Department of Evidence Based Medicine, Cardiovascular Institute and FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
BMC Public Health. 2010 Apr 12;10:189. doi: 10.1186/1471-2458-10-189.
It is still uncertain whether increased blood pressure (BP) has a stronger effect on the risk of cardiovascular disease (CVD) in lean persons than in obese persons. We tested it using a data set collected from a large cohort of Chinese adults.
Systolic and diastolic BP, body mass index (BMI) and other variables were measured in 169,871 Chinese men and women > or = 40 years of age in 1991 using standard protocols. Follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4%. Data were analyzed with Cox proportional hazards models.
After adjusted for age, sex, cigarette smoking, alcohol consumption, high school education, physical inactivity, geographic region, and urbanization, we found that the effects of systolic or diastolic BP on risk of CVD generally increased with the increasing BMI levels (underweight, normal, overweight, and obese). For example, hazard ratios (HRs) and 95% confidence interval (CI) per 1- standard deviation (SD) increase in systolic BP within corresponding BMI levels were 1.27(1.21-1.33), 1.45(1.41-1.48), 1.52 (1.45-1.59) and 1.63 (1.51-1.76), respectively. Statistically significant interactions (P < 0.0001) were observed between systolic BP, diastolic BP and BMI in relation to CVD. In baseline hypertensive participants we found both obese men and women had higher risk of CVD than normal-weight persons. The multivariate-adjusted HRs(95%CI) were 1.23(1.03-1.47) and 1.20(1.02-1.40), respectively.
Our study suggests that the magnitude of the association between BP and CVD generally increase with increasing BMI. Hypertension should not be regarded as a less serious risk factor in obese than in lean or normal-weight persons in Chinese adults.
目前尚不清楚血压升高对心血管疾病风险的影响在瘦人中是否强于肥胖人群。我们利用来自中国成年人大型队列的研究数据对此进行了检验。
1991 年，采用标准方案测量了 169871 名年龄≥40 岁的中国男女的收缩压和舒张压、体重指数（BMI）和其他变量。1999-2000 年进行了随访评估，应答率为 93.4%。采用 Cox 比例风险模型进行数据分析。
在校正年龄、性别、吸烟、饮酒、高中学历、缺乏运动、地理位置和城市化程度后，我们发现收缩压或舒张压对 CVD 风险的影响通常随着 BMI 水平的升高而增加（体重不足、正常、超重和肥胖）。例如，在相应 BMI 水平内，收缩压每增加 1 个标准差（SD）的危险比（HR）及其 95%可信区间（CI）分别为 1.27（1.21-1.33）、1.45（1.41-1.48）、1.52（1.45-1.59）和 1.63（1.51-1.76）。收缩压、舒张压与 BMI 与 CVD 之间存在统计学显著的交互作用（P<0.0001）。在基线高血压患者中，我们发现肥胖男性和女性的 CVD 风险均高于正常体重者。校正后的 HR（95%CI）分别为 1.23（1.03-1.47）和 1.20（1.02-1.40）。
本研究提示，血压与 CVD 之间的关联程度通常随着 BMI 的增加而增加。在中国成年人中，不应将高血压视为肥胖人群比瘦人或正常体重人群的风险因素较轻。
