Vart Priya, Nigatu Yeshambel T, Jaglan Ajay, van Zon Sander K R, Shafique Kashif
Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (P.V., Y.T.N., S.R.Z.).
Department of Cardiology, Gauhati Medical College and Hospital, Gauhati, India (A.J.).
J Am Heart Assoc. 2015 May 20;4(5):e001706. doi: 10.1161/JAHA.114.001706.
Elevated serum phosphorus might aggravate the effect of hypertension on mortality. The objective of this study was to examine the joint effect of hypertension and serum phosphorus on the risk of mortality.
A large prospective (n=15 833), population-based cohort of participants from the National Health and Nutritional Examination Survey III was examined to test potential synergism between hypertension, elevated serum phosphorus, and the risk of mortality. Interaction on additive scale and multiplicative scale was estimated. After a median follow-up of 14.3 years, 1691 cases of cardiovascular mortality and 3875 cases of all-cause mortality were identified. Interaction was observed between hypertension and elevated serum phosphorus on the additive scale for cardiovascular mortality (relative excess risk due to interaction, 0.99, 95% CI: 0.06; 1.92, adjusted for age, gender, race, and estimated glomerular filtration rate). No statistically significant interaction was found between hypertension and serum phosphorus for all-cause mortality on the additive scale. No significant interaction was detected on the multiplicative scale. In sensitivity analysis, excluding participants who died in first 2 years and adjustment for additional confounders resulted in essentially similar findings.
The joint effect of hypertension and elevated serum phosphorus was larger than the sum of the independent effects on cardiovascular mortality but not on all-cause mortality. Future studies should investigate whether controlling elevated serum phosphorus in hypertensive individuals helps in prevention of extra risk of cardiovascular mortality.
血清磷升高可能会加重高血压对死亡率的影响。本研究的目的是探讨高血压和血清磷对死亡风险的联合作用。
对来自第三次全国健康与营养检查调查的一个大型前瞻性队列（n = 15833）进行了研究，以检验高血压、血清磷升高与死亡风险之间的潜在协同作用。估计了相加尺度和相乘尺度上的交互作用。经过14.3年的中位随访，确定了1691例心血管死亡病例和3875例全因死亡病例。在相加尺度上，观察到高血压与血清磷升高之间存在心血管死亡的交互作用（交互作用导致的相对超额风险为0.99，95%CI：0.06；1.92，经年龄、性别、种族和估计肾小球滤过率调整）。在相加尺度上，未发现高血压与血清磷之间存在全因死亡的统计学显著交互作用。在相乘尺度上未检测到显著交互作用。在敏感性分析中，排除前两年死亡的参与者并对其他混杂因素进行调整后，结果基本相似。
高血压和血清磷升高的联合作用大于对心血管死亡的独立作用之和，但对全因死亡并非如此。未来的研究应调查控制高血压患者的血清磷升高是否有助于预防心血管死亡的额外风险。
