Wang Sukun, Majumdar Sumit R, Padwal Raj
aDepartment of Medicine, University of Alberta bAlberta Diabetes Institute, Edmonton, Alberta, Canada.
Blood Press Monit. 2015 Feb;20(1):32-8. doi: 10.1097/MBP.0000000000000087.
BACKGROUND/OBJECTIVES: In-clinic blood pressure measurement is recommended annually for all hypertensive individuals, but can be difficult to perform in obese patients. We aimed to examine a population-based cohort of obese hypertensive patients to determine whether: (a) BMI was inversely associated with annual blood pressure measurement and (b) performing annual blood pressure measurements was associated with reduced mortality independent of BMI.
PATIENTS/METHODS: We carried out a retrospective cohort analysis in 4972 obese hypertensive patients from UK primary care. Multivariable binary logistic regression was used to examine the association between obesity class (class 1=BMI 30-34.9; class 2=35.0-39.9; class 3=40 kg/m or greater) and annual blood pressure measurement. An accelerated failure time multivariable model was used to examine the association between annual blood pressure measurement and mortality.
The mean age of the patients was 52.3 ± 9.6 years, the mean BMI was 34.1 ± 4.8 kg/m, and the median follow-up was 13.5 (interquartile range 6.8-20.3) years. A total of 519 (10.4%) patients died. Annual blood pressure measurements were performed in 1605 (47.0%) patients with class 1, 429 (40.2%) with class 2, and 198 (41.1%) with class 3 obesity (P<0.001). Compared with class 1, the covariate-adjusted odds of annual blood pressure measurement was 0.85 [95% confidence interval (CI) 0.73-0.98] for class 2 and 0.87 (95% CI 0.71-1.07) for class 3. Annual blood pressure measurement was associated with an 18.9% (95% CI 9.4-28.3) increase in survival.
Less than 50% of obese hypertensive patients underwent annual blood pressure measurements and measurements were less frequent in severely obese patients. Annual blood pressure measurement was associated with increased survival. Strategies to improve measurement frequency in obese patients should be implemented.
背景/目的：建议所有高血压患者每年进行一次诊室血压测量，但肥胖患者可能难以做到。我们旨在对一组以人群为基础的肥胖高血压患者队列进行研究，以确定：（a）体重指数（BMI）是否与年度血压测量呈负相关；（b）进行年度血压测量是否与降低死亡率相关，且独立于BMI。
患者/方法：我们对来自英国初级医疗保健机构的4972例肥胖高血压患者进行了回顾性队列分析。采用多变量二元逻辑回归分析来研究肥胖等级（1级=BMI 30 - 34.9；2级=35.0 - 39.9；3级=40 kg/m²及以上）与年度血压测量之间的关联。使用加速失效时间多变量模型来研究年度血压测量与死亡率之间的关联。
患者的平均年龄为52.3±9.6岁，平均BMI为34.1±4.8 kg/m²，中位随访时间为13.5（四分位间距6.8 - 20.3）年。共有519例（10.4%）患者死亡。1级肥胖患者中有1605例（47.0%）进行了年度血压测量，2级肥胖患者中有429例（40.2%），3级肥胖患者中有198例（41.1%）（P<0.001）。与1级相比，2级肥胖患者经协变量调整后进行年度血压测量的比值比为0.85 [95%置信区间（CI）0.73 - 0.98]，3级肥胖患者为0.87（95% CI 0.71 - 1.07）。年度血压测量与生存率提高18.9%（95% CI 9.4 - 28.3）相关。
不到50%的肥胖高血压患者进行了年度血压测量，且重度肥胖患者测量频率更低。年度血压测量与生存率提高相关。应实施提高肥胖患者测量频率的策略。
