Pei Dee, Chen Yen-Lin, Tang Sai-Hung, Wu Chung-Ze, Lin Jiunn-Diann, Chang Yen-Ling, Hsu Chun-Hsien, Wang Cheng-Yi, Wang Kun, Wang Jen-Yu
From Department of Internal Medicine (DP, C-YW, KW, J-YW), Department of Pathology (Y-L Chen), Department of Radiology (S-HT), Department of Family Medicine (Y-L Chang, C-HH), Cardinal Tien Hospital, Fu-Jen Catholic University, Taipei; Division of Endocrinology and Metabolism, Department of Medicine (C-ZW), Shuang-Ho Hospital, Taipei Medical University, Taipei; and Division of Endocrinology and Metabolism, Department of Medicine (J-DL), Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Medicine (Baltimore). 2011 Sep;90(5):344-349. doi: 10.1097/MD.0b013e31822a3852.
We conducted this study to investigate whether subjects with high-normal systolic blood pressure (SBP) have an increased risk of cardiovascular disease (CVD) and/or diabetes compared to subjects with low-normal SBP, using metabolic syndrome (MetS) as a risk factor for future CVD/diabetes.The study included 6133 apparently healthy Taiwanese men aged 40-65 years. All subjects were normotensive, and none took medication for any abnormal MetS component. To avoid the effect of age on blood pressure, we stratified patients first by age then by SBP (that is, low, middle, and high SBP). We pooled all the low, middle, and high SBP groups from the different age strata to create 3 larger groups (Group 1, Group 2, and Group 3, respectively). The MetS components in subjects with the lowest SBP (Group 1) were compared with those in the other 2 groups. All of the MetS components, except for high-density lipoprotein cholesterol (HDL-C), were significantly lower in Group 1. Thus, it was not surprising that Group 2 and Group 3 had significantly higher odds ratios for abnormal body mass index, fasting plasma glucose, low-density lipoprotein-cholesterol (LDL-C), and triglycerides than Group 1 (but not for HDL-C). Specifically, Group 3 had a 1.7-fold higher odds ratio (p < 0.001) for having MetS than Group 1. Age, body mass index, fasting plasma glucose, LDL-C, and log triglycerides correlated significantly with SBP. In multivariate linear regression analysis, we found that only body mass index, fasting plasma glucose, and log triglycerides remained significantly related to SBP. Among them, body mass index had the highest β value.In conclusion, the level of SBP was highly correlated with body mass index, fasting plasma glucose, and triglycerides in subjects with normotension. Although there is not a cause-and-effect relationship, the risk of CVD and diabetes was significantly associated with an elevation of SBP, even when the SBP remained within the normal range. Further studies are needed to determine whether normotensive subjects would benefit from medical management.
我们开展这项研究，旨在调查收缩压处于正常高值的受试者与收缩压处于正常低值的受试者相比，是否有更高的心血管疾病（CVD）和/或糖尿病风险，将代谢综合征（MetS）作为未来发生CVD/糖尿病的一个风险因素。该研究纳入了6133名40 - 65岁表面健康的台湾男性。所有受试者血压正常，且无人因任何代谢综合征异常组分而服用药物。为避免年龄对血压的影响，我们首先按年龄对患者进行分层，然后按收缩压（即低、中、高收缩压）分层。我们将来自不同年龄层的所有低、中、高收缩压组合并，以创建3个更大的组（分别为第1组、第2组和第3组）。将收缩压最低的受试者组（第1组）的代谢综合征组分与其他2组进行比较。除高密度脂蛋白胆固醇（HDL - C）外，第1组所有代谢综合征组分均显著更低。因此，第2组和第组3在体重指数异常、空腹血糖、低密度脂蛋白胆固醇（LDL - C）和甘油三酯方面的优势比显著高于第1组（但HDL - C并非如此）也就不足为奇了。具体而言，第3组发生代谢综合征的优势比是第1组的1.7倍（p < 0.001）。年龄、体重指数、空腹血糖、LDL - C和甘油三酯对数与收缩压显著相关。在多变量线性回归分析中，我们发现只有体重指数、空腹血糖和甘油三酯对数与收缩压仍显著相关。其中，体重指数的β值最高。总之，在血压正常的受试者中，收缩压水平与体重指数、空腹血糖和甘油三酯高度相关。虽然不存在因果关系，但即使收缩压仍在正常范围内，CVD和糖尿病风险也与收缩压升高显著相关。需要进一步研究以确定血压正常的受试者是否能从医学管理中获益。
