在女孩中更为明显。总之，青春期的 BP，即使在正常低值范围内，也可以线性预测成年早期向高血压的进展。这种进展以及青春期和成年早期 17 岁时的 BP 和 BMI 之间的明显相互作用是性别依赖性的。
