Sex differences in impact of cumulative systolic blood pressure from childhood to adulthood on albuminuria in midlife: a 30-year prospective cohort study

Abstract

Background and objectives: Albuminuria is recognized as being a predictor of cardiovascular and renal disease. We aimed to identify the impact of the long-term burden and trends of systolic blood pressure on albuminuria in midlife, as well as to explore sex differences concerning this relationship.

Methods: This longitudinal study consisted of 1,683 adults who had been examined 4 or more times for blood pressure starting in childhood, with a follow-up time period of 30 years. The cumulative effect and longitudinal trend of blood pressure were identified by using the area under the curve (AUC) of individual systolic blood pressure measurement with a growth curve random effects model.

Results: Over 30 years of follow-up, 190 people developed albuminuria, including 53.2% males and 46.8% females (aged 43.39 ± 3.13 years in the latest follow-up). The urine albumin-to-creatinine ratio (uACR) values increased as the total and incremental AUC values increased. Additionally, women had a higher albuminuria incidence in the higher SBP AUC groups than men do (13.3% for men vs. 33.7% for women). Logistic regression showed that the ORs of albuminuria for males and females in the high total AUC group were 1.34 (0.70-2.60) and 2.94 (1.50-5.74), respectively. Similar associations were found in the incremental AUC groups.

Conclusions: Higher cumulative SBP was correlated with higher uACR levels and a risk of albuminuria in middle age, especially in women. The identification and control of cumulative SBP levels from an early age may assist in reducing the incidences of renal and cardiovascular disease for individuals in later life.

Keywords: Albuminuria; Cumulative blood pressure; Middle-aged; Prospective studies; Sex characteristics.

Fig. 1

Illustration of the area under the curve (AUC) of systolic blood pressure (SBP). The area under the curve (AUC) of systolic blood pressure (SBP) was calculated as the integral of the curve parameters during the follow-up period in each of these two subjects. The incremental AUCs were different in the two individuals as examples. a = incremental AUC; b = baseline AUC; a + b = total AUC.

Fig. 2

The urinary albumin-to-creatinine ratio (uACR) by tertiles of cumulative SBP. (A) Total AUC of SBP in all of the subjects, (B) total AUC of SBP in male subjects, (C) total AUC of SBP in female subjects; (D) incremental AUC of SBP in all of the subjects, (E) incremental AUC of SBP in male subjects, (F) incremental AUC of SBP in female subjects. Low, the first tertile of cumulative SBP; Middle, the second tertile; High, the third tertile. The uACR values among different groups were compared with the Kruskal-Wallis test; ^#: P < 0.05 compared with the Low group; ^&: P < 0.05 compared with the Middle group

Fig. 3

Differences in the prevalence of albuminuria between sexes by cumulative SBP: (A) total AUC of SBP; (B) incremental AUC of SBP

Fig. 4

Effects of the cumulative burden and trends of SBP (classified according to tertiles) on albuminuria in adults between sexes(sensitivity analyses). All models adjusted for age, sex, body mass index at baseline, body mass index, waist, hips, smoking statue, alcohol consumption, exercise, history of hypertension, diabetes, hyperlipidaemia in 2017, and fasting blood glucose, ALT, AST, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, serum uric acid and serum creatinine