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Blood pressure, nephrosclerosis, and age autopsy findings from the Honolulu Heart Program
R E Tracy1, C J MacLean, D M Reed
1Pathology Department, Louisiana State University Medical Center, New Orleans.
Insights
This study quantifies nephrosclerosis using a new method in Japanese-American men, finding it predicts blood pressure levels. The findings validate a predictive function for blood pressure and cardiovascular health.
Area of Science:
- Nephrology
- Cardiovascular Pathology
- Gerontology
Background:
- Nephrosclerosis, indicated by fibrous intimal thickening in small renal arteries, is a key aspect of arteriosclerosis.
- The Honolulu Heart Program provided a cohort of Japanese-American men with prior clinical data, including blood pressure.
- A novel morphometric technique was employed to quantify nephrosclerosis.
Purpose of the Study:
- To measure nephrosclerosis using a new morphometric procedure.
- To verify a previously established mathematical function for predicting blood pressure (BP) based on nephrosclerosis and age.
- To explore the relationship between nephrosclerosis, blood pressure, and causes of death.
Main Methods:
- A new morphometric procedure was used on 154 autopsies of Japanese-American men.
- Periodic acid-Schiff (PAS)-stained renal cortex sections were analyzed.
- Interlobular artery diameters and intimal thicknesses were measured at 'remote' (80-130 microns) and 'close' (160-300 microns) levels.
Main Results:
- The previously developed mathematical function accurately predicted observed blood pressure levels in 92% of subjects.
- Correlation coefficients between blood pressure and nephrosclerosis measures at close and remote levels were significant (r = 0.34 and 0.40).
- Subjects with cardiovascular-renal causes of death showed significant differences in nephrosclerosis and blood pressure compared to others.
Conclusions:
- The study validates a predictive function for blood pressure using quantified nephrosclerosis and age.
- Nephrosclerosis and blood pressure are significant contributing factors to cardiovascular-renal causes of death.
- The association between nephrosclerosis and aortic atherosclerosis is stronger than explained by blood pressure alone.
Abstract:
The aspect of nephrosclerosis reflected by fibrous intimal thickening of small arteries (arteriosclerosis) was measured by a newly introduced morphometric procedure in 154 autopsies of Japanese-American men in Honolulu. These men were subjects of the Honolulu Heart Program and had previously been assessed for blood pressure and other clinical characteristics in a prospective study. In periodic acid-Schiff (PAS)-stained sections of renal cortex, measurements were made of interlobular artery diameters and intimal thicknesses. Vessels of outer diameter 80 to 130 microns and 160 to 300 microns were examined separately and are called the "remote" and "close" levels of the interlobular arteries, respectively, defined in relation to the heart. Nephrosclerosis thus quantified, together with age, could be used to predict the levels of blood pressure (BP) to be found in retrospective review of past records. The mathematical function obtained in a former study to make these predictions was found to predict the observed levels of blood pressure to an acceptable degree in the groupings that involved 92% of the subjects. Verification of that formerly obtained predictive function is now claimed. Correlation coefficients relating BP to close and remote measures were about of equal magnitude (r = 0.34 and 0.40, respectively). Subjects with cardiovascular-renal causes of death differed in both nephrosclerosis and blood pressure from subjects whose cause of death was unrelated to cardiovascular-renal diseases; the two factors taken together each contributed significantly to the cause of death difference. Correlations between nephrosclerosis and aortic atherosclerosis were stronger than could be explained solely by a linkage to observed values of blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)