Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Am J Hypertens. 2021 Apr 2;34(3):234-241. doi: 10.1093/ajh/hpab009.
High blood pressure (BP) is a strong modifiable risk factor for cardiovascular disease (CVD). Longitudinal BP patterns themselves may reflect the burden of risk and vascular damage due to prolonged cumulative exposure to high BP levels. Current studies have begun to characterize BP patterns as a trajectory over an individual's lifetime. These BP trajectories take into account the absolute BP levels as well as the slope of BP changes throughout the lifetime thus incorporating longitudinal BP patterns into a single metric. Methodologic issues that need to be considered when examining BP trajectories include individual-level vs. population-level group-based modeling, use of distinct but complementary BP metrics (systolic, diastolic, mean arterial, mid, and pulse pressure), and potential for measurement errors related to varied settings, devices, and number of readings utilized. There appear to be very specific developmental periods during which divergent BP trajectories may emerge, specifically adolescence, the pregnancy period, and older adulthood. Lifetime BP trajectories are impacted by both individual-level and community-level factors and have been associated with incident hypertension, multimorbidity (CVD, renal disease, cognitive impairment), and overall life expectancy. Key unanswered questions remain around the additive predictive value of BP trajectories, intergenerational contributions to BP patterns (in utero BP exposure), and potential genetic drivers of BP patterns. The next phase in understanding BP trajectories needs to focus on how best to incorporate this knowledge into clinical care to reduce the burden of hypertensive-related outcomes and improve health equity.
高血压（BP）是心血管疾病（CVD）的一个强有力的可改变的危险因素。纵向血压模式本身可能反映了由于长期累积暴露于高 BP 水平而导致的风险负担和血管损伤。目前的研究已经开始将血压模式描述为个体一生中的轨迹。这些血压轨迹考虑了个体的绝对血压水平以及整个生命周期中血压变化的斜率，从而将纵向血压模式纳入单一指标中。在检查血压轨迹时需要考虑的方法学问题包括个体水平与人群水平的基于群组的建模、使用不同但互补的血压指标（收缩压、舒张压、平均动脉压、中值和脉搏压），以及与不同的设置、设备和读数数量相关的潜在测量误差。似乎在特定的发育时期可能会出现不同的血压轨迹，特别是青春期、妊娠期间和老年期。一生中的血压轨迹受到个体水平和社区水平因素的影响，与高血压事件、多种疾病（心血管疾病、肾脏疾病、认知障碍）和总体预期寿命有关。关于血压轨迹的附加预测价值、血压模式的代际贡献（宫内 BP 暴露）以及血压模式的潜在遗传驱动因素，仍存在许多未解决的关键问题。理解血压轨迹的下一阶段需要关注如何将这方面的知识最好地纳入临床护理，以减少与高血压相关的结果的负担并改善健康公平性。
