Yan Lijing L, Liu Kiang, Matthews Karen A, Daviglus Martha L, Ferguson T Freeman, Kiefe Catarina I
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill 60611, USA.
JAMA. 2003 Oct 22;290(16):2138-48. doi: 10.1001/jama.290.16.2138.
Although psychosocial factors are correlated, previous studies on risk factors for hypertension have typically examined psychosocial factors individually and have yielded inconsistent findings.
To examine the role of psychosocial factors of time urgency/impatience (TUI), achievement striving/competitiveness (ASC), hostility, depression, and anxiety on long-term risk of hypertension. DESIGN, SETTING, AND STUDY POPULATION: A population-based, prospective, observational study using participant data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. A total of 3308 black and white adults aged 18 to 30 years (when recruited in 1985 and 1986) from 4 US metropolitan areas and followed up through 2000 to 2001.
Fifteen-year cumulative incidence of hypertension (systolic blood pressure of 140 mm Hg or higher, diastolic blood pressure of 90 mm Hg or higher, or taking antihypertensive medication).
The incidence of hypertension at year 15 was 15% from baseline and 13.6% from year 5. After adjusting for the same set of hypertension risk factors and each of the psychosocial factors of TUI, ASC, hostility, depression, and anxiety in 5 separate logistic regression models, higher TUI and hostility were significantly associated with risk of developing hypertension at 15-year follow-up for the total sample. Compared with the lowest score group, the adjusted odds ratio (OR) for TUI was 1.51 (95% confidence interval [CI], 1.12-2.03) for a score of 1; 1.47 (95% CI, 1.08-2.02) for a score of 2; and 1.84 (95% CI, 1.29-2.62) for a score of 3 to 4 (P for trend =.001). Compared with the lowest quartile group, the adjusted OR for hostility was 1.06 (95% CI, 0.76-1.47) for quartile 2; 1.38 (95% CI, 1.00-1.91) for quartile 3; and 1.84 (95% CI, 1.33-2.54) for quartile 4 (P for trend <.001). No consistent patterns were found for ASC, depression, or anxiety. Race- and sex-specific analyses and multivariable models with simultaneous adjustment for all 5 psychosocial factors and other hypertension risk factors had generally similar results.
Among young adults, TUI and hostility were associated with a dose-response increase in the long-term risk of hypertension.
尽管社会心理因素之间存在相关性，但先前关于高血压危险因素的研究通常单独考察社会心理因素，结果并不一致。
探讨时间紧迫感/不耐烦（TUI）、成就追求/竞争意识（ASC）、敌意、抑郁和焦虑等社会心理因素对高血压长期风险的作用。
设计、地点和研究人群：一项基于人群的前瞻性观察性研究，使用来自青年动脉粥样硬化风险发展研究（CARDIA研究）的参与者数据。1985年和1986年招募了来自美国4个大都市地区的3308名18至30岁的黑人和白人成年人，并随访至2000年至2001年。
15年高血压累积发病率（收缩压140mmHg及以上、舒张压90mmHg及以上或正在服用抗高血压药物）。
15年时高血压发病率从基线起为15%，从第5年起为13.6%。在5个单独的逻辑回归模型中，对同一组高血压危险因素以及TUI、ASC、敌意、抑郁和焦虑等社会心理因素进行调整后，较高的TUI和敌意与总样本在15年随访时患高血压的风险显著相关。与最低评分组相比，TUI评分为1时调整后的比值比（OR）为1.51（95%置信区间[CI]，1.12 - 2.03）；评分为2时为1.47（95%CI，1.08 - 2.02）；评分为3至4时为1.84（95%CI，1.29 - 2.62）（趋势P值 = 0.001）。与最低四分位数组相比，敌意的四分位数2调整后的OR为1.06（95%CI，0.76 - 1.47）；四分位数3为1.38（95%CI，1.00 - 1.91）；四分位数4为1.84（95%CI，1.33 - 2.54）（趋势P值 < 0.001）。未发现ASC、抑郁或焦虑的一致模式。种族和性别特异性分析以及同时调整所有5种社会心理因素和其他高血压危险因素的多变量模型结果总体相似。
在年轻成年人中，TUI和敌意与高血压长期风险的剂量反应性增加有关。
