Cardiovascular and metabolic predictors of progression of prehypertension into hypertension: the Strong Heart Study.
Cardiovascular and metabolic predictors of progression of prehypertension into hypertension: the Strong Heart Study.
复制标题
DOI：
10.1161/hypertensionaha.109.129031
复制
发表时间：
2009-11
期刊：
影响因子：
--
通讯作者：
Devereux RB
中科院分区：
文献类型：
--
作者：
De Marco M;de Simone G;Roman MJ;Chinali M;Lee ET;Russell M;Howard BV;Devereux RB
高血压前期（由JNC-7定义）经常演变为高血压（HTN）并增加心血管风险。尚不清楚代谢和/或心脏特征是否有利于高血压前期受试者HTN的发展。我们评估了625名参加强心研究（SHS）的未治疗高血压前期受试者的基线人体测量、实验室和超声心动图特征，这些受试者无心血管疾病（63%为女性; 22%为糖尿病;平均年龄59±7岁），以确定4年高血压发病率的预测因素。根据ADA标准评估糖尿病，并使用糖尿病特异性高血压定义。HTN的4年发病率为38%。HTN的发生与基线收缩压无关（OR= 1.60/10 mmHg，95% CI=1.30-2.00; p<0.0001），腰围（OR=1.10/10 cm，95% CI=1.01-1.30; p=0.04）和糖尿病（OR= 2.73，95% CI=1.77-4.21; p<0.0001），对年龄、性别、HbA 1c、HOMA指数、CRP、纤维蛋白原、LDL-HDL胆固醇、胰高糖素、血浆肌酸酐或尿白蛋白/肌酸酐。高左心室质量指数（OR=1.15/5 g/m2.7，95% CI=1.01-1.25; p= 0.03）或每搏输出量指数（OR=1.25/5ml/m2.04，95% CI=1.10-1.50; p= 0.03），以及基线收缩压和糖尿病的存在，也被确定为HTN事件的独立预测因子，而没有来自其他人体测量、代谢或超声心动图参数的额外预测贡献（所有P>0.10）。因此，38%的SHS高血压前期参与者进展为HTN可以通过较高的左心室质量和每搏输出量以及基线收缩压和普遍的糖尿病来预测。
Prehypertension (defined by JNC-7) frequently evolves to hypertension (HTN) and increases cardiovascular risk. It is unclear whether metabolic and/or cardiac characteristics favor development of HTN in prehypertensive subjects. We evaluated baseline anthropometric, laboratory and echocardiographic characteristics of 625 untreated prehypertensive participants in the Strong Heart Study (SHS), without prevalent cardiovascular disease (63% women; 22% diabetes; mean age 59±7 years) to identify predictors of 4-year incidence of hypertension. Diabetes was assessed by ADA criteria and diabetes-specific definition of hypertension was used. Four-year incidence of HTN was 38%. Incident HTN was independently predicted by baseline systolic blood pressure (OR= 1.60 per 10 mmHg, 95% CI=1.30-2.00; p<0.0001), waist circumference (OR=1.10 per 10 cm, 95% CI=1.01-1.30; p=0.04) and diabetes (OR= 2.73, 95% CI=1.77-4.21; p<0.0001), with no significant effect for age, gender, HbA1c, HOMA index, CRP, fibrinogen, LDL-HDL cholesterol, tryglicerides, plasma creatinine or urine albumin/creatinine. Higher left ventricular mass index (OR=1.15 per 5 g/m2.7, 95% CI=1.01-1.25; p= 0.03) or stroke volume index (OR=1.25 per 5 ml/m2.04, 95% CI=1.10-1.50; p= 0.03) were also identified, together with baseline systolic blood pressure and presence of diabetes, as independent predictors of incident HTN, without additional predictive contribution from other anthropometric, metabolic or echocardiographic parameters (all p>0.10). Thus, progression to HTN in 38% of SHS pre-hypertensive participants could be predicted by higher left ventricular mass and stroke volume in addition to baseline systolic blood pressure and prevalent diabetes.