Johns Hopkins University, USA.
Department of Public Health, Texas Tech University Health Sciences Center, USA.
Eur J Prev Cardiol. 2021 Oct 25;28(13):1445-1451. doi: 10.1177/2047487320915342.
Cumulative blood pressure (BP) is a measure that incorporates the severity and duration of BP exposure. The prognostic significance of cumulative BP in young adults for cardiovascular diseases (CVDs) in comparison to BP severity alone is, however, unclear.
We investigated 3667 Coronary Artery Risk Development in Young Adults participants who attended six visits over 15 years (year-0 (1985-1986), year-2, year-5, year-7, year-l0, and year-15 exams). Cumulative BP was calculated as the area under the curve (mmHg × years) from year 0 through year 15. Cox models assessed the association between cumulative BP (year 0 through year 15), current BP (year 15), and BP change (year 0 and year 15) and CVD outcomes. Mean (standard deviation) age at year 15 was 40.2 (3.6) years, 44.1% were men, and 44.1% were African-American. Over a median follow-up of 16 years, there were 47 heart failure (HF), 103 coronary heart disease (CHD), 71 stroke, and 191 CVD events. Cumulative systolic BP (SBP) was associated with HF (hazard ratio (HR) = 2.14 (1.58-2.90)), CHD (HR = 1.49 (1.19-1.87)), stroke (HR = 1.81 (1.38-2.37)), and CVD (HR = 1.73 (1.47-2.05)). For CVD, the C-statistic for SBP (year 15) was 0.69 (0.65-0.73) and change in C-statistic with the inclusion of SBP change and cumulative SBP was 0.60 (0.56-0.65) and 0.72 (0.69-0.76), respectively. For CVD, using year-15 SBP as a reference, the net reclassification index (NRI) for cumulative SBP was 0.40 (p < 0.0001) and the NRI for SBP change was 0.22 (p = 0.001).
Cumulative BP in young adults was associated with the subsequent risk of HF, CHD, stroke, and CVD. Cumulative BP provided incremental prognostic value and improved risk reclassification for CVD, when compared to single BP assessments or changes in BP.
累积血压（BP）是一种综合了血压暴露的严重程度和持续时间的衡量指标。然而，与单纯的血压严重程度相比，年轻成年人累积血压对心血管疾病（CVDs）的预后意义尚不清楚。
我们调查了 3667 名参加冠状动脉风险发展在年轻人研究的参与者，他们在 15 年内参加了六次访问（第 0 年（1985-1986 年）、第 2 年、第 5 年、第 7 年、第 10 年和第 15 年检查）。累积血压通过从第 0 年到第 15 年的曲线下面积（mmHg×年）来计算。Cox 模型评估了累积 BP（第 0 年至第 15 年）、当前 BP（第 15 年）和 BP 变化（第 0 年和第 15 年）与 CVD 结局之间的关联。第 15 年时的平均（标准差）年龄为 40.2（3.6）岁，44.1%为男性，44.1%为非裔美国人。在中位随访 16 年后，有 47 例心力衰竭（HF）、103 例冠心病（CHD）、71 例中风和 191 例 CVD 事件。累积收缩压（SBP）与 HF（风险比（HR）=2.14（1.58-2.90））、CHD（HR=1.49（1.19-1.87））、中风（HR=1.81（1.38-2.37））和 CVD（HR=1.73（1.47-2.05））相关。对于 CVD，SBP（第 15 年）的 C 统计量为 0.69（0.65-0.73），纳入 SBP 变化和累积 SBP 后 C 统计量的变化分别为 0.60（0.56-0.65）和 0.72（0.69-0.76）。对于 CVD，以第 15 年的 SBP 为参照，累积 SBP 的净重新分类指数（NRI）为 0.40（p<0.0001），SBP 变化的 NRI 为 0.22（p=0.001）。
年轻成年人的累积血压与 HF、CHD、中风和 CVD 的后续风险相关。与单一 BP 评估或 BP 变化相比，累积 BP 提供了额外的预后价值和改善的风险再分类。
