Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
College of Public Health, University of Oklahoma, Oklahoma City.
JAMA. 2014 Feb 5;311(5):490-7. doi: 10.1001/jama.2013.285122.
Single measures of blood pressure (BP) levels are associated with the development of atherosclerosis; however, long-term patterns in BP and their effect on cardiovascular disease risk are poorly characterized.
To identify common BP trajectories throughout early adulthood and to determine their association with presence of coronary artery calcification (CAC) during middle age.
DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort data from 4681 participants in the CARDIA study, who were black and white men and women aged 18 to 30 years at baseline in 1985-1986 at 4 urban US sites, collected through 25 years of follow-up (2010-2011). We examined systolic BP, diastolic BP, and mid-BP (calculated as [SBP+DBP]/2, an important marker of coronary heart disease risk among younger populations) at baseline and years 2, 5, 7, 10, 15, 20, and 25. Latent mixture modeling was used to identify trajectories in systolic, diastolic, and mid-BP over time.
Coronary artery calcification greater than or equal to Agatston score of 100 Hounsfield units (HU) at year 25.
We identified 5 distinct mid-BP trajectories: low-stable (21.8%; 95% CI, 19.9%-23.7%; n=987), moderate-stable (42.3%; 40.3%-44.3%; n=2085), moderate-increasing (12.2%; 10.4%-14.0%; n=489), elevated-stable (19.0%; 17.1%-20.0%; n=903), and elevated-increasing (4.8%; 4.0%-5.5%; n=217). Compared with the low-stable group, trajectories with elevated BP levels had greater odds of having a CAC score of 100 HU or greater. Adjusted odds ratios were 1.44 (95% CI, 0.83-2.49) for moderate-stable, 1.86 (95% CI, 0.91-3.82) for moderate-increasing, 2.28 (95% CI, 1.24-4.18), for elevated-stable, and 3.70 (95% CI, 1.66-8.20) for elevated-increasing groups. The adjusted prevalence of a CAC score of 100 HU or higher was 5.8% in the low-stable group. These odds ratios represent an absolute increase of 2.7%, 5%, 6.3%, and 12.9% for the prevalence of a CAC score of 100 HU or higher for the moderate-stable, moderate-increasing, elevated-stable and elevated-increasing groups, respectively, compared with the low-stable group. Associations were not altered after adjustment for baseline and year 25 BP. Findings were similar for trajectories of isolated systolic BP trajectories but were attenuated for diastolic BP trajectories.
Blood pressure trajectories throughout young adulthood vary, and higher BP trajectories were associated with an increased risk of CAC in middle age. Long-term trajectories in BP may assist in more accurate identification of individuals with subclinical atherosclerosis.
单次血压（BP）测量值与动脉粥样硬化的发展有关；然而，BP 的长期模式及其对心血管疾病风险的影响仍描述不足。
确定整个青年早期常见的 BP 轨迹，并确定其与中年时存在冠状动脉钙化（CAC）的关系。
设计、地点和参与者：前瞻性队列研究数据来自于 CARDIA 研究中的 4681 名参与者，他们是基线时年龄在 18 至 30 岁的黑人和白人男性和女性，于 1985-1986 年在 4 个美国城市地点开始研究，随访时间长达 25 年（2010-2011 年）。我们在基线时和第 2、5、7、10、15、20 和 25 年时检查了收缩压、舒张压和中压（通过[SBP+DBP]/2 计算得出，这是年轻人群中冠心病风险的一个重要标志物）。我们使用潜在混合模型来识别随时间变化的收缩压、舒张压和中压轨迹。
第 25 年 CAC 评分大于或等于 100 豪斯菲尔德单位（HU）。
我们确定了 5 种不同的中压轨迹：低稳定型（21.8%；95%CI，19.9%-23.7%；n=987）、中稳定型（42.3%；40.3%-44.3%；n=2085）、中升高型（12.2%；10.4%-14.0%；n=489）、高稳定型（19.0%；17.1%-20.0%；n=903）和高升高型（4.8%；4.0%-5.5%；n=217）。与低稳定型组相比，BP 水平升高的轨迹发生 CAC 评分大于或等于 100 HU 的可能性更大。调整后的优势比分别为 1.44（95%CI，0.83-2.49）、1.86（95%CI，0.91-3.82）、1.86（95%CI，0.91-3.82）、2.28（95%CI，1.24-4.18）和 3.70（95%CI，1.66-8.20）。低稳定组 CAC 评分大于或等于 100 HU 的调整后患病率为 5.8%。这些优势比分别代表中稳定组、中升高组、高稳定组和高升高组 CAC 评分大于或等于 100 HU 的患病率相对于低稳定组的绝对增加了 2.7%、5%、6.3%和 12.9%。调整基线和第 25 年 BP 后，相关性仍然存在。孤立收缩压轨迹的相关性相似，但舒张压轨迹的相关性减弱。
整个青年早期的 BP 轨迹各不相同，较高的 BP 轨迹与中年时 CAC 风险增加相关。BP 的长期轨迹可能有助于更准确地识别亚临床动脉粥样硬化患者。
