在肥胖患病率较高的社区样本中，与超重肥胖相比，血压对左心室舒张功能障碍的相对影响。

Relative impact of blood pressure as compared to an excess adiposity on left ventricular diastolic dysfunction in a community sample with a high prevalence of obesity.

作者信息

Millen Aletta M E, Libhaber Carlos D, Majane Olebogeng H I, Libhaber Elena, Maseko Muzi J, Woodiwiss Angela J, Norton Gavin R

机构信息

aCardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology bDepartment of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa *Aletta M.E. Millen, Carlos D. Libhaber, Angela J. Woodiwiss, and Gavin R. Norton contributed equally to the writing of this article.

出版信息

J Hypertens. 2014 Dec;32(12):2457-64; discussion 2464. doi: 10.1097/HJH.0000000000000330.

DOI:10.1097/HJH.0000000000000330

PMID:25215435

Abstract

AIM

To determine whether blood pressure (BP) or an excess adiposity, both frequently observed comorbidities that independently relate to left ventricular diastolic dysfunction (LVDD), have a greater impact on LVDD at a community level.

METHODS

We assessed the relative independent impact of an excess adiposity versus BP on indices of LVDD as determined from the ratios of early-to-late transmitral blood flow velocity (E/A) and E/the mean of lateral and septal wall myocardial tissue lengthening at the level of the mitral annulus (e'; (E/e') in 417 randomly recruited participants of a community-based study with a high prevalence of excess adiposity (43% obese and 25% morbidly obese).

RESULTS

In multivariate adjusted models, including adjustments for appropriate BP values (SBP for E/e' and DBP for E/A), waist circumference was independently associated with E/A (partial r = -0.12, P < 0.02) and E/e' (partial r = 0.15, P < 0.005). In contrast, BMI was independently associated with E/e' (partial r = 0.11, P < 0.05), but not E/A (partial r = -0.09, P = 0.08). In multivariate models, SBP had a greater impact on E/e' (standardized β-coefficient = 0.32 ± 0.05, P < 0.0001) than did waist circumference (standardized β-coefficient = 0.16 ± 0.05, P < 0.005; P < 0.05 for comparison), whereas DBP had a similar impact on E/A (standardized β-coefficient = -0.10 ± 0.03, P < 0.005) as did waist circumference (standardized β-coefficient = -0.10 ± 0.04, P < 0.05). Importantly, whereas SBP was the main factor independently associated with an increased E/e' (≥10) (P < 0.0005), waist circumference was not independently associated with either a decreased E/A (≤0.75) (P = 0.82) or an increased E/e' (≥10; P = 0.15).

CONCLUSION

In a community sample with a high prevalence of excess adiposity, BP exceeds obesity as the most important modifiable risk factor for LVDD. These data suggest that in communities with a high prevalence of obesity, if weight loss programmes fail to produce sustainable target body weights, rigorous BP management to lower than normal thresholds may be sufficient to prevent LVDD.

摘要

目的

确定血压（BP）或肥胖，这两种常见的合并症均独立与左心室舒张功能障碍（LVDD）相关，在社区层面上对LVDD的影响是否更大。

方法

我们评估了肥胖与血压对LVDD指标的相对独立影响，LVDD指标由二尖瓣血流速度早期与晚期比值（E/A）以及二尖瓣环水平外侧和间隔壁心肌组织延长平均值与E的比值（e'；E/e'）确定，这417名参与者是从一个肥胖率较高（43%肥胖和25%病态肥胖）的社区研究中随机招募的。

结果

在多变量调整模型中，包括对适当血压值进行调整（E/e'用收缩压，E/A用舒张压），腰围与E/A（偏相关系数r = -0.12，P < 0.02）和E/e'（偏相关系数r = 0.15，P < 0.005）独立相关。相比之下，体重指数与E/e'（偏相关系数r = 0.11，P < 0.05）独立相关，但与E/A（偏相关系数r = -0.09，P = 0.08）无关。在多变量模型中，收缩压对E/e'的影响（标准化β系数 = 0.32 ± 0.05，P < 0.0001）大于腰围（标准化β系数 = 0.16 ± 0.05，P < 0.005；比较P < 0.05），而舒张压对E/A的影响（标准化β系数 = -0.10 ± 0.03，P < 0.005）与腰围相似（标准化β系数 = -0.10 ± 0.04，P < 0.05）。重要的是，虽然收缩压是与E/e'升高（≥10）独立相关的主要因素（P < 0.0005），但腰围与E/A降低（≤0.75）（P = 0.82）或E/e'升高（≥10；P = 0.15）均无独立相关性。