Yano Yuichiro, Reis Jared P, Levine Deborah A, Bryan R Nick, Viera Anthony J, Shimbo Daichi, Tedla Yacob G, Allen Norrina B, Schreiner Pamela J, Bancks Michael P, Sidney Stephen, Pletcher Mark J, Liu Kiang, Greenland Philip, Lloyd-Jones Donald M, Launer Lenore J
From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.).
Hypertension. 2017 Dec;70(6):1091-1098. doi: 10.1161/HYPERTENSIONAHA.117.10144. Epub 2017 Oct 9.
The aims of this study are to assess the relationships of visit-to-visit blood pressure (BP) variability in young adulthood to hippocampal volume and integrity at middle age. We used data over 8 examinations spanning 25 years collected in the CARDIA study (Coronary Artery Risk Development in Young Adults) of black and white adults (age, 18-30 years) started in 1985 to 1986. Visit-to-visit BP variability was defined as by SD and average real variability (ARV, defined as the absolute differences of BP between successive BP measurements). Hippocampal tissue volume standardized by intracranial volume (%) and integrity assessed by fractional anisotropy were measured by 3-Tesla magnetic resonance imaging at the year-25 examination (n=545; mean age, 51 years; 54% women and 34% African Americans). Mean systolic BP (SBP)/diastolic BP levels were 110/69 mm Hg at year 0 (baseline), 117/73 mm Hg at year 25, and ARV and SD were 7.7 and 7.9 mm Hg, respectively. In multivariable-adjusted linear models, higher ARV was associated with lower hippocampal volume (unstandardized regression coefficient [standard error] with 1-SD higher ARV: -0.006 [0.003]), and higher SD with lower hippocampal fractional anisotropy (-0.02 [0.01]; all <0.05), independent of cumulative exposure to SBP during follow-up. Conversely, cumulative exposure to SBP and diastolic BP was not associated with hippocampal volume. There was no interaction by sex or race between ARV or SD with hippocampal volume or integrity. In conclusion, visit-to-visit BP variability during young adulthood may be useful in assessing the potential risk for reductions in hippocampal volume and integrity in midlife.
本研究的目的是评估青年期逐次就诊血压（BP）变异性与中年期海马体体积和完整性之间的关系。我们使用了1985年至1986年启动的CARDIA研究（青年成人冠状动脉风险发展研究）中收集的、跨越25年的8次检查数据，该研究涉及黑人和白人成年人（年龄18 - 30岁）。逐次就诊血压变异性通过标准差（SD）和平均实际变异性（ARV，定义为连续血压测量之间血压的绝对差值）来定义。在第25年检查时，通过3特斯拉磁共振成像测量经颅内体积标准化的海马体组织体积（%）以及通过分数各向异性评估的完整性（n = 545；平均年龄51岁；54%为女性，34%为非裔美国人）。平均收缩压（SBP）/舒张压水平在第0年（基线）为110/69 mmHg，在第25年为117/73 mmHg，ARV和SD分别为7.7和7.9 mmHg。在多变量调整线性模型中，较高的ARV与较低的海马体体积相关（ARV每升高1个标准差的未标准化回归系数[标准误]：-0.006 [0.003]），较高的SD与较低的海马体分数各向异性相关（-0.02 [0.01]；均P<0.05），独立于随访期间SBP的累积暴露量。相反，SBP和舒张压的累积暴露量与海马体体积无关。ARV或SD与海马体体积或完整性之间不存在性别或种族的交互作用。总之，青年期逐次就诊血压变异性可能有助于评估中年期海马体体积减小和完整性受损的潜在风险。
