Structural and Functional Vascular Alterations and Incident Hypertension in Normotensive Adults
Structural and Functional Vascular Alterations and Incident Hypertension in Normotensive Adults
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DOI：
10.1093/aje/kwp319
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发表时间：
2010-01-01
影响因子：
5
通讯作者：
Kestenbaum, Bryan R.
中科院分区：
文献类型：
--
作者：
Peralta, Carmen A.;Adeney, Kathryn L.;Kestenbaum, Bryan R.
临床高血压前可能存在血管异常。通过泊松回归，作者研究了2512名血压正常、无心血管疾病的美国成年人的冠状动脉钙化(CAC)、颈总动脉内中膜厚度(CIMT)、主动脉扩张性、大小动脉弹性与高血压的关系。计算发生高血压(血压=140/90毫米汞柱或新的降压药)的发生率比。在人口统计学调整的模型中，CAC增加与高血压发病相关(CAC评分为30~99、100~399、400的发生率比(IRR)=1.35，95%可信区间(CI)：1.04、1.75；IRR=1.35，95%CI：1.02、1.78；以及IRR=1.59、95%CI：1.12、2.25)，但经进一步调整后有所减弱。常见CIMT增加与高血压发病相关(IRR=1.77，95%CI：1.28，2.46；IRR=1.80，95%CI：1.28，2.53)。主动脉扩张性最低的参与者与最高的参与者相比，患高血压的风险增加(IRR=1.75，95%CI：1.10，2.79)，大动脉弹性最低的参与者也是如此(IRR=1.49，95%CI：1.11，1.99)。小动脉弹性降低与高血压发病呈正相关(IRR=2.01，95%CI：1.39，2.91；IRR=2.47，95%CI：1.71，3.57；IRR=2.73，95%CI：1.88，3.95；IRR=2.85，95%CI：1.95，4.16)。血管结构和功能异常是高血压发病的独立预测因素。这些发现对于了解高血压的发病机制具有重要意义。
Vascular abnormalities may exist before clinical hypertension. Using Poisson regression, the authors studied the association of coronary artery calcium (CAC), common carotid intima-media thickness (CIMT), aortic distensibility, and large and small arterial elasticity with incident hypertension among 2,512 normotensive US adults free of cardiovascular disease. Incidence rate ratios for incident hypertension (blood pressure >= 140/90 mm Hg or new antihypertensive medication) were calculated. Increased CAC was associated with incident hypertension in demographics-adjusted models (incidence rate ratio (IRR) = 1.35, 95% confidence interval (CI): 1.04, 1.75; IRR = 1.35, 95% CI: 1.02, 1.78; and IRR = 1.59, 95% CI: 1.12, 2.25 for CAC scores of 30-99, 100-399, and >= 400, respectively) but was attenuated after further adjustment. Increased common CIMT was associated with incident hypertension (IRR = 1.77, 95% CI: 1.28, 2.46 for quintile 4; IRR = 1.80, 95% CI: 1.28, 2.53 for quintile 5). Participants with the lowest, compared with the highest, aortic distensibility had an increased risk of hypertension (IRR = 1.75, 95% CI: 1.10, 2.79), as did those with the lowest large arterial elasticity (IRR = 1.49, 95% CI: 1.11, 1.99). Lower small arterial elasticity was incrementally associated with incident hypertension starting at quintile 2 (IRR = 2.01, 95% CI: 1.39, 2.91; IRR = 2.47, 95% CI: 1.71, 3.57; IRR = 2.73, 95% CI: 1.88, 3.95; and IRR = 2.85, 95% CI: 1.95, 4.16). Structural and functional vascular abnormalities are independent predictors of incident hypertension. These findings are important for understanding the pathogenesis of hypertension.