成年人臂间和踝间收缩压差异与亚临床靶器官损伤的相关性分析

Association between inter-arm and inter-ankle systolic blood pressure differences and subclinical target organ damage in adults

摘要:

目的]探讨臂间收缩压差异(sIAD)和踝间收缩压差异(sIAND)与亚临床靶器官损伤(包括左心室肥厚、动脉硬化、蛋白尿和复合靶器官损伤)的相关性。 [方法]研究纳入了2023年汉中儿童高血压研究队列随访的2 069例受试者。采用无创性自动波形分析仪测量sIAD与sIAND。根据sIAND＜10 mmHg与≥10 mmHg将受试者分为sIAND正常组和sIAND异常组。采用Logistic回归分析sIAD和sIAND与亚临床靶器官损伤之间的关系。使用限制性立方样条模型评估sIAD、sIAND与复合靶器官损伤之间的剂量反应关系。使用受试者工作特征曲线下面积比较sIAD和sIAND不同标准对亚临床靶器官损伤的诊断效能。 [结果]参与者平均年龄48.28岁,女性占46.7%。sIAND正常者1 466例,异常者603例。在校正多种混杂因素后,sIAD与动脉硬化的发生风险显著相关(OR＝1.02,95%CI:1.00～1.04)。然而,sIAD与左心室肥厚、蛋白尿和复合靶器官损伤之间无显著相关性。与sIAND正常组相比,sIAND异常组左心室肥厚(OR＝1.72,95%CI:1.18～2.50)、动脉硬化(OR＝1.65,95%CI:1.33～2.06)、蛋白尿(OR＝1.78,95%CI:1.36～2.33)和复合靶器官损伤(OR＝1.76,95%CI:1.43～2.15)的发生风险显著增加。限制性立方样条模型显示,sIAND与亚临床靶器官损伤之间存在显著线性关联(P＜0.001),而sIAD与亚临床靶器官损伤之间无显著线性或者非线性关系。在诊断复合靶器官损伤时,与单独使用sIAND相比,联合使用sIAD和sIAND的诊断效能差异无显著性,而单独使用sIAD的诊断效能显著降低。 [结论]sIAND而非sIAD与亚临床靶器官损伤显著相关,提示sIAND可能成为亚临床靶器官损伤的预测指标。

Abstract:

Aim To investigate the correlation between inter-arm systolic blood pressure difference (sIAD), inter-ankle systolic blood pressure difference (sIAND) and subclinical target organ damage (including left ventricular hypertrophy, arteriosclerosis, proteinuria, and composite target organ damage). Methods This study enrolled 2 069 participants from the 2023 follow-up of the Hanzhong Pediatric Hypertension Research cohort. sIAD and sIAND were measured using a non-invasive automatic waveform analyzer. Participants were divided into normal and abnormal sIAND groups based on sIAND values of ＜10 mmHg or ≥10 mmHg. Logistic regression analysis was used to assess the relationships between sIAD, sIAND and subclinical target organ damage. Restricted cubic spline models were employed to evaluate the dose-response relationship between sIAD, sIAND and composite target organ damage. The area under the receiver operating characteristic curve (AUC) was used to compare the diagnostic performance of different criteria for sIAD and sIAND in identifying subclinical target organ damage. Results The participants had an average age of 48.28 years, with 46.7% being female. There were 1 466 individuals with normal sIAND and 603 with abnormal sIAND. After adjusting for multiple confounding factors, sIAD was significantly associated with an increased risk of arterial stiffness (OR＝1.2,5%CI:1.00～1.04). However, sIAD was not significantly associated with left ventricular hypertrophy (LVH), proteinuria, or composite target organ damage. Compared with the normal sIAND group, the abnormal sIAND group had significantly higher risks of LVH (OR＝1.2,5%CI:1.18～2.50), arterial stiffness (OR＝1.5,5%CI:1.33～2.06), proteinuria (OR＝1.8,5%CI:1.36～2.33), and composite target organ damage (OR＝1.6,5%CI:1.43～2.15). Restricted cubic spline models indicated a significant linear association between sIAND and subclinical target organ damage (P for linearity ＜0.001), whereas no significant linear or nonlinear relationships were observed for sIAD. Furthermore, in terms of diagnostic efficacy for composite target organ damage, the combined use of sIAD and sIAND showed comparable efficacy to using sIAND alone, whereas using sIAD alone was significantly less effective. Conclusion sIAND, but not sIAD, is significantly associated with subclinical target organ damage, suggesting that sIAND may serve as a predictive indicator for subclinical target organ damage.