Cumulative exposure to systolic blood pressure during young adulthood through midlife and the urine albumin-to-creatinine ratio at midlife

Holly Kramer, Laura Colangelo, Cora E. Lewis, David R. Jacobs, Mark Pletcher, Kirstin Bibbins-Domingo, Alex Chang, David Siscovick, Michael Shlipak, Carmen A. Peralta, Nisha Bansal, Paul Muntner, Kiang Liu

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

BACKGROUND Higher blood pressure during young adulthood may increase cardiovascular and kidney disease risk later in life. This study examined the association of cumulative systolic blood pressure (SBP) exposure during young adulthood through midlife with urine albumin-to-creatinine ratios (ACR) measured during midlife. METHODS We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a biracial cohort recruited in 4 urban areas during years 1985-1986. Cumulative SBP was calculated as the average SBP between 2 exams multiplied by years between exams over 20 year years. ACR was measured 20 years after baseline when participants were age 43-50 years (midlife). A generalized additive model was used to examine the association of log ACR as a function of cumulative SBP with adjustment for covariates including SBP measured concurrently with ACR. RESULTS Cumulative SBP ranged from a low of 1,671 to a high of 3,260 mm Hg. Participants in the highest cumulative SBP quartile were more likely to be male (61.4% vs. 20.7%; P < 0.001), Black (61.5% vs. 25.6%; P < 0.001) and have elevated ACR (18.7% vs. 4.8%; P < 0.001) vs. lowest quartile. Spline regression curves of ACR vs. cumulative SBP demonstrated an inflection point in ACR with cumulative SBP levels >2,350 mm Hg with linear increases in ACR above this threshold. Adjusted geometric mean ACR values were significantly higher with cumulative SBP ≥2,500 vs. <2500 (9.18 [1.06] vs. 6.92 [1.02]; P < 0.0001). CONCLUSION Higher SBP during young adulthood through midlife is associated with higher ACR during midlife.

Original languageEnglish (US)
Pages (from-to)502-509
Number of pages8
JournalAmerican journal of hypertension
Volume30
Issue number5
DOIs
StatePublished - May 1 2017

Bibliographical note

Funding Information:
The Coronary Artery Risk Development in Young Adults Study (CARDIA) is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (HHSN268201300025C and HHSN268201300026C), Northwestern University (HHSN268201300027C), University of Minnesota (HHSN268201300028C), Kaiser Foundation Research Institute (HHSN268201300029C), and Johns Hopkins University School of Medicine (HHSN268200900041C). CARDIA is also partially supported by the Intramural Research Program of the National Institute on Aging (NIA) and an intra-agency agreement between NIA and NHLBI (AG0005).

Keywords

  • albumin-to-creatinine ratios
  • blood pressure
  • chronic kidney disease
  • hypertension
  • microalbuminuria
  • midlife
  • race
  • risk factors
  • systolic blood pressure
  • urine albumin excretion
  • young adulthood

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