Cumulative Exposure to Systolic Blood Pressure During Young Adulthood Through Midlife and the Urine Albumin-to-Creatinine Ratio at Midlife.
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).


CONCLUSIONS
Higher SBP during young adulthood through midlife is associated with higher ACR during midlife.
Department of Public Health Sciences, Division of Nephrology and Hypertension, Maywood, Illinois, USA.|Department of Medicine, Division of Nephrology and Hypertension, Maywood, Illinois, USA.
Holly
H
Kramer
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Laura
L
Colangelo
Departments of Medicine, Division of Preventive Medicine, University of Alabama, Birmingham, Alabama, USA.
Cora E
CE
Lewis
Division of Epidemiology and Community Health, School of Public Health University of Minnesota, Minneapolis, MN and also affiliated with the Department of Nutrition, University of Oslo, Oslo,Norway.
David R
DR
Jacobs
Departments of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.|Department of Medicine, University of California, San Francisco, California, USA.
Mark
M
Pletcher
Departments of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.|Department of Medicine, University of California, San Francisco, California, USA.|Department of Medicine, Division of Nephrology, University of California, San Francisco, California, USA.
Kirstin
K
Bibbins-Domingo
Department of Medicine, Division of Nephrology, Geisinger Health Systems, Danville, Pennsylvania, USA.
Alex
A
Chang
The New York Academy of Medicine, New York, New York, USA.|Departments of Medicine and Epidemiology, University of Washington, Seattle Departments of Medicine, Seattle, Washington, USA.
David
D
Siscovick
General Internal Medicine Section, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California, USA.
Michael
M
Shlipak
Department of Medicine, University of California, San Francisco, California, USA.|Department of Medicine, Division of Nephrology, University of California, San Francisco, California, USA.
Carmen A
CA
Peralta
Division of Nephrology, University of Washington, Seattle Departments of Medicine, Seattle, Washington, USA.
Nisha
N
Bansal
Department of Epidemiology, University of Alabama, Birmingham, Alabama, USA.
Paul
P
Muntner
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Kiang
K
Liu
D000328:Adult; D000367:Age Factors; D000419:Albuminuria / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D015415:Biomarkers / Q000652:urine; D001794:Blood Pressure; D016009:Chi-Square Distribution; D003404:Creatinine / Q000652:urine*; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D007668:Kidney / Q000503:physiopathology*; D016018:Least-Squares Analysis; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States
D015415:Biomarkers; D003404:Creatinine
albumin-to-creatinine ratios; blood pressure; chronic kidney disease; hypertension; microalbuminuria; midlife; race; risk factors; systolic blood pressure; urine albumin excretion; young adulthood; young adulthood.