Weber M A, Smith D H, Neutel J M
The Brookdale University Hospital, SUNY Health Science Center, Brooklyn, NY 11212, USA.
Am J Nephrol. 2000 May-Jun;20(3):169-74. doi: 10.1159/000013579.
Hypertension is characterized not only by a metabolic syndrome that includes obesity and insulin resistance, but also by increases in left-ventricular mass (LVM), reduced arterial compliance and altered renal function. This investigation has examined a possible role for the renin-angiotensin system as well as body mass and insulin values in mediating these cardiovascular and renal aspects of the hypertension syndrome.
This was a cross-sectional study of 142 patients identified by community screening. Mean (+/-SE) age was 46 +/- 1 years and patients had stage I-II hypertension (blood pressure: 145 +/- 1/98 +/- 0.5 mm Hg). For analysis, patients were divided into 2 groups: those with body mass index (BMI) <27 kg/m(2) (lean, n = 72) or BMI >27 kg/m(2) (overweight, n = 70).
By univariate analysis, LVM in lean patients correlated significantly with plasma renin activity (PRA), plasma aldosterone, BMI and systolic BP; but with multivariate regression, only PRA (p < 0.01) and BMI (p < 0.04) remained in the model as independent predictors of LVM. For LVM in overweight patients, only BMI (p < 0.02) remained in the model. For total arterial compliance (stroke volume/pulse pressure) only fasting plasma insulin (in the overweight group) was significantly related (p < 0.01). For urinary protein excretion, the only predictor in lean patients was PRA (p < 0.02), whereas in overweight patients it was BMI (p < 0.03). For creatinine clearance, BMI (p < 0.01 in overweight patients) remained in the model, though by univariate regression PRA had an age-dependent dichotomous relationship to clearance: r = +0.25 (p < 0.01) in patients <55 years, but r = -0.54 (p < 0.01) in patients > or =55 years.
These findings suggest that in overweight patients cardiovascular and renal values depend chiefly on body weight and insulin, but that in normal weight hypertensives the renin-angiotensin system may play the major role.
高血压不仅以包括肥胖和胰岛素抵抗在内的代谢综合征为特征，还表现为左心室质量（LVM）增加、动脉顺应性降低和肾功能改变。本研究探讨了肾素 - 血管紧张素系统以及体重和胰岛素值在介导高血压综合征的这些心血管和肾脏方面可能发挥的作用。
这是一项对通过社区筛查确定的142例患者进行的横断面研究。平均（±标准误）年龄为46±1岁，患者患有I - II期高血压（血压：145±1/98±0.5 mmHg）。为进行分析，患者被分为两组：体重指数（BMI）<27 kg/m²的患者（瘦组，n = 72）或BMI>27 kg/m²的患者（超重组，n = 70）。
单因素分析显示，瘦组患者的LVM与血浆肾素活性（PRA）、血浆醛固酮、BMI和收缩压显著相关；但多因素回归分析显示，模型中仅PRA（p < 0.01）和BMI（p < 0.04）作为LVM的独立预测因素保留下来。对于超重患者的LVM，模型中仅保留了BMI（p < 0.02）。对于总动脉顺应性（每搏输出量/脉压），仅空腹血浆胰岛素（在超重组中）有显著相关性（p < 0.01）。对于尿蛋白排泄，瘦组患者的唯一预测因素是PRA（p < 0.02），而超重患者则是BMI（p < 0.03）。对于肌酐清除率，BMI（超重患者中p < 0.01）保留在模型中，尽管单因素回归分析显示PRA与清除率存在年龄依赖性的二分关系：<55岁患者中r = +0.25（p < 0.01），但≥55岁患者中r = -0.54（p < 0.01）。
这些发现表明，超重患者的心血管和肾脏指标主要取决于体重和胰岛素，但在正常体重的高血压患者中，肾素 - 血管紧张素系统可能起主要作用。
