青年时期血压模式与中年心血管疾病和死亡率的关联。
Association of Blood Pressure Patterns in Young Adulthood With Cardiovascular Disease and Mortality in Middle Age.
机构信息
Department of Family Medicine and Community Health, Duke University, Durham, North Carolina.
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
出版信息
JAMA Cardiol. 2020 Apr 1;5(4):382-389. doi: 10.1001/jamacardio.2019.5682.
IMPORTANCE
Determining blood pressure (BP) patterns in young adulthood that are associated with cardiovascular disease (CVD) events in later life may help to identify young adults who have an increased risk for CVD.
OBJECTIVE
To determine whether the long-term variability of BP across clinical visits and the rate of change in BP from young adulthood to midlife are associated with CVD and all-cause mortality by middle age, independently of mean BP during young adulthood and a single BP in midlife.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included a community-based sample of 3394 African American and white participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, enrolled from March 1985 through June 1986. Patterns of systolic BP (SBP) were evaluated with measurements at year 0 (baseline) and 2, 5, 7, and 10 years after baseline. Visit-to-visit SBP variability was estimated as BP variability independent of the mean (VIM). Data were collected from March 1985 through August 2015 and analyzed from June through October 2019.
MAIN OUTCOMES AND MEASURES
Cardiovascular disease and all-cause mortality experienced through August 2015 were adjudicated. The associations of each SBP pattern with CVD events and all-cause mortality were determined using Cox proportional hazards regression models.
RESULTS
At year 10, the mean (SD) age of the 3394 participants was 35.1 (3.6) years; 1557 (45.9%) were African American; 1892 (55.7%) were women; and 103 (3.0%) were taking antihypertensive medication. During a median follow-up of 20.0 (interquartile range, 19.4-20.2) years, 162 CVD events and 181 deaths occurred. When all BP pattern measurements were entered into the same model including a single SBP measurement at the year 10 examination, the hazard ratios for CVD events for each 1-SD increase in SBP measures were 1.25 (95% CI, 0.90-1.74) for mean SBP, 1.23 (95% CI, 1.07-1.43) for VIM SBP, and 0.99 (95% CI, 0.81-1.26) for annual change of SBP. The VIM for SBP was the only BP pattern associated with all-cause mortality (hazard ratio, 1.24; 95% CI, 1.09-1.41).
CONCLUSIONS AND RELEVANCE
The results of this study suggest that the assessment of visit-to-visit SBP variability may help identify young adults at increased risk for CVD and all-cause mortality later in life.
重要性
确定年轻成年人中与晚年心血管疾病（CVD）事件相关的血压（BP）模式，可能有助于识别具有更高 CVD 风险的年轻成年人。
目的
确定在年轻成年期和中年期之间，从年轻成年期到中年期的 BP 长期变化率和 BP 变化率是否与 CVD 和全因死亡率相关，而与年轻成年期的平均 BP 和中年期的单次 BP 无关。
设计、地点和参与者：这项前瞻性队列研究包括来自冠状动脉风险发展在年轻人（CARDIA）研究中的 3394 名非裔美国人和白人参与者的基于社区的样本，于 1985 年 3 月至 1986 年 6 月招募。通过基线和基线后 2、5、7 和 10 年的测量评估收缩压（SBP）的 SBP 模式。通过 SBP 可变性独立于平均值（VIM）来估计就诊间 SBP 可变性。数据于 1985 年 3 月至 2015 年 8 月收集，并于 2019 年 6 月至 10 月进行分析。
主要结果和措施
通过 2015 年 8 月评估心血管疾病和全因死亡率。使用 Cox 比例风险回归模型确定每个 SBP 模式与 CVD 事件和全因死亡率的关联。
结果
在第 10 年，3394 名参与者的平均（SD）年龄为 35.1（3.6）岁；1557 名（45.9%）为非裔美国人；1892 名（55.7%）为女性；103 名（3.0%）正在服用抗高血压药物。在中位随访 20.0（四分位距，19.4-20.2）年期间，发生了 162 例 CVD 事件和 181 例死亡。当所有 BP 模式测量值都包含在包括第 10 次检查中单次 SBP 测量的相同模型中时，SBP 测量值每增加 1-SD，CVD 事件的风险比分别为 1.25（95%CI，0.90-1.74），平均 SBP，1.23（95%CI，1.07-1.43），SBP 的年变化为 VIM SBP，0.99（95%CI，0.81-1.26）。SBP 的 VIM 是唯一与全因死亡率相关的 BP 模式（风险比，1.24；95%CI，1.09-1.41）。
结论和相关性
这项研究的结果表明，评估就诊间 SBP 可变性可能有助于识别晚年 CVD 和全因死亡率风险增加的年轻成年人。
Zotero 插件