Mazza A, Zamboni S, Tikhonoff V, Scarpa R, Cuppini S, Zennaro R, Pessina A C, Casiglia E
Department of Internal Medicine, General Hospital Rovigo, Rovigo, Italy.
J Hum Hypertens. 2007 Dec;21(12):934-41. doi: 10.1038/sj.jhh.1002245. Epub 2007 Jun 14.
The classification of arterial hypertension (HT) to define metabolic syndrome (MS) is unclear in that different cutoffs of blood pressure (BP) have been proposed. We evaluated the categorization of HT most qualified to define MS in relationship with coronary heart disease (CHD) mortality at a population level. A total of 3257 subjects aged > or =65 years were followed up for 12 years. MS was defined according to the criteria of the National Education Cholesterol Program using three different categories of HT: MS-1 (systolic blood pressure (SBP) > or =130 and diastolic blood pressure (DBP) > or =85 mm Hg), MS-2 (SBP > or =130 or DBP > or =85 mm Hg) and MS-3 (pulse pressure (PP) > or =75 mm Hg in men and > or =80 mm Hg in women). Gender-specific adjusted hazard ratio (HR) with 95% confidence intervals (CI) for CHD mortality was derived from Cox analysis in the three MS groups, both including and excluding antihypertensive treatment. In women with MS untreated for HT, the risk of CHD mortality was always significantly higher than in those without MS, independent of categorization; the HR of MS was 1.73 (CI 1.12-2.67) using MS-1, 1.75 (CI 1.10-2.83) using MS-2 and 2.39 (CI 3.71-1.31) using MS-3. In women with MS treated for HT, the HR of CHD mortality was significantly increased only in the MS-3 group (1.92, CI 1.1-2.88). MS did not predict CHD in men. In conclusion, MS can predict CHD mortality in elderly women with untreated HT but not in those with treated HT; in the latter, PP is the most predictive BP value.
由于人们提出了不同的血压临界值，动脉高血压（HT）用于定义代谢综合征（MS）的分类尚不明确。我们在人群层面评估了最适合定义MS的HT分类与冠心病（CHD）死亡率之间的关系。共有3257名年龄≥65岁的受试者接受了12年的随访。根据国家胆固醇教育计划的标准，使用三种不同的HT类别来定义MS：MS-1（收缩压（SBP）≥130且舒张压（DBP）≥85 mmHg）、MS-2（SBP≥130或DBP≥85 mmHg）和MS-3（男性脉压（PP）≥75 mmHg，女性≥80 mmHg）。在三个MS组中，通过Cox分析得出了包括和不包括抗高血压治疗的情况下，特定性别的CHD死亡率调整风险比（HR）及95%置信区间（CI）。在未接受HT治疗的MS女性中，无论分类如何，CHD死亡风险始终显著高于无MS的女性；使用MS-1时，MS的HR为1.73（CI 1.12 - 2.67），使用MS-2时为1.75（CI 1.10 - 2.83），使用MS-3时为2.39（CI 3.71 - 1.31）。在接受HT治疗的MS女性中，仅MS-3组的CHD死亡率HR显著升高（1.92，CI 1.1 - 2.88）。MS不能预测男性的CHD。总之，MS可预测未接受HT治疗的老年女性的CHD死亡率，但不能预测接受治疗的女性；在后者中，PP是最具预测性的血压值。
