Hypertension Unit, First Cardiology Department, "Hippokration" Hospital, Athens, Greece.
Am J Cardiol. 2011 Jul 15;108(2):240-5. doi: 10.1016/j.amjcard.2011.03.035. Epub 2011 May 14.
The prognostic significance, interdependence, and hierarchy of cardiovascular risk factors could evolve with advancing age. Our study reports on the interdependence among blood pressure (BP), other metabolic syndrome components, and high-sensitivity C-reactive protein according to age in hypertensive subjects. A total of 5,712 nondiabetic patients (50.1% men, age range 40 to 95 years) evaluated in outpatient hypertension clinics were included and divided into 5 age groups (age 40 to 49, 50 to 59, 60 to 69, 70 to 79, and >80 years). BP, evaluated by both office and 24-hour ambulatory BP monitoring, and the metabolic and inflammation parameters were determined after a ≥2-week drug washout period. The prevalence of the metabolic syndrome (Adult Treatment Panel III definition) remained stable across the age groups. We observed a stable or increased association between waist circumference and insulin resistance (Homeostasis Model of Assessment-Insulin Resistance index) and fasting plasma glucose. However, the association between waist circumference and ambulatory BP monitoring systolic BP (r(2) decrease from 9.9% to 1.0%, p <0.001), high-density lipoprotein cholesterol (r(2) decreased from 21% to 4.9%, p = 0.002), and triglyceride levels (r(2) decreased from 17.5% to 1.9%, p <0.001) decreased with age. High-sensitivity C-reactive protein correlated with all metabolic syndrome components in all age groups (p <0.001 for all). It became the strongest determinant of ambulatory BP monitoring systolic BP (p <0.001) and high-density lipoprotein cholesterol (p <0.05) in patients >80 years old. In contrast, its association with waist circumference markedly decreased. In conclusion, hypertension and dyslipidemia, but not fasting plasma glucose, dissociate from central obesity with advancing age. They are increasingly determined by low-grade inflammation, independently of central obesity. These changing associations might underlie the weakening of obesity as a cardiovascular risk factor in older persons.
心血管危险因素的预后意义、相互依存性和层次结构可能会随着年龄的增长而变化。我们的研究报告了根据年龄在高血压患者中血压（BP）、其他代谢综合征成分和高敏 C 反应蛋白之间的相互依存关系。共有 5712 名非糖尿病患者（50.1%为男性，年龄在 40 至 95 岁之间）在门诊高血压诊所接受评估，并分为 5 个年龄组（年龄 40 至 49 岁、50 至 59 岁、60 至 69 岁、70 至 79 岁和>80 岁）。在药物洗脱期≥2 周后，通过诊室和 24 小时动态血压监测评估 BP，并确定代谢和炎症参数。根据成人治疗小组 III 定义，代谢综合征的患病率在各年龄组中保持稳定。我们观察到腰围与胰岛素抵抗（评估胰岛素抵抗的稳态模型指数）和空腹血糖之间的稳定或增强的关联。然而，腰围与动态血压监测收缩压（r(2)从 9.9%降至 1.0%，p<0.001）、高密度脂蛋白胆固醇（r(2)从 21%降至 4.9%，p=0.002）和甘油三酯水平（r(2)从 17.5%降至 1.9%，p<0.001）之间的关联随着年龄的增长而降低。高敏 C 反应蛋白与所有年龄组的所有代谢综合征成分相关（p<0.001）。它成为 80 岁以上患者动态血压监测收缩压（p<0.001）和高密度脂蛋白胆固醇（p<0.05）的最强决定因素。相比之下，其与腰围的关联显著降低。总之，随着年龄的增长，高血压和血脂异常，但不是空腹血糖，与中心性肥胖分离。它们越来越受到低水平炎症的影响，而与中心性肥胖无关。这些变化的关联可能是老年人肥胖作为心血管危险因素的减弱的原因。
