Associations of Long-Term Visit-to-Visit Blood Pressure Variability With Subclinical Kidney Damage and Albuminuria in Adulthood: a 30-Year Prospective Cohort Study.
Associations of Long-Term Visit-to-Visit Blood Pressure Variability With Subclinical Kidney Damage and Albuminuria in Adulthood: a 30-Year Prospective Cohort Study.
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长期访视血压变异与成年亚临床肾损伤和蛋白尿的关联：一项 30 年前瞻性队列研究
DOI：
10.1161/hypertensionaha.121.18658
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发表时间：
2022-06
期刊：
影响因子：
8.3
通讯作者：
Mu, Jian-Jun
中科院分区：
文献类型：
--
作者：
Wang, Yang;Zhao, Peng;Chu, Chao;Du, Ming-Fei;Zhang, Xiao-Yu;Zou, Ting;Hu, Gui-Lin;Zhou, Hao-Wei;Jia, Hao;Liao, Yue-Yuan;Chen, Chen;Ma, Qiong;Wang, Dan;Yan, Yu;Sun, Yue;Wang, Ke-Ke;Niu, Ze-Jiaxin;Zhang, Xi;Man, Zi-Yue;Wu, Yong-Xing;Wang, Lan;Li, Hui-Xian;Zhang, Jie;Li, Chun-Hua;Gao, Wei-Hua;Gao, Ke;Lu, Wan-Hong;Desir, Gary, V;Delles, Christian;Chen, Fang-Yao;Mu, Jian-Jun
背景资料：最近的证据表明，长期访视间血压变异性（BPV）可能与心血管疾病的风险有关。因此，我们的目的是确定从儿童到中年的长期BPV与成年期亚临床肾损害（SKD）和蛋白尿的潜在相关性。研究方法：使用正在进行的汉中青少年高血压研究队列的数据，招募基线年龄为6至18岁的儿童和青少年，我们通过SD和平均真实的变异性（ARV）评估了30年（6次访视）的BPV。存在SKD定义为估计的肾小球滤过率为30 - 60 mL/min/1.73 m2或尿白蛋白/肌酐比值升高至少30 mg/g。白蛋白尿定义为尿白蛋白/肌酐比值≥30 mg/g。结果：在30年的随访中，1771名参与者中发生了204起SKD事件。在对30年的人口统计学、临床特征和平均血压进行校正后，较高的SDSBP、ARVSBP、SDDBP、ARVDBP、SDMAP、ARVMAP和ARVPP与较高的SKD风险显著相关。当我们使用从儿童到成年的累积BP暴露而不是平均BP作为调整因素时，结果相似。此外，更大的长期BPV也与白蛋白尿的风险相关。从儿童到中年的长期BPV与成年期SKD和蛋白尿的风险较高相关，与随访期间平均BP或累积BP暴露无关。结论：从早期识别长期BPV可能有助于预测晚年的肾脏疾病和心血管疾病。
Background: Recent evidence indicates that long-term visit-to-visit blood pressure variability (BPV) may be associated with risk of cardiovascular disease. We, therefore, aimed to determine the potential associations of long-term BPV from childhood to middle age with subclinical kidney damage (SKD) and albuminuria in adulthood. Methods: Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, which recruited children and adolescents aged 6 to 18 years at baseline, we assessed BPV by SD and average real variability (ARV) for 30 years (6 visits). Presence of SKD was defined as estimated glomerular filtration rate between 30 and 60 mL/min per 1.73 m2 or elevated urinary albumin-to creatinine ratio at least 30 mg/g. Albuminuria was defined as urinary albumin-to creatinine ratio ≥30 mg/g. Results: During 30 years of follow-up, of the 1771 participants, 204 SKD events occurred. After adjustment for demographic, clinical characteristics, and mean BP during 30 years, higher SDSBP , ARVSBP , SDDBP , ARVDBP , SDMAP , ARVMAP , and ARVPP were significantly associated with higher risk of SKD. When we used cumulative exposure to BP from childhood to adulthood instead of mean BP as adjustment factors, results were similar. In addition, greater long-term BPV was also associated with the risk of albuminuria. Long-term BPV from childhood to middle age was associated with higher risk of SKD and albuminuria in adulthood, independent of mean BP or cumulative exposure to BP during follow-up. Conclusions: Identifying long-term BPV from early age may assist in predicting kidney disease and cardiovascular disease in later life.