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从童年到青年期的血压轨迹与心血管风险的关联:长达23年的佐治亚压力与心脏纵向研究结果

Blood Pressure Trajectories From Childhood to Young Adulthood Associated With Cardiovascular Risk: Results From the 23-Year Longitudinal Georgia Stress and Heart Study.

作者信息

Hao Guang, Wang Xiaoling, Treiber Frank A, Harshfield Gregory, Kapuku Gaston, Su Shaoyong

机构信息

From the Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta University (G.H., X.W., G.H., G.K., S.S.); and Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.).

出版信息

Hypertension. 2017 Mar;69(3):435-442. doi: 10.1161/HYPERTENSIONAHA.116.08312. Epub 2017 Jan 16.

Abstract

The purpose of this study is to identify subgroups of individuals with similar trajectories in blood pressure (BP) from childhood to young adulthood and to determine the relationship of BP trajectories with carotid intima-media thickness (IMT) and left ventricular mass index (LVMI). BP was measured ≤16 times during a 23-year period in 683 participants from childhood to young adulthood. IMT and LVMI were measured in 551 participants and 546 participants, respectively. Using latent class models, 3 trajectory groups in BP from childhood to young adulthood were identified, including high-increasing, moderate-increasing, and low-increasing groups. We found that trajectory of systolic BP was a significant predictor of both IMT and LVMI with increased rate of growth in systolic BP associated with higher levels of IMT and LVMI ( <0.001). Similar to the BP trajectory groups from childhood to young adulthood, 3 trajectory groups in BP during childhood (≤18 years) were identified, and participants in the high-increasing group had thicker IMT (<0.001) and increased LVMI (=0.043) in comparison with those in the low-increasing group. Results were similar for mid-BP trajectories but not for diastolic BP trajectories. Our results suggested that different BP trajectories exist from childhood to young adulthood, and the trajectories were independently associated with IMT and LVMI. We, for the first time, reported the association between systolic BP trajectories derived from childhood with subclinical cardiovascular risk in young adulthood, indicating that monitoring trajectories of BP from childhood may help identify a high cardiovascular risk population in early life.

摘要

本研究的目的是识别从儿童期到青年期血压(BP)轨迹相似的个体亚组,并确定血压轨迹与颈动脉内膜中层厚度(IMT)和左心室质量指数(LVMI)之间的关系。在23年期间,对683名参与者从儿童期到青年期进行了≤16次血压测量。分别对551名参与者和546名参与者测量了IMT和LVMI。使用潜在类别模型,识别出从儿童期到青年期的3个血压轨迹组,包括高增长组、中度增长组和低增长组。我们发现,收缩压轨迹是IMT和LVMI的显著预测因素,收缩压增长速度增加与更高水平的IMT和LVMI相关(<0.001)。与从儿童期到青年期的血压轨迹组相似,识别出了儿童期(≤18岁)的3个血压轨迹组,与低增长组相比,高增长组的参与者IMT更厚(<0.001)且LVMI增加(=0.043)。血压轨迹中期的结果相似,但舒张压轨迹的结果不同。我们的结果表明,从儿童期到青年期存在不同的血压轨迹,且这些轨迹与IMT和LVMI独立相关。我们首次报告了儿童期收缩压轨迹与青年期亚临床心血管风险之间的关联,表明监测儿童期血压轨迹可能有助于在生命早期识别高心血管风险人群。

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