Life course trajectories of systolic blood pressure using longitudinal data from eight UK cohorts.
Life course trajectories of systolic blood pressure using longitudinal data from eight UK cohorts.
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DOI：
10.1371/journal.pmed.1000440
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发表时间：
2011-06
期刊：
影响因子：
15.8
通讯作者：
Hardy R
中科院分区：
文献类型：
--
作者：
Wills AK;Lawlor DA;Matthews FE;Sayer AA;Bakra E;Ben-Shlomo Y;Benzeval M;Brunner E;Cooper R;Kivimaki M;Kuh D;Muniz-Terrera G;Hardy R
对来自英国的8个基于人群和职业的队列的分析揭示了整个生命过程中人群血压变化的模式。我们对收缩压（SBP）的年龄相关进展的理解大部分来自横断面数据，而不是直接捕获个体内的变化。我们使用来自七个基于人群的队列和一个主要是白领职业队列的纵向数据来估计收缩压的生命历程轨迹，每个队列都来自英国，数据涵盖不同但重叠的年龄阶段。数据来自30,372个人，包括102,583个收缩压观察，年龄从7岁到80岁以上。对每个队列进行多水平模型拟合。男女都有四个明显的生命过程阶段：收缩压的快速增加与青春期生长高峰相吻合，成年早期的缓慢增加，第四个十年开始的中年加速，以及成年后期的减速期，收缩压的增加减慢，最终收缩压下降。在调整了成年后体重指数的增加后，这些阶段仍然存在，尽管水平较低。在排除服用抗高血压药物的个体后，老年期的减速和下降不太明显。与基于人群的队列相比，职业队列的平均收缩压较低，中年年增长率较低，中年加速较晚。最大的性别差异出现在26岁时（男性高出8.2毫米汞柱，95% CI: 6.7, 9.8）；然后女性经历了更陡峭的增长，并在第七个十年赶上了。我们的调查显示了英国儿童时期收缩压进展的一般模式，并提示了普通人群和职业人群在成年期这种模式的可能差异。约三分之一的美国和英国成年人患有高血压（hypertension）。虽然高血压没有明显的症状，但它可以导致危及生命的心脏病发作、中风和其他形式的心血管疾病（CVD）。它是通过测量血压来诊断的——血压是指血液在体内流动时对大血管内部施加的力。心脏泵出血液时血压最高（收缩压[SBP]），心脏再次充血时血压最低（舒张压[DBP]）。正常成人血压的定义是收缩压小于130毫米汞柱（mm Hg），舒张压小于85毫米汞柱（血压130/85）。读数超过140/90表明有高血压。影响血压的因素很多，但超重的人和吃高脂肪或高盐食物的人患高血压的风险很高。此外，血压会随着年龄的增长而升高。轻度高血压通常可以通过改变生活方式来纠正，但许多人服用降压药来降低血压。一些试验表明收缩压是心血管疾病的一个重要的、可改变的危险因素。但是，为了确定预防心血管疾病的最佳方法，重要的是要了解收缩压在一生中是如何变化的，以及生活方式因素是如何影响这种与年龄相关的进展的。教科书上对年龄相关的收缩压变化的描述是基于在不同年龄的人群中在一个时间点测量收缩压的研究。然而，这种“横断面”研究没有捕捉到个体内收缩压的变化，并且可能受到与特定历史时期相关的环境效应的影响。测量与年龄相关的收缩压变化的最佳方法是通过纵向研究，在单一队列中重复测量收缩压多年。这样的研究正在进行中，但这些研究中的个体要达到老年还需要几十年的时间。因此，在这项研究中，研究人员使用了来自多个英国队列的数据，这些队列在不同但重叠的生命时期重复测量收缩压，以调查收缩压的生命历程轨迹。研究人员使用统计模型分析了七个基于人群的队列（参与者从普通人群中随机选择）和一个职业队列（公务员）的收缩压纵向研究数据。对30,372名年龄从7岁到80岁以上的个体进行了收缩压测量。研究人员的分析揭示了男女收缩压变化的四个阶段：青春期收缩压的快速增加，成年早期的缓慢增加，40岁开始的中年加速，以及成年后期收缩压增加减慢然后逆转的时期。当服用抗高血压药物的人被排除在分析之外时，最后一个阶段就不那么明显了。在调整了成年期身体质量指数（一种体脂测量）的增加后，与年龄相关的收缩压变化幅度相似，但每个年龄段的平均收缩压较低。与以人群为基础的队列相比，职业队列的平均收缩压较低，年收缩压增长较浅，中年加速较晚，这可能是由于社会决定的可改变的收缩压相关因素，如饮食和生活方式。最后，尽管女性在成年早期的收缩压低于男性，但她们在中年时的收缩压上升幅度更大（可能是因为更年期对盐敏感性的影响），因此到70岁时，男性和女性的平均收缩压相似。这些发现描述了英国儿童早期收缩压年龄相关进展的一般模式。这些发现可能无法推广，因为其他人群可能会接触到不同分布的可改变因素。此外，它们的准确性可能会受到不同队列间收缩压测量方法差异的影响。然而，这些发现——特别是职业队列中年收缩压的增加速度比人群队列慢——表明年龄相关血压升高的关键决定因素是可以改变的，可以作为心血管疾病预防的目标。目前需要进一步的研究来确定哪些因素影响收缩压的生命历程轨迹，并发现这些因素何时对收缩压的影响最大。请通过本摘要的在线版本http://dx.doi.org/10.1371/journal.pmed.1000440访问这些网站。美国国家心肺和血液研究所有关于高血压的患者信息（英语和西班牙语）美国心脏协会提供关于高血压和心血管疾病的信息（几种语言）英国国家健康服务选择网站也为患者提供关于高血压和心血管疾病的详细信息MedlinePlus提供了关于高血压，心脏病，和笔画（英文和西班牙文）
Analysis of eight population-based and occupational cohorts from the UK reveals the patterns of change of blood pressure in the population through the life course. Much of our understanding of the age-related progression of systolic blood pressure (SBP) comes from cross-sectional data, which do not directly capture within-individual change. We estimated life course trajectories of SBP using longitudinal data from seven population-based cohorts and one predominantly white collar occupational cohort, each from the United Kingdom and with data covering different but overlapping age periods. Data are from 30,372 individuals and comprise 102,583 SBP observations spanning from age 7 to 80+y. Multilevel models were fitted to each cohort. Four life course phases were evident in both sexes: a rapid increase in SBP coinciding with peak adolescent growth, a more gentle increase in early adulthood, a midlife acceleration beginning in the fourth decade, and a period of deceleration in late adulthood where increases in SBP slowed and SBP eventually declined. These phases were still present, although at lower levels, after adjusting for increases in body mass index though adulthood. The deceleration and decline in old age was less evident after excluding individuals who had taken antihypertensive medication. Compared to the population-based cohorts, the occupational cohort had a lower mean SBP, a shallower annual increase in midlife, and a later midlife acceleration. The maximum sex difference was found at age 26 (+8.2 mm Hg higher in men, 95% CI: 6.7, 9.8); women then experienced steeper rises and caught up by the seventh decade. Our investigation shows a general pattern of SBP progression from childhood in the UK, and suggests possible differences in this pattern during adulthood between a general population and an occupational population. Please see later in the article for the Editors' Summary About a third of US and UK adults have high blood pressure (hypertension). Although hypertension has no obvious symptoms, it can lead to life-threatening heart attacks, stroke, and other forms of cardiovascular disease (CVD). It is diagnosed by measuring blood pressure—the force that blood moving around the