Baker Heart and Diabetes Institute, Melbourne, Australia.
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Am J Hypertens. 2017 Aug 1;30(8):772-775. doi: 10.1093/ajh/hpx091.
Aortic reservoir function independently predicts end-organ damage in cross-sectional analyses. However, longitudinal associations are more important regarding causation, but this has never been examined at rest or in response to light-moderate intensity exercise. The aim of this study was to determine the association between the change in aortic reservoir characteristics, in particular excess pressure integral (Pexcess) at rest and in response to exercise and the change in kidney function among healthy individuals followed over time.
Aortic reservoir function (Pexcess and reservoir pressure), aortic stiffness, brachial and central blood pressure (BP), and renal function (estimated glomerular filtration rate [eGFR]) were recorded among 33 healthy individuals (57 ± 9 years; 55% male) at baseline and after an average 3.0 ± 0.3 years.
Over the follow up period, there was a significant increase in resting brachial BP, central BP, Pexcess, and aortic stiffness (P < 0.05 all). The change over time in resting Pexcess (but not aortic stiffness) was significantly related to the change in eGFR (r = -0.38, P = 0.038) and remained independent of age at follow up, change in 24-hour ambulatory systolic BP and body mass index (β = -0.0300, P = 0.043). There was no association between the change in aortic pulse wave velocity and the change eGFR (P = 0.46) nor were there any associations with exercising hemodynamics.
Pexcess is independently associated with a decline in renal function among healthy people followed over 3 years. These novel findings indicate the need to determine the underlying physiological determinants of aortic reservoir function.
在横断面分析中，主动脉储存功能独立预测靶器官损伤。然而，就因果关系而言，纵向关联更为重要，但这一点从未在静息或轻中度运动时得到过检验。本研究旨在确定主动脉储存特征（特别是静息和运动时的过剩压力积分（Pexcess））变化与健康个体肾功能变化之间的关联，这些个体在随访期间随时间发生变化。
在基线和平均 3.0 ± 0.3 年后，记录 33 名健康个体（57 ± 9 岁；55%为男性）的主动脉储存功能（Pexcess 和储存压力）、主动脉僵硬度、肱动脉和中心血压（BP）以及肾功能（估计肾小球滤过率[eGFR]）。
在随访期间，静息肱动脉 BP、中心 BP、Pexcess 和主动脉僵硬度均显著升高（P < 0.05 均）。静息 Pexcess 的随时间变化（但不是主动脉僵硬度）与 eGFR 的变化显著相关（r = -0.38，P = 0.038），并且独立于随访时的年龄、24 小时动态收缩压和体重指数的变化（β = -0.0300，P = 0.043）。主动脉脉搏波速度的变化与 eGFR 的变化之间没有关联（P = 0.46），与运动时的血液动力学也没有关联。
在随访 3 年以上的健康人群中，Pexcess 与肾功能下降独立相关。这些新发现表明需要确定主动脉储存功能的潜在生理决定因素。
