青少年高血压与未来终末期肾病的关联。
Association of Adolescent Hypertension With Future End-stage Renal Disease.
机构信息
Division of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ben Gurion University, Beer Sheva, Israel.
IDF Medical Corps, Tel Hashomer, Ramat Gan, Israel.
出版信息
JAMA Intern Med. 2019 Apr 1;179(4):517-523. doi: 10.1001/jamainternmed.2018.7632.
IMPORTANCE
Hypertension is a leading risk factor of cardiovascular morbidity and mortality. The role of nonmalignant hypertension as the sole initiating factor of end-stage renal disease (ESRD) in non-African American populations has recently been questioned.
OBJECTIVE
To investigate the association between hypertension and future ESRD in otherwise healthy adolescents.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study examined the data of 16- to 19-year-old healthy candidates for military service in the Israel Defense Forces between January 1, 1967, and December 31, 2013. Data were obtained from the central conscription registry of the Israel Defense Forces and the ESRD registry of the Israel Ministry of Health. Participants underwent a comprehensive medical assessment prior to their military service. Individuals with evidence of renal damage or kidney-related risk factors were excluded. The data analysis was conducted from February 12, 2017, to October 16, 2018.
MAIN OUTCOMES AND MEASURES
End-stage renal disease as recorded by the Israeli ESRD registry, including hemodialysis, peritoneal dialysis, renal transplant diagnosed between January 1, 1990, and December 31, 2014.
RESULTS
The cohort included 2 658 238 adolescents (1 596 709 [60.1%] male with a mean [SD] age of 17.4 [0.5] years), of whom 7997 (0.3%) had an established hypertension diagnosis. Half of the individuals in the hypertensive group were overweight (1559 [20.1%]) or obese (2243 [28.9%]), and most (7235 [90.5%]) were male. During a median follow-up of 19.6 years (52 287 945 person-years), 2189 individuals developed ESRD, with an incidence rate of 3.9 per 100 000 person-years. Adolescent hypertension was found to be associated with future ESRD (crude hazard ratio [HR], 5.07; 95% CI, 3.73-6.88). In a multivariable model adjusted for sex, age, years of education, body mass index, and other sociodemographic variables, the HR was 1.98 (95% CI, 1.42-2.77). When excluding participants with severe hypertension, the association with ESRD remained statistically significant (HR, 1.93; 95% CI, 1.37-2.70). In the subanalysis of nonoverweight adolescents, the association between hypertension and ESRD was statistically significant as well (HR, 2.11; 95% CI, 1.05-4.24).
CONCLUSIONS AND RELEVANCE
Hypertension appears to be associated with a doubling of the risk of future ESRD in an otherwise healthy adolescent population.
重要性
高血压是心血管发病率和死亡率的主要危险因素。最近，人们对非恶性高血压作为非非裔美国人终末期肾病（ESRD）的唯一起始因素的作用提出了质疑。
目的
研究 otherwise healthy 青少年中高血压与未来 ESRD 之间的关系。
设计、地点和参与者：本回顾性队列研究分析了 1967 年 1 月 1 日至 2013 年 12 月 31 日期间在以色列国防军服兵役的 16 至 19 岁健康候选人的资料。数据来自以色列国防军中央征兵登记处和以色列卫生部 ESRD 登记处。参与者在服兵役前接受了全面的医疗评估。有肾脏损伤或肾脏相关风险因素的人被排除在外。数据分析于 2017 年 2 月 12 日至 2018 年 10 月 16 日进行。
主要结果和措施
以色列 ESRD 登记处记录的终末期肾病，包括血液透析、腹膜透析、1990 年 1 月 1 日至 2014 年 12 月 31 日诊断的肾移植。
结果
队列包括 2658238 名青少年（1596709 名男性，平均年龄为 17.4[0.5]岁），其中 7997 名（0.3%）患有高血压确诊。高血压组中有一半人超重（1559 名[20.1%]）或肥胖（2243 名[28.9%]），大多数（7235 名[90.5%]）是男性。在中位随访 19.6 年（52287945 人年）期间，2189 人发展为 ESRD，发病率为 3.9/100000 人年。青少年高血压与未来 ESRD 有关（未校正危险比[HR]，5.07；95%CI，3.73-6.88）。在调整性别、年龄、受教育年限、体重指数和其他社会人口统计学变量后，HR 为 1.98（95%CI，1.42-2.77）。当排除严重高血压患者后，与 ESRD 的关联仍具有统计学意义（HR，1.93；95%CI，1.37-2.70）。在非超重青少年的亚分析中，高血压与 ESRD 之间的关联也具有统计学意义（HR，2.11；95%CI，1.05-4.24）。
结论和相关性
在 otherwise healthy 青少年人群中，高血压似乎与未来 ESRD 风险增加一倍有关。
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