body exerts on the inside of large blood vessels. Blood pressure is highest when the heart is pumping out blood (systolic blood pressure [SBP]) and lowest when the heart is re-filling with blood (diastolic blood pressure [DBP]). Normal adult blood pressure is defined as an SBP of less than 130 millimeters of mercury (mm Hg) and a DBP of less than 85 mm Hg (a blood pressure of 130/85). A reading of more than 140/90 indicates hypertension. Many factors affect blood pressure, but overweight people and individuals who eat fatty or salty food are at high risk of developing hypertension. Moreover, blood pressure tends to increase with age. Mild hypertension can often be corrected by making lifestyle changes, but many people take antihypertensive drugs to reduce their blood pressure. Several trials have indicated that SBP is an important, modifiable risk factor for CVD. But, to determine the best way to prevent CVD, it is important to understand how SBP changes through life and how lifestyle factors affect this age-related progression. Textbook descriptions of age-related changes in SBP are based on studies that measured SBP at a single time point in groups (cohorts) of people of different ages. However, such “cross-sectional” studies do not capture within-individual changes in SBP and may be affected by environmental effects related to specific historical periods. The best way to measure age-related changes in SBP is through longitudinal studies in which SBP is repeatedly measured over many years in a single cohort. Such studies are underway, but it will be some decades before individuals in these studies reach old age. In this study, therefore, the researchers use data from multiple UK cohorts that had repeated SBP measurements taken over different but overlapping periods of life to investigate the life course trajectory of SBP. The researchers used statistical models to analyze data from longitudinal studies of SBP in seven population-based cohorts (the participants were randomly chosen from the general population) and in one occupational cohort (civil servants). SBP measurements were available for 30,372 individuals with ages spanning from seven years to more than 80 years. The researchers' analysis revealed four phases of SBP change in both sexes: a rapid increase in SBP during adolescent growth, a gentler increase in early adulthood, a midlife acceleration beginning in the fourth decade of life, and a period in late adulthood when SBP increases slowed and then reversed. This last phase was less marked when people taking antihypertensive drugs were excluded from the analysis. After adjusting for increases in body mass index (a measure of body fat) during adulthood, the magnitude of the SBP age-related changes was similar but the average SBP at each age was lower. Compared to the population-based cohorts, the occupational cohort had a lower average SBP, a shallower annual increase in SBP, and a later midlife acceleration, possibly because of socially determined modifiable SBP-related factors such as diet and lifestyle. Finally, although women had lower SBPs in early adulthood than men, they experienced steeper midlife SBP rises (probably because of a menopause-related effect on salt sensitivity) so that by the seventh decade of life, men and women had similar average SBPs. These findings describe the general pattern of age-related progression of SBP from early childhood in the UK. The findings may not be generalizable because other populations may be exposed to different distributions of modifiable factors. In addition, their accuracy may be affected by differences between cohorts in how SBP was measured. Nevertheless, these findings—in particular, the slower midlife increase in SBP in the occupational cohort than in the population-based cohorts—suggest that the key determinants of age-related increases in blood pressure are modifiable and could be targeted for CVD prevention. Further research is now needed to identify exactly which factors affect the life course trajectory of SBP and to discover when these factors have their greatest influence on SBP. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000440. The US National Heart Lung and Blood Institute has patient information about high blood pressure (in English and Spanish) The American Heart Association provides information on high blood pressure and on cardiovascular diseases (in several languages) The UK National Health Service Choices Web site also provides detailed information for patients about hypertension and about cardiovascular disease MedlinePlus provides links to further information about high blood pressure, heart disease, and stroke (in English and Spanish)
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