Trajectories of Childhood Blood Pressure and Adult Left Ventricular Hypertrophy: The Bogalusa Heart Study.
Trajectories of Childhood Blood Pressure and Adult Left Ventricular Hypertrophy: The Bogalusa Heart Study.
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儿童血压和成人左心室肥厚的轨迹：Bogalusa 心脏研究
DOI：
10.1161/hypertensionaha.118.10975
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发表时间：
2018-07
期刊：
影响因子：
--
通讯作者：
Chen W
中科院分区：
文献类型：
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作者：
Zhang T;Li S;Bazzano L;He J;Whelton P;Chen W
本纵向研究旨在描述儿童期血压（BP）的纵向轨迹，并研究水平独立的儿童期BP轨迹对成人左心室肥厚（LVH）和重塑模式的影响。纵向队列包括1154名成年人（787名白人和367名黑人），他们从儿童期（4-19岁）到成年期（20-51岁）重复测量血压4 - 15次，并在成年期评估超声心动图LV尺寸。模型估计的水平和线性斜率的BP在儿童年龄点计算在1年的时间间隔，分别使用生长曲线参数和它们的一阶导数。线性和非线性曲线参数的BP显示显着的种族和性别差异，从15岁起。在种族性别组中，LVH成人的长期血压水平高于正常左心室质量的成人。左室肥厚组与正常组血压的线性和非线性斜率参数差异一致且显著。校正协变量后，4 ~ 9岁青春期前儿童的收缩压水平独立线性斜率与成人LVH的相关性显著为负相关（比值比=0.75-0.82; P=0.001-0.015），而13 ~ 19岁青少年的相关性显著为正相关（比值比=1.29-1.46; P=0.001-0.008）。这些关联在不同种族性别群体中是一致的。值得注意的是，在12至19岁的青春期，儿童期血压线性斜率与向心性左心室肥厚的相关性明显强于与偏心性左心室肥厚的相关性。这些观察结果表明，成人左室肥厚和几何模式的BP轨迹的影响起源于童年。青春期是LVH发展的关键时期，这对早期预防具有重要意义。
This longitudinal study aims to characterize longitudinal blood pressure (BP) trajectories from childhood and examine the impact of level-independent childhood BP trajectories on adult left ventricular hypertrophy (LVH) and remodeling patterns. The longitudinal cohort consisted of 1154 adults (787 whites and 367 blacks) who had repeated measurements of BP 4 to 15 times from childhood (4–19 years) to adulthood (20–51 years) and assessment of echocardiographic LV dimensions in adulthood. Model-estimated levels and linear slopes of BP at childhood age points were calculated in 1-year intervals using the growth curve parameters and their first derivatives, respectively. Linear and nonlinear curve parameters of BP showed significant race and sex differences from age 15 years onwards. Adults with LVH had higher long-term BP levels than adults with normal LVM in race–sex groups. Linear and nonlinear slope parameters of BP differed consistently and significantly between LVH and normal groups. Associations of level-independent linear slopes of systolic BP with adult LVH were significantly inverse (odds ratio=0.75–0.82; P=0.001–0.015) in preadolescent children of 4 to 9 years but significantly positive (odds ratio=1.29–1.46; P=0.001–0.008) in adolescents of 13 to 19 years, adjusting for covariates. These associations were consistent across race–sex groups. Of note, the association of childhood BP linear slopes with concentric LVH was significantly stronger than that with eccentric LVH during the adolescence period of 12 to 19 years. These observations indicate that the impact of BP trajectories on adult LVH and geometric patterns originates in childhood. Adolescence is a crucial period for the development of LVH in later life, which has implications for early prevention.