Objective: The aim of this study was to investigate the association of both peripheral and central systolic blood pressure (pSBP and cSBP) with urinary albumin-to-creatinine ratio (UACR) in a community-based population in Beijing. Methods: A total of 3 479 Chinese subjects with questionnaire, UACR, pSBP, and cSBP data available were included from an atherosclerosis cohort of Peking University First Hospital in Shijingshan District, Beijing followed up from April to July in 2014. Multivariate linear regression analyses were used to examine the effect of pSBP and cSBP on lnUACR, and further tests for interactions were performed according to associated covariates. Results: Subjects were (59.0±8.6) years old, 36.2% (n=1 260) were male, 46.0% (n=1 595) had hypertension, and 20.2% (n=700) had diabetes. The pSBP and cSBP was (126.9 ± 16.4) mmHg (1 mmHg=0.133 kPa), and (136.3 ± 16.7) mmHg, respectively. P(50) (P(25)-P(75)) of UACR was 6.2 (4.2-11.1) mg/g. Both pSBP and cSBP were linearly associated with lnUACR adjusted for age, sex, body mass index, smoking status, drinking status, triglyceride, HDL-C, LDL-C, fasting glucose, creatinine, history of cardiovascular disease, antihypertensive and hypoglycemic agents (every 10 mmHg increase for pSBP: β=0.12, 95%CI: 0.10-0.15, P<0.001; for cSBP: β=0.11, 95%CI: 0.09-0.14, P< 0.001). The relationships were remained in subgroups such as non-hypertension group, non-diabetes group, normal UACR group, and 3-combination group (every 10 mmHg increase for pSBP: β=0.09, 95%CI: 0.05-0.13; β=0.12, 95%CI: 0.10-0.15; β=0.07, 95%CI: 0.06-0.09; β=0.08, 95%CI: 0.05-0.12. for cSBP: β=0.07, 95%CI: 0.04-0.11; β=0.11, 95%CI: 0.08-0.13; β=0.07, 95%CI: 0.05-0.08; β=0.06, 95%CI: 0.03-0.09, all P<0.001). Furthermore, analyses for interaction found that both pSBP and cSBP were more strongly associated with lnUACR in males, current smokers and subjects with high serum creatinine level (≥87 µmol/L) when compared with females, non-current smokers and subjects with low serum creatinine level (<87 µmol/L), respectively (all P for interaction<0.05). Conclusion: The results showed that both pSBP and cSBP were independently associated with UACR in this Chinese community-based population even in low risk population suggesting well-controlled both peripheral and central blood pressure may reduce urinary albumin. Males, current smokers and subjects with higher serum creatinine should pay more attention to the impacts of pSBP and cSBP on UACR.
目的：探讨北京社区人群外周和中心动脉血压与尿白蛋白肌酐比值（UACR）的关系。 方法：研究对象来自北京大学第一医院心内科于2014年4月至7月在北京市石景山区随访的动脉粥样硬化研究队列。纳入标准为：问卷调查资料完整；完成UACR检查；完成外周动脉收缩压（pSBP）和中心动脉收缩压（cSBP）测量。最终纳入了3 479名研究对象。采用多因素线性回归分析pSBP和cSBP对UACR的自然对数值（lnUACR）的影响，并进行相关因素的交互作用检验。 结果：研究对象年龄为（59.0±8.6）岁，男性为36.2%（1 260名），合并高血压和糖尿病的比例分别为46.0%（1 595例）和20.2% （700例）。pSBP和cSBP分别为（126.9±16.4）和（136.3±16.7）mmHg （1 mmHg=0.133 kPa）。UACR的P(50) （P(25)~P(75)）为6.2(4.2~11.1) mg/g。调整性别、年龄、BMI、吸烟、饮酒、FBG、TG、LDL-C、HDL-C、血肌酐、心血管疾病病史、降压药和降糖药后，多因素回归分析结果显示，pSBP和cSBP每升高10 mmHg， lnUACR分别增加0.12 (95%CI：0.10~0.15）和0.11 (95%CI：0.09~0.14）（P值均<0.001）；在非高血压、非糖尿病、UACR正常以及三者均符合的亚组人群中，lnUACR分别增加了0.09 （95%CI：0.05~0.13）和0.07 （95%CI：0.04~0.11），0.12 (95%CI：0.10~0.15）和0.11 (95%CI：0.08~0.13），0.07 (95%CI：0.06~0.09）和0.07 (95%CI：0.05~0.08），0.08 (95%CI：0.05~0.12）和0.06 (95%CI：0.03~0.09）（P值均<0.001）。交互作用检验发现，与女性、现在不吸烟、血肌酐<87 µmol/L的人群相比，男性、现在吸烟及血肌酐≥87 µmol/L的人群lnUACR与pSBP和cSBP的关联更强，差异有统计学意义（交互作用P值均<0.05）。 结论： pSBP和cSBP均与UACR呈正相关，在低风险人群中的结果一致，提示早期控制外周和中心血压均可能减少尿白蛋白，而在男性、现在吸烟及血肌酐升高的人群中更应该重视pSBP和cSBP对UACR的影响。.
Keywords: Atherosclerosis; Blood pressure; Urinary albumin-to-creatinine ratio.