青年期至中年期收缩压的累积暴露与中年期尿白蛋白与肌酐比值
Cumulative Exposure to Systolic Blood Pressure During Young Adulthood Through Midlife and the Urine Albumin-to-Creatinine Ratio at Midlife.
作者信息
Kramer Holly, Colangelo Laura, Lewis Cora E, Jacobs David R, Pletcher Mark, Bibbins-Domingo Kirstin, Chang Alex, Siscovick David, Shlipak Michael, Peralta Carmen A, Bansal Nisha, Muntner Paul, Liu Kiang
机构信息
Department of Public Health Sciences, Division of Nephrology and Hypertension, Maywood, Illinois, USA.
Department of Medicine, Division of Nephrology and Hypertension, Maywood, Illinois, USA.
出版信息
Am J Hypertens. 2017 May 1;30(5):502-509. doi: 10.1093/ajh/hpx012.
BACKGROUND
Higher blood pressure during young adulthood may increase cardiovascular and kidney disease risk later in life. This study examined the association of cumulative systolic blood pressure (SBP) exposure during young adulthood through midlife with urine albumin-to-creatinine ratios (ACR) measured during midlife.
METHODS
We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a biracial cohort recruited in 4 urban areas during years 1985-1986. Cumulative SBP was calculated as the average SBP between 2 exams multiplied by years between exams over 20 year years. ACR was measured 20 years after baseline when participants were age 43-50 years (midlife). A generalized additive model was used to examine the association of log ACR as a function of cumulative SBP with adjustment for covariates including SBP measured concurrently with ACR.
RESULTS
Cumulative SBP ranged from a low of 1,671 to a high of 3,260 mm Hg. Participants in the highest cumulative SBP quartile were more likely to be male (61.4% vs. 20.7%; P < 0.001), Black (61.5% vs. 25.6%; P < 0.001) and have elevated ACR (18.7% vs. 4.8%; P < 0.001) vs. lowest quartile. Spline regression curves of ACR vs. cumulative SBP demonstrated an inflection point in ACR with cumulative SBP levels >2,350 mm Hg with linear increases in ACR above this threshold. Adjusted geometric mean ACR values were significantly higher with cumulative SBP ≥2,500 vs. <2500 (9.18 [1.06] vs. 6.92 [1.02]; P < 0.0001).
CONCLUSION
Higher SBP during young adulthood through midlife is associated with higher ACR during midlife.
背景
青年期血压升高可能会增加日后患心血管疾病和肾脏疾病的风险。本研究调查了青年期至中年期累积收缩压（SBP）暴露与中年期测量的尿白蛋白与肌酐比值（ACR）之间的关联。
方法
我们使用了青年成人冠状动脉风险发展（CARDIA）研究的数据，该研究于1985 - 1986年在4个城市地区招募了一个双种族队列。累积SBP计算为两次检查之间的平均SBP乘以20年期间检查之间的年数。在基线20年后，当参与者年龄为43 - 50岁（中年）时测量ACR。使用广义相加模型来研究log ACR与累积SBP之间的关联，并对包括与ACR同时测量的SBP在内的协变量进行调整。
结果
累积SBP范围从低至1671到高至3260 mmHg。累积SBP最高四分位数的参与者比最低四分位数的参与者更可能是男性（61.4%对20.7%；P < 0.001）、黑人（61.5%对25.6%；P < 0.001）且ACR升高（18.7%对4.8%；P < 0.001）。ACR与累积SBP的样条回归曲线显示，当累积SBP水平>2350 mmHg时，ACR出现拐点，高于此阈值时ACR呈线性增加。累积SBP≥2500与<2500相比，调整后的几何平均ACR值显著更高（9.18 [1.06]对6.92 [1.02]；P < 0.0001）。
结论
青年期至中年期较高的SBP与中年期较高的ACR相关。
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