青少年时期血压轨迹及血压变异性与靶器官损害相关性的队列研究  

A cohort study on the association between blood pressure trajectories and variability in adolescence and subsequent target organ damage

作　　者：郭统帅 孙月 王丹[1] 胡桂霖 贾昊 杜鸣飞 牟建军[1] Guo Tongshuai;Sun Yue;Wang Dan;Hu Guilin;Jia Hao;Du Mingfei;Mu Jianjun(Department of Cardiology,First Affiliated Hospital of Medical School,Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院心血管内科,西安710061

出　　处：《中华心血管病杂志》2025年第1期28-36,共9页Chinese Journal of Cardiology

基　　金：国家自然科学基金(82070437);陕西省重点研发计划(2023-ZDLSF-50)。

摘　　要：目的探讨中国人群儿童期至中年期的血压轨迹及血压变异性与靶器官损伤发生风险的相关性。方法本研究为基于人群的长期随访队列研究。入选1987—2023年在汉中青少年高血压队列中至少进行了5次血压测量的参与者作为研究对象。采用基于群组的轨迹模型识别不同的收缩压和舒张压轨迹, 并根据血压轨迹将入选研究对象分为低增长组、中增长组和高增长组。通过标准差、独立于均值的变异性(VIM)和平均真实的变异性(ARV)等指标评估血压变异性, 在2023年末次随访时(中年期)评估靶器官损伤。采用logistic回归模型分析血压轨迹及血压变异性与靶器官损伤发生风险的关系。结果共入选2 447名研究对象, 中位年龄48岁, 男性1 373人(56.1%)。分组结果为:(1)根据收缩压:低增长组868人, 中增长组1 238人, 高增长组341人;(2)根据舒张压:低增长组894人, 中增长组1 263人, 高增长组290人。与收缩压低增长组相比, 收缩压中增长组(动脉硬化:OR=4.14, 95%CI 2.96~5.79;蛋白尿:OR=2.06, 95%CI 1.38~3.07;左心室肥厚:OR=1.68, 95%CI 1.00~2.82)和高增长组(动脉硬化:OR=15.44, 95%CI 10.14~23.50;蛋白尿:OR=5.80, 95%CI 3.63~9.29;左心室肥厚:OR=2.93, 95%CI 1.55~5.53)的靶器官损伤发生风险更高(P均<0.05)。舒张压中增长组较低增长组动脉硬化(OR=3.72, 95%CI 2.69~5.12)和蛋白尿(OR=1.67, 95%CI 1.15~2.42)的发生风险更高(P均<0.05), 而高增长组各靶器官损伤发生风险均较低增长组更高(动脉硬化:OR=10.84, 95%CI 7.08~16.61;蛋白尿:OR=3.72, 95%CI 2.31~5.99;左心室肥厚:OR=2.38, 95%CI 1.23~4.59;P均<0.05)。此外, 较高的收缩压变异性与动脉硬化(标准差:OR=2.25, 95%CI 1.96~2.57;VIM:OR=1.64, 95%CI 1.45~1.86;ARV:OR=1.70, 95%CI 1.50~1.93)和蛋白尿(标准差:OR=1.65, 95%CI 1.44~1.89;VIM:OR=1.41, 95%CI 1.22~1.63;ARV:OR=1.45, 95%CI 1.26~1.67)的发生风险增加相关(P均<0.05)。舒张压相关变异性指标与靶器官损伤相�Objective:To investigate the relationship between blood pressure trajectories and blood pressure variability with the risk of target organ damage in Chinese population from childhood to middle age.Methods:This study is a population-based,long-term follow-up cohort study.Participants who had their blood pressure measured at least 5 times in the Hanzhong Adolescent hypertension cohort from 1987 to 2023 were included in this study.Group-based trajectory modeling was used to identify different systolic and diastolic blood pressure trajectories,and the subjects were divided into low-increasing group,moderate-increasing group and high-increasing group according to blood pressure trajectories.Blood pressure variability was assessed using standard deviation(SD),variability independent of the mean(VIM),and average real variability(ARV).Target organ damage was evaluated during the final follow-up in 2023(middle age).Logistic regression models were used to analyze the relationship between blood pressure trajectories and blood pressure variability with the risk of target organ damage.Results:A total of 2447 subjects were included,with a median age of 48 years,of whom 1373 were male(56.1%).Based on systolic blood pressure,868 were in the low-increasing group,1238 in the moderate-increasing group,and 341 in the high-increasing group.For diastolic blood pressure,the distribution was 894,1263 and 290,respectively.Compared with the low-increasing group of systolic blood pressure,the moderate-increasing group(arteriosclerosis:OR=4.14,95%CI 2.96-5.79;proteinuria:OR=2.06,95%CI 1.38-3.07;left ventricular hypertrophy:OR=1.68,95%CI 1.00-2.82)and high-increasing group(arterial stiffness:OR=15.44,95%CI 10.14-23.50;proteinuria:OR=5.80,95%CI 3.63-9.29;left ventricular hypertrophy:OR=2.93,95%CI 1.55-5.53)had a higher risk of target organ damage(all P<0.005).The moderate-increasing group of diastolic blood pressure had a higher incidence of arterial stiffness(OR=3.72,95%CI 2.69-5.12)and proteinuria(OR=1.67,95%CI 1.15-2.42)than the low-increa

关 键 词：血压 血压轨迹 血压变异性 靶器官损害 

分 类 号：R54[医药卫生—心血管疾病]