胰岛素抵抗患者尿白蛋白排泄与中心及外周血压的相关性。

Association between urinary albumin excretion and both central and peripheral blood pressure in subjects with insulin resistance.

机构信息

Hypertension Unit, Nephrology Department, Hospital Universitari del Mar, Barcelona, Spain.

出版信息

J Hypertens. 2013 Jan;31(1):103-8. doi: 10.1097/HJH.0b013e32835ac7b5.

DOI:10.1097/HJH.0b013e32835ac7b5

PMID:23137953

Abstract

BACKGROUND

Central blood pressure (cBP) predicts cardiovascular events. Regarding subclinical organ damage, the relationship between urinary albumin excretion (UAE) and cBP is rather unknown.

OBJECTIVE

We aimed to determine whether cBP is related to UAE, and if this relationship is stronger than that observed with peripheral blood pressure (pBP).

METHODS

Three hundred and twenty-four hypertensives (61% men, aged 65 ± 10 years) with insulin-resistance (77% diabetics; 23% nondiabetics with metabolic syndrome) were studied. Office pBP and cBP (radial applanation tonometry) were determined. UAE (albumin/creatinine) was averaged from three first-morning-void urine samples. Differences between patients with/without microalbuminuria, and the relationship between UAE and both pBP and cBP were analyzed. The strength of such relationship (cBP vs. pBP) was compared using a noninferiority test.

RESULTS

Microalbuminuria was detected in 25% of all patients. After age-adjustment and sex-adjustment, both central and peripheral SBP and pulse pressure (PP) (mmHg) were higher in microalbuminurics than in normoalbuminurics [central SBP (cSBP): 130 ± 20 vs. 124 ± 19; peripheral (pSBP): 147 ± 22 vs. 139 ± 20; central pulse pressure (cPP): 52 ± 15 vs. 47 ± 14; peripheral pulse pressure (pPP): 67 ± 16 vs. 62 ± 16, P < 0.05 for all]. Partial correlation coefficients (age-adjusted and sex-adjusted) between blood pressure (BP) and UAE were 0.175 for cSBP, 0.143 for pSBP, 0.124 for cPP (P < 0.05 for all), and 0.092 for pPP (P = 0.117). Neither cBP nor pBP were superior to each other in their association with UAE or with microalbuminuria. Comparisons between cBP and pBP by means of noninferiority tests revealed no differences in the magnitude of correlation coefficients (P = 0.265 for SBP; P = 0.212 for PP), or differences in means between patients with/without microalbuminuria (P = 0.327 for SBP; P = 0.054 for PP).

CONCLUSION

Although cBP is related with UAE, this relationship is not superior to that of office peripheral BP.

摘要

背景

中心血压（cBP）可预测心血管事件。关于亚临床器官损伤，尿白蛋白排泄（UAE）与 cBP 的关系尚不清楚。

目的

我们旨在确定 cBP 是否与 UAE 相关，以及这种关系是否强于与外周血压（pBP）的关系。

方法

研究了 324 名高血压患者（61%为男性，年龄 65±10 岁），其中 77%为胰岛素抵抗患者（77%为糖尿病患者；23%为代谢综合征的非糖尿病患者）。测定了诊室 pBP 和 cBP（桡动脉平板血压计）。UAE（白蛋白/肌酐）由三个晨尿样本来平均。分析了 UAE 与 pBP 和 cBP 之间的差异，并分析了 UAE 与微白蛋白尿之间的关系。使用非劣效性检验比较了这种关系（cBP 与 pBP）的强度。

结果

所有患者中有 25%检测到微量白蛋白尿。经过年龄调整和性别调整后，微量白蛋白尿患者的中央和外周收缩压（SBP）和脉压（PP）（mmHg）均高于正常白蛋白尿患者[中央 SBP（cSBP）：130±20 vs. 124±19；外周（pSBP）：147±22 vs. 139±20；中央脉搏压（cPP）：52±15 vs. 47±14；外周脉搏压（pPP）：67±16 vs. 62±16，P<0.05）。BP 和 UAE 之间的偏相关系数（年龄和性别调整后）为 cSBP 为 0.175，pSBP 为 0.143，cPP 为 0.124（P<0.05），pPP 为 0.092（P=0.117）。cBP 和 pBP 均与 UAE 或微量白蛋白尿无相关性。通过非劣效性检验比较 cBP 和 pBP，发现相关系数的幅度没有差异（SBP 的 P=0.265；PP 的 P=0.212），或微量白蛋白尿患者和无微量白蛋白尿患者之间的平均值也没有差异（SBP 的 P=0.327；PP 的 P=0.054）。