Stamler R, Ford C E, Stamler J
Northwestern University Medical School, Chicago, IL 60611.
Hypertension. 1991 Apr;17(4):553-64. doi: 10.1161/01.hyp.17.4.553.
Specific causes of death were analyzed for 10,908 participants in the Hypertension Detection and Follow-up Program, to explore possible explanations for the observed excess 8.3-year mortality from all causes in hypertensives with low body mass. Although the cardiovascular mortality rate among men in the lowest decile of body mass (body mass index 21.96 or less) was 50% higher than that of men in the median class (body mass index 26.4-28.8), death rate for noncardiovascular deaths was more than 2 1/2 times higher in men with lean versus median body mass. The pattern was similar among women. Among noncardiovascular causes, striking differences in mortality rates between lean hypertensives and those of average body mass were observed for cirrhotic death (relative risk of 12+ in men and 11+ in women), for nonmalignant respiratory disease in men (relative risk of 7+), for violent death (both sexes), and for malignant neoplasms in men. Prevalence of smoking was almost twice as high in the lowest compared with the median body mass group; among the lean, excess deaths, particularly noncardiovascular deaths, were concentrated among smokers. Thus, male smokers in the lowest decile of body mass constituted only 3% of the study population, but contributed 8% of all deaths, 11% of all noncardiovascular deaths, and 22% of all cirrhotic deaths. A larger proportion of deaths occurred early in follow-up in the lean versus other hypertensives, suggesting occult disease among the lean at baseline. There was no evidence that more severe or treatment-resistant hypertension was present in or could explain excess mortality among the hypertensives with low body mass. The inference from the findings is not that overweight is protective for hypertensives nor that excess risk is due to leanness per se. Rather, a reasonable hypothesis, particularly from findings on specific causes of death, is that excess mortality in lean hypertensives is due to deleterious lifestyles, particularly smoking and excess alcohol intake, contributing to both leanness and risk of death.
对高血压检测与随访项目中的10908名参与者的具体死因进行了分析，以探究体重低的高血压患者全因死亡率比观察到的高出8.3年的可能原因。尽管体重处于最低十分位数（体重指数为21.96或更低）的男性心血管死亡率比处于中位数组（体重指数为26.4 - 28.8）的男性高50%，但体重偏瘦的男性非心血管死亡率比体重处于中位数的男性高出2.5倍多。女性中也呈现出类似的模式。在非心血管病因中，体重偏瘦的高血压患者与平均体重者相比，肝硬化死亡（男性相对风险为12以上，女性为11以上）、男性非恶性呼吸道疾病（相对风险为7以上）、暴力死亡（男女皆是）以及男性恶性肿瘤的死亡率存在显著差异。体重最低组的吸烟率几乎是中位数体重组的两倍；在体重偏瘦者中，额外死亡，尤其是非心血管死亡，集中在吸烟者中。因此，体重处于最低十分位数的男性吸烟者仅占研究人群的3%，但却导致了8%的全因死亡、11%的所有非心血管死亡以及22%的所有肝硬化死亡。与其他高血压患者相比，体重偏瘦者在随访早期的死亡比例更高，这表明基线时体重偏瘦者存在隐匿性疾病。没有证据表明体重低的高血压患者存在更严重或难治性高血压，也无法解释其额外死亡率。研究结果的推断并非是超重对高血压患者有保护作用，也不是额外风险本身源于消瘦。相反，一个合理的假设，特别是基于特定死因的研究结果，是体重偏瘦的高血压患者的额外死亡率是由于有害的生活方式，尤其是吸烟和过量饮酒，这既导致了消瘦又增加了死亡风险。
