Boyko Edward J, Shaw Jonathan E, Zimmet Paul Z, Chitson Pierrot, Tuomilehto Jaakko, Alberti Kurt George M M
International Diabetes Institute, Melbourne, Australia.
J Hypertens. 2008 Sep;26(9):1742-9. doi: 10.1097/HJH.0b013e328306c965.
To estimate the associations between new-onset hypertension and glycemia, insulin resistance, and overall and regional adiposity in a prospective study conducted in Mauritius.
Three thousand five hundred and eighty-one adults without hypertension, pregnancy, or known diabetes at baseline (1987) were followed for incident hypertension in 1992 and 1998, (systolic blood pressure > or =140 mmHg or diastolic blood pressure > or =90 mmHg or antihypertensive medication treatment). Other measurements included fasting plasma glucose and 2-h plasma glucose after a 75-g oral glucose load, fasting insulin, BMI, waist circumference, smoking, alcohol use, exercise, and demographic information. Insulin sensitivity was estimated by the computerized homeostasis model assessment (HOMA2) program.
In multivariable logistic models that included age, gender, ethnicity, alcohol use, exercise, education, systolic blood pressure, diastolic blood pressure, homeostasis model assessment, fasting plasma glucose, 2-h plasma glucose, BMI, and waist circumference, the independent predictors of incident hypertension by time of follow-up were (odds ratio for a 1 SD increase; 95% confidence interval): 1992 - age (1.73; 1.47-2.03), Creole ethnicity (1.42; 1.04-1.94), 2-h plasma glucose (1.26; 1.04-1.51); 1998 - age (1.60; 1.40-1.83) and BMI (1.33; 1.05-1.69). Also, systolic blood pressure and diastolic blood pressure significantly predicted hypertension at both time points.
Risk factor patterns depended on duration of follow-up. Over 5 years, hypertension was related to 2-h plasma glucose but not to measures of body size or homeostasis model assessment, while over 11 years, incident hypertension was related to BMI but not waist circumference, 2-h plasma glucose, or homeostasis model assessment. These findings support a more important role for 2-h plasma glucose and overall adiposity than waist circumference, fasting plasma glucose, or insulin resistance in the development of hypertension in Mauritius.
在毛里求斯进行的一项前瞻性研究中，评估新发高血压与血糖、胰岛素抵抗以及全身和局部肥胖之间的关联。
对3581名在基线时（1987年）无高血压、妊娠或已知糖尿病的成年人进行随访，观察其在1992年和1998年是否发生高血压（收缩压≥140 mmHg或舒张压≥90 mmHg或接受抗高血压药物治疗）。其他测量指标包括空腹血糖、75克口服葡萄糖负荷后2小时血糖、空腹胰岛素、体重指数（BMI）、腰围、吸烟、饮酒、运动以及人口统计学信息。胰岛素敏感性通过计算机稳态模型评估（HOMA2）程序进行估算。
在包含年龄、性别、种族、饮酒、运动、教育程度、收缩压、舒张压、稳态模型评估、空腹血糖、2小时血糖、BMI和腰围的多变量逻辑模型中，随访时新发高血压的独立预测因素为（标准差每增加1的比值比；95%置信区间）：1992年——年龄（1.73；1.47 - 2.03）、克里奥尔人种族（1.42；1.04 - 1.94）、2小时血糖（1.26；1.04 - 1.51）；1998年——年龄（1.60；1.40 - 1.83）和BMI（1.33；1.05 - 1.69）。此外，收缩压和舒张压在两个时间点均显著预测高血压。
危险因素模式取决于随访时间。超过5年，高血压与2小时血糖相关，但与体型测量或稳态模型评估无关；而超过11年，新发高血压与BMI相关，但与腰围、2小时血糖或稳态模型评估无关。这些发现支持在毛里求斯高血压发展过程中，2小时血糖和总体肥胖比腰围、空腹血糖或胰岛素抵抗发挥更重要的作用。
