De Pergola Giovanni, Nardecchia Adele, Guida Pietro, Silvestris Franco
Clinical Nutrition Unit, Hypertension Center, Internal Medicine IV, Department of Internal Medicine and Clinical Oncology, University of Bari, School of Medicine, Policlinico, Via Putignani 236, Bari, Italy.
Eur J Cardiovasc Prev Rehabil. 2011 Apr;18(2):240-7. doi: 10.1177/1741826710389367. Epub 2011 Feb 11.
Obesity has been recognized as an independent risk factor for arterial hypertension.
This study was addressed to identify parameters predictive of 24-h mean systolic and/or diastolic blood pressure levels in obesity.
A cohort of 180 euthyroid overweight and obese patients, 79 women and 101 men, aged 20-63 years, normotensive (n = 62) or with recently developed hypertension (n = 118), and never treated with antihypertensive drugs, was examined. Waist circumference, fasting insulin, thyroid stimulating hormone (TSH), free thyroxine (FT) FT(3), FT(4), glucose, and lipid (cholesterol, high-density lipoprotein cholesterol and triglyceride) serum concentrations, and 24-h urinary aldosterone and catecholamines were measured. Ambulatory blood pressure monitoring (ABPM) was performed and hypertension was confirmed when 24-h mean systolic blood pressure was ≥125 mmHg and/or 24-h mean diastolic blood pressure was ≥80 mmHg, according to the 2007 European Society of Hypertension and European Society of Cardiology Practice Guidelines for the Management of Arterial Hypertension.
24-h noradrenaline (p < 0.01) and adrenaline (p < 0.05) levels were higher in hypertensive than in normotensive subjects. The odds ratio (OR) was determined by several univariate and multivariate logistic regression analyses to evaluate the predictive factors of high 24-h blood pressure mean values. When subjects with high systolic and/or high diastolic blood pressure levels (n = 118) were compared to individuals with normal systolic and diastolic blood pressure levels (n = 62), multivariate analysis showed an independent association of hypertension with male gender and 24-h noradrenaline levels. When subjects with high systolic blood pressure levels (n = 108) were compared with those with normal systolic blood pressure levels (n = 72), multivariate analysis showed an independent association of high systolic blood pressure with noradrenaline levels. Lastly, when subjects with high diastolic blood pressure levels (n = 87) were compared with those with normal diastolic blood pressure levels (n = 93), multivariate analysis showed an independent negative association between high diastolic blood pressure and body mass index.
the present study shows that diastolic blood pressure is independently and negatively associated with body mass index in normotensive or with recently discovered hypertension overweight and obese subjects, and never treated with antihypertensive drugs. These results suggest that obesity per se is responsible for a decrease in diastolic blood pressure before hypertensive state becomes stable. This study also confirms that male gender and daily noradrenaline production contribute to hypertension, and to higher systolic blood pressure levels in particular.
肥胖已被公认为动脉高血压的独立危险因素。
本研究旨在确定肥胖患者24小时平均收缩压和/或舒张压水平的预测参数。
对180例甲状腺功能正常的超重和肥胖患者进行了检查，其中79例女性和101例男性，年龄在20 - 63岁之间，血压正常（n = 62）或近期患高血压（n = 118），且从未接受过抗高血压药物治疗。测量了腰围、空腹胰岛素、促甲状腺激素（TSH）、游离甲状腺素（FT）、FT(3)、FT(4)、血糖和血脂（胆固醇、高密度脂蛋白胆固醇和甘油三酯）血清浓度，以及24小时尿醛固酮和儿茶酚胺。进行了动态血压监测（ABPM），根据2007年欧洲高血压学会和欧洲心脏病学会动脉高血压管理实践指南，当24小时平均收缩压≥125 mmHg和/或24小时平均舒张压≥80 mmHg时确诊为高血压。
高血压患者的24小时去甲肾上腺素（p < 0.01）和肾上腺素（p < 0.05）水平高于血压正常者。通过几个单变量和多变量逻辑回归分析确定比值比（OR），以评估24小时血压平均值升高的预测因素。将收缩压和/或舒张压水平高的受试者（n = 118）与收缩压和舒张压水平正常的个体（n = 62）进行比较时，多变量分析显示高血压与男性性别和24小时去甲肾上腺素水平独立相关。将收缩压水平高的受试者（n = 108）与收缩压水平正常的受试者（n = 72）进行比较时，多变量分析显示高收缩压与去甲肾上腺素水平独立相关。最后，将舒张压水平高的受试者（n = 87）与舒张压水平正常的受试者（n = 93）进行比较时，多变量分析显示高舒张压与体重指数之间存在独立的负相关。
本研究表明，在血压正常或近期发现高血压的超重和肥胖且未接受过抗高血压药物治疗的受试者中，舒张压与体重指数独立且呈负相关。这些结果表明，在高血压状态稳定之前，肥胖本身会导致舒张压降低。本研究还证实，男性性别和每日去甲肾上腺素分泌与高血压有关，尤其是与较高的收缩压水平有关。
