Raaijmakers Anke, Zhang Zhen-Yu, Claessens Jolien, Cauwenberghs Nicholas, van Tienoven Theun Pieter, Wei Fang-Fei, Jacobs Lotte, Levtchenko Elena, Pauwels Steven, Kuznetsova Tatiana, Allegaert Karel, Staessen Jan A
Departments of Pediatrics and Neonatology (A.R., E.L.) and Laboratory Medicine (J.C., S.P.), University Hospitals Leuven, Belgium; KU Leuven Department of Development and Regeneration (A.R., E.L., K.A.) and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (Z.-Y.Z., N.C., F.-F.W., L.J., T.K., J.A.S.), University of Leuven, Belgium; Department of Sociology, Vrije Universiteit Brussel, Belgium (T.P. v.T.); R&D Group VitaK, Maastricht University, The Netherlands (J.A.S.); and Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands (K.A.).
Hypertension. 2017 Mar;69(3):443-449. doi: 10.1161/HYPERTENSIONAHA.116.08643. Epub 2017 Jan 23.
Low birth weight and prematurity are risk factors for hypertension in adulthood. Few studies in preterm or full-term born children reported on plasma renin activity (PRA). We tested the hypothesis that renin might modulate the incidence of hypertension associated with prematurity. We enrolled 93 prematurely born children with birth weight <1000 g and 87 healthy controls born at term, who were all examined at ≈11 years. Renal length and glomerular filtration rate derived from serum cystatin C were 0.28 cm (95% confidence interval, 0.09-0.47) and 11.5 mL/min per 1.73 m (6.4-16.6) lower in cases, whereas their systolic/diastolic blood pressure (BP) was 7.5 mm Hg (4.8-10.3)/4.0 mm Hg (2.1-5.8) higher (<0.001 for all). The odds of having systolic prehypertension or systolic hypertension associated with extreme low birth weight were 6.43 (2.52-16.4; <0.001) and 10.9 (2.46-48.4; =0.002). Twenty-four hours of urinary sodium excretion was similar in cases and controls (102.1 versus 106.8 mmol; =0.47). Sodium load per nephron was estimated as sodium excretion divided by kidney length (mmol/cm). PRA was 0.54 ng/mL per hour (0.23-0.85; =0.001) lower in cases. PRA, systolic BP, and sodium load were available in 43 cases and 56 controls. PRA decreased with systolic BP (slope -0.022 ng/mL per hour/; =0.048), but was unrelated to sodium load (slope +0.13 mmol/cm; =0.54). The slope of PRA on systolic BP was similar (=0.17) in cases and controls. In conclusion, extremely low birth weight predisposes young adolescents to low-renin hypertension, but does not affect the inverse association between PRA and BP.
URL: https://www.clinicaltrials.gov. Unique identifier: NCT02147457.
低出生体重和早产是成年期高血压的危险因素。关于早产或足月出生儿童的血浆肾素活性（PRA）的研究报道较少。我们检验了肾素可能调节与早产相关的高血压发病率这一假设。我们纳入了93名出生体重<1000g的早产儿童和87名足月出生的健康对照儿童，他们均在约11岁时接受检查。病例组的肾脏长度和根据血清胱抑素C得出的肾小球滤过率分别低0.28cm（95%置信区间，0.09 - 0.47）和11.5mL/min/1.73m²（6.4 - 16.6），而他们的收缩压/舒张压（BP）分别高7.5mmHg（4.8 - 10.3）/4.0mmHg（2.1 - 5.8）（所有P<0.001）。与极低出生体重相关的收缩期高血压前期或收缩期高血压的比值比分别为6.43（2.52 - 16.4；P<0.001）和10.9（2.46 - 48.4；P = 0.002）。病例组和对照组的24小时尿钠排泄量相似（102.1对106.8mmol；P = 0.47）。每个肾单位的钠负荷通过钠排泄量除以肾脏长度来估算（mmol/cm）。病例组的PRA每小时低0.54ng/mL（0.23 - 0.85；P = 0.001）。43例病例和56名对照者有PRA、收缩压和钠负荷的数据。PRA随收缩压降低（斜率 -0.022ng/mL每小时/；P = 0.048），但与钠负荷无关（斜率 +0.13mmol/cm；P = 0.54）。病例组和对照组中PRA对收缩压的斜率相似（P = 0.17）。总之，极低出生体重使青少年易患低肾素性高血压，但不影响PRA与血压之间的负相关关系。
