Hansen T W, Thijs L, Li Y, Boggia J, Liu Y, Asayama K, Kikuya M, Björklund-Bodegård K, Ohkubo T, Jeppesen J, Torp-Pedersen C, Dolan E, Kuznetsova T, Stolarz-Skrzypek K, Tikhonoff V, Malyutina S, Casiglia E, Nikitin Y, Lind L, Sandoya E, Kawecka-Jaszcz K, Filipovský J, Imai Y, Wang J, O'Brien E, Staessen J A
Steno Diabetes Centre, Gentofte and Research Centre for Prevention and Health, Glostrup, Denmark.
Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
J Hum Hypertens. 2014 Sep;28(9):535-42. doi: 10.1038/jhh.2013.145. Epub 2014 Jan 16.
Overweight clusters with high blood pressure (BP), but the independent contribution of both risk factors remains insufficiently documented. In a prospective population study involving 8467 participants (mean age 54.6 years; 47.0% women) randomly recruited from 10 populations, we studied the contribution of body mass index (BMI) to risk over and beyond BP, taking advantage of the superiority of ambulatory over conventional BP. Over 10.6 years (median), 1271 participants (15.0%) died and 1092 (12.9%), 637 (7.5%) and 443 (5.2%) experienced a fatal or nonfatal cardiovascular, cardiac or cerebrovascular event. Adjusted for sex and age, low BMI (<20.7 kg m(-2)) predicted death (hazard ratio (HR) vs average risk, 1.52; P<0.0001) and high BMI (> or = 30.9 kg m(-2)) predicted the cardiovascular end point (HR, 1.27; P=0.006). With adjustments including 24-h systolic BP, these HRs were 1.50 (P<0.001) and 0.98 (P=0.91), respectively. Across quartiles of the BMI distribution, 24-h and nighttime systolic BP predicted every end point (1.13 < or = standardized HR < or = 1.67; 0.046 < or = P<0.0001). The interaction between systolic BP and BMI was nonsignificant (P > or = .22). Excluding smokers removed the contribution of BMI categories to the prediction of mortality. In conclusion, BMI only adds to BP in risk stratification for mortality but not for cardiovascular outcomes. Smoking probably explains the association between increased mortality and low BMI.
超重与高血压聚集相关，但这两种风险因素的独立作用仍缺乏充分记录。在一项前瞻性人群研究中，我们从10个人群中随机招募了8467名参与者（平均年龄54.6岁；47.0%为女性），利用动态血压相对于传统血压的优势，研究了体重指数（BMI）在血压之外对风险的影响。在10.6年（中位数）的时间里，1271名参与者（15.0%）死亡，1092名（12.9%）、637名（7.5%）和443名（5.2%）经历了致命或非致命的心血管、心脏或脑血管事件。在对性别和年龄进行调整后，低BMI（<20.7kg/m²）可预测死亡（风险比（HR）与平均风险相比，1.52；P<0.0001），高BMI（≥30.9kg/m²）可预测心血管终点（HR，1.27；P=0.006）。在纳入24小时收缩压等调整因素后，这些HR分别为1.50（P<0.001）和0.98（P=0.91）。在BMI分布的四分位数中，24小时和夜间收缩压可预测每个终点（1.13≤标准化HR≤1.67；0.046≤P<0.0001）。收缩压与BMI之间的相互作用不显著（P≥0.22）。排除吸烟者后，BMI类别对死亡率预测的贡献消失。总之，BMI仅在死亡率风险分层中增加了血压的预测价值，而在心血管结局方面并非如此。吸烟可能解释了死亡率增加与低BMI之间的关联。
