Combined effects of child and adult elevated blood pressure on subclinical atherosclerosis: the International Childhood Cardiovascular Cohort Consortium.
Combined effects of child and adult elevated blood pressure on subclinical atherosclerosis: the International Childhood Cardiovascular Cohort Consortium.
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DOI：
10.1161/circulationaha.113.001614
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发表时间：
2013-07-16
期刊：
影响因子：
37.8
通讯作者：
Juonala M
中科院分区：
文献类型：
--
作者：
Juhola J;Magnussen CG;Berenson GS;Venn A;Burns TL;Sabin MA;Srinivasan SR;Daniels SR;Davis PH;Chen W;Kähönen M;Taittonen L;Urbina E;Viikari JSA;Dwyer T;Raitakari OT;Juonala M
儿童期血压（BP）水平升高与随后的动脉粥样硬化有关。然而，尚不确定这种风险是否在成年后获得正常BP的个体中减弱。本研究探讨了儿童和成人血压水平对成人颈动脉内膜中层厚度（cIMT）的影响。该队列由来自4项前瞻性研究的4，210名参与者组成（平均随访23年）。儿童血压升高的定义是根据国家高血压教育计划的表格。在成年期，收缩压≥ 120 mmHg、舒张压≥ 80 mmHg或自我报告使用抗高血压药物的个体的血压被归类为升高。在左颈总动脉中测量cIMT。高IMT定义为IMT ≥年龄、性别、种族和队列特异性第90百分位数。与儿童期和成人期血压正常的个体相比，血压持续升高的个体和儿童期血压正常但成人期血压升高的个体cIMT高风险增加（RR[95%CI]分别为1.82[1.47-2.38]和1.57[1.22-2.02]）。相比之下，儿童时期血压升高但成人时期血压升高的个体风险没有显著增加（1.24[0.92-1.67]）。此外，与血压持续升高的患者相比，这些患者cIMT增加的风险较低（0.66[0.50-0.88]）。当控制年龄、性别、肥胖和应用不同的BP定义时，结果是一致的。从儿童到成年血压持续升高的个体患颈动脉粥样硬化的风险增加。如果儿童期血压升高在成年后消退，则这种风险降低。
Elevated blood pressure (BP) levels in childhood have been associated with subsequent atherosclerosis. However, it is uncertain whether this risk is attenuated in individuals who acquire normal BP by adulthood. The present study examined the effect of child and adult BP levels on carotid artery intima-media thickness (cIMT) in adulthood. The cohort consisted of 4,210 participants from four prospective studies (mean follow-up 23 years). Childhood elevated BP was defined according to the tables from the National High Blood Pressure Education Program. In adulthood BP was classified as elevated for individuals with systolic BP ≥120mmHg, diastolic BP ≥80mmHg or with self-reported use of antihypertensive medications. cIMT was measured in the left common carotid artery. High IMT was defined as an IMT ≥age-, sex-, race-, and cohort-specific 90th percentile. Individuals with persistently elevated BP and individuals with normal childhood BP, but elevated adult BP had increased risk of high cIMT (RR[95%CI]) 1.82[1.47-2.38] and 1.57[1.22-2.02], respectively) when compared to individuals with normal child and adult BP. In contrast, individuals with elevated BP as children but not as adults did not have significantly increased risk (1.24[0.92-1.67]). In addition, these individuals had lower risk of increased cIMT (0.66[0.50-0.88]) when compared to those with persistently elevated BP. The results were consistent when controlling for age, sex, adiposity and when different BP definitions were applied. Individuals with persistently elevated BP from childhood to adulthood had increased risk of carotid atherosclerosis. This risk was reduced if elevated BP during childhood resolved by adulthood.