儿童期至成年期血压变化对成年期心肾功能的影响

Effect of blood pressure status changes from childhood to adulthood on hypertension related cardiacrenal function in adulthood

目的分析儿童、成年血压状态对高血压心肾功能的影响。方法对1987年开展的“北京儿童血压研究”队列人群（6～18岁儿童共2505人）于2005年进行随访，随访412例，包括血压测量和心血管相关因素的健康体检。结果该人群成年期高血压患病率14．8％（61／412），高血压患者中超重肥胖者占83．6％，心肾功能异常的检出率为72．1％，随高血压严重程度增加，心肾损害愈严重。Logistic回归分析示，儿童成年高血压者发生相关器官功能异常的危险度（OR=4．072，95％CI=1．472～11．266）高于儿童期没有高血压而成年高血压者（OR=3．509，95％CI=1．548～7．957）；儿童期高血压，成年转为非高血压者发生心肾功能损害的危险性与两时期都没有高血压者比较没有明显增加（DR=1．086，95％CI=0．514—2．298，χ^2=0．047，P〉0．05）。结论单独存在儿童期高血压，成年血压正常后，发生高血压心肾功能异常的危险性没有明显增加，儿童期和成年期持续存在高血压者，成年期发生高血压心肾功能异常的危险性增强。防治儿童高血压有利于成人心血管病的防治工作。

Objective To assess the effect of blood pressure （BP） changes from childhood to adulthood on hypertension related cardiac and renal function in adulthood. Methods The ＂Beijing children and adolescents BP study cohort＂ consists of 2505 subjects 6-18 years of age who were enrolled in the baseline BP investigation in 1987. Among them, 412 individuals aged 23-37 years were successfully followed up in 2005. In this study, clinical examinations and questionnaire survey about risk factors of cardiovascular disease （CVD） were carried out. Results Among 412 adults, the prevalence rate of hypertension was 14. 8% （ 61/412 ） ; 83.6% of persons with hypertension were overweight or had obesity. Hypertension related cardiac and renal functional abnormalities were relatively common （72. 1% ） clinical signs among this adult population. With BP level elevation, cardiac and renal functions damage became more severe. The morbidity of cardiac and renal functional abnormalities in those who were hypertensive in childhood and were not hypertensive in adulthood was similar to those who were not hypertensive at both times. The morbidity of microalbuminuria and abnormalities in electrocardiogram （ECG） were higher in those who were hypertensive at both times than those who had appropriate BP levels in childhood and became hypertensive in adulthood. Adjusted for age, gender, BMI and body surface area （BSA） during adulthood, the left ventricular enddiastolic dimension （ LVd）, the left ventricular mass （ LVM）, the intraventricular septal thickness （ IVST）, the left ventricular posterior wall thickness （INPWT） in the group of hypertension were higher than that in the group which was not hypertensive, and the ejection fraction （EF） was lower in the group of hypertension in adulthood. The LVd, LVM, IVST, LVPWT and EF in those who were hypertensive in childhood and were not hypertensive in adulthood were similar to those who were not hypertensive at both times. Logistic regression analysis showed that persons who were hypertensive in childhood and remained so during adulthood were at an increased risk of cardiac and renal functional damage （OR = 4. 072, 95% CI = 1. 472 - 11. 266）. Those who were hypertensive in childhood and became normotensive in adulthood did not have significant abnormalities in cardiac and renal functions （OR = 1. 086,95% CI =0. 514 -2. 298 ,χ^2 = 0. 047, P = 0. 828 ）. Conclusion Persons who were hypertensive at both times were at an increased risk of cardiac and renal function damage. Those who were hypertensive in childhood and became normotensive in adulthood did not have significant abnormalities in cardiac and renal functions. Thus prevention and control of hypertension in children and adolescents may have important beneficial effects on prevention of CVD in adulthood.