Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China.
J Clin Hypertens (Greenwich). 2022 Apr;24(4):418-429. doi: 10.1111/jch.14447. Epub 2022 Mar 3.
This study aimed to explore whether brachial-ankle pulse wave velocity (baPWV) and brachial artery flow-mediated dilation (FMD) or the interaction of both parameters are associated with subclinical target organ damage (STOD) indices in patients with essential hypertension. A total of 4618 patients registered from January 2015 to October 2020 were included. baPWV and FMD were measured to evaluate arterial stiffness and endothelial dysfunction. Whereas left ventricular hypertrophy (LVH), urine albumin-creatinine ratio (UACR), and carotid intima-media thickness (CIMT) were obtained as STOD indicators. On multivariable logistic regression analysis with potential confounders, higher quartiles of baPWV and FMD were significantly associated with an increased risk of STOD. In patients <65 years of age, the odds ratio (OR) of LVH, UACR, and CIMT ≥.9 mm for the fourth versus the first quartile of baPWV were 1.765 (1.390-2.240), 2.832 (2.014-3.813), and 3.075 (2.315-4.084), respectively. In interaction analysis, an increase in baPWV shows a progressively higher risk of STOD across the quartiles of FMD. Also, the estimated absolute risks of LVH, UACR, and CIMT ≥.9 mm for the first to fourth quartile of baPWV increased from 1.88 to 2.75, 2.35 to 4.44, and 3.10 to 6.10, respectively, in patients grouped by FMD quartiles. The addition of baPWV to FMD slightly improved risk prediction for STOD. BaPWV and FMD were independently associated with an increased risk of STOD in patients with essential hypertension especially among patients <65 years of age. Patients with elevated baPWV and decreased FMD parameters are at increased risk of STOD.
这项研究旨在探讨肱踝脉搏波速度（baPWV）和肱动脉血流介导的扩张（FMD）或两者参数的相互作用是否与原发性高血压患者的亚临床靶器官损害（STOD）指数相关。共纳入了 2015 年 1 月至 2020 年 10 月期间登记的 4618 例患者。测量 baPWV 和 FMD 以评估动脉僵硬和内皮功能。而左心室肥厚（LVH）、尿白蛋白肌酐比（UACR）和颈动脉内膜中层厚度（CIMT）作为 STOD 指标。在进行多变量逻辑回归分析时，考虑了潜在的混杂因素，较高四分位的 baPWV 和 FMD 与 STOD 风险增加显著相关。在<65 岁的患者中，与第 1 四分位相比，第 4 四分位的 LVH、UACR 和 CIMT≥.9mm 的第四 quartile 的比值比（OR）分别为 1.765（1.390-2.240）、2.832（2.014-3.813）和 3.075（2.315-4.084）。在交互分析中，baPWV 增加与 FMD 四分位的 STOD 风险呈递增关系。此外，根据 FMD 四分位分组，baPWV 第 1 至第 4 四分位的 LVH、UACR 和 CIMT≥.9mm 的估计绝对风险从 1.88 增加到 2.75、2.35 增加到 4.44 和 3.10 增加到 6.10。当 FMD 降低时，baPWV 增加会略微提高 STOD 的风险预测。baPWV 和 FMD 与原发性高血压患者的 STOD 风险增加独立相关，尤其是在<65 岁的患者中。baPWV 升高和 FMD 参数降低的患者发生 STOD 的风险增加。
