Associations of Long-Term Visit-to-Visit Blood Pressure Variability With Subclinical Kidney Damage and Albuminuria in Adulthood: a 30-Year Prospective Cohort Study

Abstract

Background: Recent evidence indicates that long-term visit-to-visit blood pressure variability (BPV) may be associated with risk of cardiovascular disease. We, therefore, aimed to determine the potential associations of long-term BPV from childhood to middle age with subclinical kidney damage (SKD) and albuminuria in adulthood. Methods: Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, which recruited children and adolescents aged 6 to 18 years at baseline, we assessed BPV by SD and average real variability (ARV) for 30 years (6 visits). Presence of SKD was defined as estimated glomerular filtration rate between 30 and 60 mL/min per 1.73 m 2 or elevated urinary albumin-to creatinine ratio at least 30 mg/g. Albuminuria was defined as urinary albumin-to creatinine ratio ≥30 mg/g. Results: During 30 years of follow-up, of the 1771 participants, 204 SKD events occurred. After adjustment for demographic, clinical characteristics, and mean BP during 30 years, higher SD SBP , ARV SBP , SD DBP , ARV DBP , SD MAP , ARV MAP , and ARV PP were significantly associated with higher risk of SKD. When we used cumulative exposure to BP from childhood to adulthood instead of mean BP as adjustment factors, results were similar. In addition, greater long-term BPV was also associated with the risk of albuminuria. Long-term BPV from childhood to middle age was associated with higher risk of SKD and albuminuria in adulthood, independent of mean BP or cumulative exposure to BP during follow-up. Conclusions: Identifying long-term BPV from early age may assist in predicting kidney disease and cardiovascular disease in later life.

Association between high-mobility group box 2 and subclinical hypertension-mediated organ damage in young adults

“… 33 , 34 Taken together, all of the above measurements followed a standardized protocol 33 , 34 , 37 , 38 and were obtained by an experienced and certified sonographer. According to the current guidelines, 6 , 39 – 41 subclinical HMOD is defined as echocardiographic evidence of LVH [LVH was defined as left ventricular mass index (LVMI) > 115 g/m 2 for men and > 95 g/m 2 for women], 33 ultrasound evidence of carotid artery wall thickening (common cIMT > 0.9 mm) or plaques (a plaque was defined as a focal thickening ⩾ 1.5 mm in any segment of the carotid arteries), 33 increased arterial stiffness (cf-PWV ⩾ 10 m/s), 38 , 39 and microalbuminuria [a urinary albumin/creatinine ratio (UACR) ⩾ 2.5 mg/mmol in men or ⩾ 3.5 mg/mol in women] or early-stage renal damage [estimated glomerular filtration rate (eGFR): 30–60 mL/min/1.73 m 2 ]. 40 …”

Early-Life Cardiovascular Risk Factor Trajectories and Vascular Aging in Midlife: A 30-Year Prospective Cohort Study

“…Total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and fasting blood glucose were measured using an automatic biochemical analyzer (model 7600; Hitachi, Ltd, Tokyo, Japan) as previously described. 19,25,27,30,32…”

“…Details on the objectives and design of the study have been described elsewhere. 24,25 Briefly, the study began in 1987 when 4623 school children were enrolled from 26 rural sites from 3 towns (Qili, Laojun, and Shayan) in Hanzhong, Shanxi, China. During the baseline survey, the inclusion criteria were as follows: elementary and middle school students in 1987; no chronic disease by medical records; the ability to communicate fluently in Mandarin; and volunteered to participate in this study.…”

“…BP was measured by trained and certified observers using a standard mercury sphygmomanometer for the first 6 visits and electronic sphygmomanometer (Omron M6, Kyoto, Japan) in the 2017 follow-up as previously described. 19,[24][25][26][27] For children, BP was measured using standardized pediatric techniques with appropriate cuff size. Reading at Korotkoff phase I as SBP and the reading at Korotkoff phase V as diastolic BP.…”

“…Total cholesterol, triglycerides, highdensity lipoprotein (HDL), low-density lipoprotein (LDL), and fasting blood glucose were measured using an automatic biochemical analyzer (model 7600; Hitachi, Ltd, Tokyo, Japan) as previously described. 19,25,27,30,32 Participants who reported continuous or cumulative smoking for 6 months or more during their lifetime were defined as cigarette smokers. 31 Alcohol consumption was defined as daily alcohol use (liquor, beer, or wine) for ≥6.…”