青春期的血壓可以預測青年時的高血壓
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
June 18, 2010 — 根據線上發表於6月14日高血壓(Hypertension)期刊的研究結果，青春期的血壓可以預測青年時的高血壓，正常血壓的青少男成年時發生高血壓的機率是青少女的3到4倍。
麻州波士頓布萊根婦女醫院的Amir Tirosh博士等人寫道，雖然青春期的高血壓前期代表著後來發生高血壓的風險增加，但是需要大範圍且追蹤期長的研究來進一步瞭解青春期血壓與青年時血壓之間的關聯。
研究世代包括了「Metabolic Lifestyle and Nutrition Assessment in Young Adults」研究中的23,191名青春期少年和3789名青春期少女，開始時，平均年紀為17.4歲，血壓小於140/90 mm Hg，根據目前的小兒血壓準則和身體質量指數(BMI)分類，在17-25歲時，採回溯方式確認高血壓發生率，在25 -42歲時，以前瞻方式再度測量血壓。
在17-42歲期間，有3810例新的高血壓案例，根據存活分析，男性的累積高血壓風險是女性的3-4倍高。校正年紀和BMI進行Cox回歸模式、並以開始時的血壓分類，顯示在17歲時屬於正常血壓範圍內的各種血壓組其高血壓風險比(HR)逐漸增加，沒有明顯的閾值效應，在血壓130-139/85- 89 mm Hg這組，男孩的HR是2.50 (95%信心區間是1.75 - 3.57)、女孩是2.31 (95% CI，0.71 - 7.60)。
Tirosh博士在新聞稿中表示，血壓值低於高血壓範圍的程度可以作為未來高血壓的良好預測因子，收縮壓達110的青少年未來發生高血壓的比率，比那些血壓值為100者高，且男孩和女孩間有所不同。
校正17歲時的血壓之後，當時的BMI和未來的高血壓風險有強烈關聯，特別是男孩。不過，30歲時的BMI減弱了此一關聯，特別是女孩。
Tirosh博士表示，BMI被視為和用來預測高血壓風險之血壓值有交互影響的獨立風險因素，整合之後，這些因素提供了一個簡單且有用、可作為在青少年時偵測那些成年時發生高血壓風險較高者的工具。
研究限制包括，只有在17歲時、於一個相當緊張、高度壓力的不良環境中為這研究世代測量一次血壓，17歲時的資料庫在基本資訊上相當有限。
Tirosh博士結論表示，只要開始調整生活型態和採取預防高血壓、心臟病和糖尿病的措施，都不算晚。年長者比較會接受高血壓、心臟病與其預防，但是，現在我們知道，對於小兒科醫師而言，血壓和體重的些微變化也是及早開始預防的警訊，預防疾病總是勝過治療它。
Talpiot 醫學領袖計畫、Chaim Sheba醫學中心、以色列Tel-Hashomer和以色列防衛軍醫學部隊資助此研究，研究作者們皆宣告沒有相關財務關係。
Hypertension. 線上發表於2010年6月14日。
Adolescent BP Predicts Progression to Hypertension in Young Adulthood
By Laurie Barclay, MD
Medscape Medical News
June 18, 2010 — Adolescent blood pressure (BP) predicts progression to hypertension in young adulthood, with teen-age boys with normal BP 3 to 4 times more likely than girls to have high BP early in adulthood, according to the results of a study reported online June 14 in Hypertension.
"Although prehypertension at adolescence is accepted to indicate increased future risk of hypertension, large-scale/long follow-up studies are required to better understand how adolescent ...BP tracks into young adulthood," write Amir Tirosh, MD, PhD, from Brigham and Women's Hospital in Boston, Massachusetts, and colleagues.
The study cohort consisted of 23,191 male and 3789 female adolescents enrolled in the Metabolic Lifestyle and Nutrition Assessment in Young Adults study. At baseline, mean age was 17.4 years, and BP was less than 140/90 mm Hg or categorized according to current criteria for pediatric BP and body mass index (BMI) values. Incidence of hypertension was determined retrospectively between the ages of 17 and 25 years and prospectively with repeated BP measurements between the ages of 25 and 42 years.
Between the ages of 17 and 42 years, 3810 new cases of hypertension were detected, with a cumulative risk for hypertension 3 to 4 times higher in men vs women, based on survival analyses. Cox regression models adjusted for age and BMI and stratified by baseline BP showed that the hazard ratio (HR) of hypertension increased gradually across BP groups within the normotensive range at age 17 years. There was no apparent threshold effect. In the group with BP 130 to 139/85 to 89 mm Hg, the HR was 2.50 (95% confidence interval [CI], 1.75 - 3.57) for boys and 2.31 (95% CI, 0.71 - 7.60) for girls.
"Blood pressure values well below the hypertensive range already can serve as good predictors for future hypertension," Dr. Tirosh said in a news release. "The rate of progression to hypertension is higher in teen-agers whose systolic blood pressure is 110 versus those whose blood pressure is 100 and is different between boys and girls."
Even after adjustment for BP at age 17 years, BMI at that age was strongly associated with a future risk for hypertension, especially in boys. However, BMI at age 30 years attenuated this association, especially in girls.
"BMI is considered an independent risk factor that interacts with blood pressure to predict future risk of hypertension," Dr. Tirosh said. "Together, these factors provide a simple and useful tool that can serve as a red flag to detect subgroups of teens at high risk of hypertension as adults while in their teens."
Limitations of this study include single-visit measurement of BP at age 17 years in a fairly stressful setting, higher-stress military environment in the study cohort, and database of age 17 years limited to rather basic information.
"It is never too early to start lifestyle modification and intervene to prevent hypertension, heart disease and diabetes," Dr. Tirosh concluded. "Hypertension, heart disease and their prevention have been perceived as more relevant to an older population, but now we know that slight changes in blood pressure and weight should represent an alert for pediatricians to begin prevention as early as possible. It is better to prevent a disease than treat it."
The Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel, and the Israeli Defense Forces Medical Corps funded this study. The study authors have disclosed no relevant financial relationships.
Hypertension. Published online June 14, 2010.
