Blood pressure trajectories in early adulthood and subclinical atherosclerosis in middle age.
Blood pressure trajectories in early adulthood and subclinical atherosclerosis in middle age.
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DOI：
10.1001/jama.2013.285122
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发表时间：
2014-02-05
影响因子：
120.7
通讯作者：
Lloyd-Jones, Donald
中科院分区：
文献类型：
--
作者：
Allen, Norrina B.;Siddique, Juned;Wilkins, John T.;Shay, Christina;Lewis, Cora E.;Goff, David C.;Jacobs, David R., Jr.;Liu, Kiang;Lloyd-Jones, Donald
血压（BP）水平的单一测量与动脉粥样硬化的发展有关；然而，血压的长期模式及其对心血管疾病风险的影响尚不清楚。确定成年早期常见的血压轨迹，并确定其与中年冠状动脉钙化（CAC）存在的关系。我们使用了CARDIA研究的数据，从1985-1986年的基线到25年的随访（2010-2011）。前瞻性队列研究CARDIA参与者为18-30岁的黑人和白人男性和女性。我们在基线和第2、5、7、10、15、20和25年检查了收缩压、舒张压和中压[计算为(SBP+DBP)/2，这是年轻人群中冠心病风险的重要标志]。潜在混合模型用于识别收缩压、舒张压和中血压随时间的变化轨迹。25岁时冠状动脉钙化大于或等于Agatston评分100。在4,681名参与者中，我们确定了5种不同的中期血压轨迹：低稳定（22% [95% CI 19.9-23.7], n=987），中度稳定（42% [40.3-44.3],n=2,085），中度升高（12% [10.4-14.0],n=489），升高-稳定（19% [17.1-20.0],n=903）和升高-升高（5% [4.0-5.5],n=217）。与低稳定组相比，血压水平升高的轨迹患CAC的几率更大。中度稳定组校正优势比（95% CI）为1.44(0.83-2.49)，中度增加组为1.86(0.91-3.82)，高度稳定组为2.28(1.24-3.70)，高度增加组为3.70（1.66-8.20）。低稳定组CAC≥100的校正患病率为5.8%。与低稳定组相比，中度稳定组、中度增加组、高度稳定组和高度增加组CAC≥100的发生率分别增加了2.7%、5%、6.3%和12.9%。调整基线和第25年BP后，相关性没有改变。孤立收缩期血压轨迹的结果相似，但舒张期血压轨迹的结果有所减弱。整个青年期的血压轨迹各不相同，较高的血压轨迹与中年时CAC的风险增加有关。血压的长期轨迹可能有助于更准确地识别亚临床动脉粥样硬化患者。
Single measures of blood pressure (BP) levels are associated with the development of atherosclerosis; however, long-term patterns in BP and their impact on CVD risk are poorly characterized. To identify common BP trajectories throughout early adulthood and to determine their association with presence of coronary artery calcification (CAC) during middle age. We used data from the CARDIA study from baseline in 1985-1986 through 25 years of follow-up (2010-2011). Prospective cohort study CARDIA participants were Black and White men and women aged 18-30 years at baseline. We examined systolic BP, diastolic BP, and mid-BP [calculated as (SBP+DBP)/2 and an important marker of CHD risk among younger populations] at baseline and years 2, 5, 7, 10, 15, 20, and 25. Latent mixture modeling was used to identify trajectories in SBP, DBP and mid-BP over time. Coronary artery calcification greater than or equal to Agatston score of 100 Agatston units at year 25. Among 4,681 participants, we identified 5 distinct mid-BP trajectories: Low-Stable (22% [95% CI 19.9-23.7], n=987), Moderate-Stable (42% [40.3-44.3], n=2,085), Moderate-Increasing (12% [10.4-14.0], n=489), Elevated-Stable (19% [17.1-20.0], n=903) and Elevated-Increasing (5% [4.0-5.5], n=217). As compared to the Low-Stable group, trajectories with elevated BP levels had greater odds of having CAC >100. Adjusted odds ratios (95% CI) were 1.44 (0.83-2.49) for Moderate-Stable, 1.86 (0.91-3.82) for Moderate-Increasing, 2.28 (1.24-3.70) for Elevated-Stable, and 3.70 (1.66-8.20) for Elevated-Increasing groups. The adjusted prevalence of CAC ≥ 100 was 5.8% in the Low-Stable group. These ORs represent an absolute increase of 2.7%, 5%, 6.3% and 12.9% for the prevalence of CAC ≥100 for the Moderate-Stable, Moderate-Increasing, Elevated Stable and Elevated Increasing groups respectively as compared to the Low-Stable Group. Associations were not altered after adjustment for baseline and year 25 BP. Findings were similar for trajectories of isolated systolic BP trajectories, but were attenuated for diastolic BP trajectories. BP trajectories throughout young adulthood vary and higher BP trajectories were associated with an increased risk of CAC in middle age. Long-term trajectories in BP may assist in more accurate identification of individuals with subclinical atherosclerosis.
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影响因子：
3.6
作者：
Nagin, Daniel S.;Odgers, Candice L.
通讯作者：
Odgers, Candice L.
DOI：
10.1016/0197-2456(91)90002-4
发表时间：
1991-02-01
期刊：
Controlled clinical trials
影响因子：
--
作者：
Cutter, G R;Burke, G L;Manolio, T A
通讯作者：
Manolio, T A
影响因子：
5
作者：
Carr, JJ;Crouse, JR;Burke, GL
通讯作者：
Burke, GL
影响因子：
158.5
作者：
Detrano, Robert;Guerci, Alan D.;Kronmal, Richard A.
通讯作者：
Kronmal, Richard A.
DOI：
10.1016/0735-1097(90)90282-t
发表时间：
1990-03-15
影响因子：
24
作者：
AGATSTON, AS;JANOWITZ, WR;DETRANO, R
通讯作者：
DETRANO, R