Ho Aaron K, Bartels Christie M, Thorpe Carolyn T, Pandhi Nancy, Smith Maureen A, Johnson Heather M
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA;
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA;
Am J Hypertens. 2016 Aug;29(8):984-91. doi: 10.1093/ajh/hpw020. Epub 2016 Feb 24.
Among adults with hypertension, obesity independently contributes to cardiovascular disease. Weight loss and hypertension control are critical to reduce cardiovascular events. The purpose of this study was to evaluate rates and predictors of achieving weight loss among adults who achieved hypertension control within 1 year of developing incident hypertension.
Retrospective electronic health record analysis was performed of ≥18 year olds with a body mass index ≥30.0kg/m(2), who received regular primary care from 2008 to 2011 and achieved hypertension control. Exclusions were less than 60 days follow-up, prior hypertension diagnosis, prior antihypertensive prescription, or pregnancy. The primary outcome was clinically significant weight loss (≥5kg); the secondary outcome was modest (2.0-4.9kg) weight loss. Multinomial logistic regression identified predictors of achieving weight loss (≥5 or 2.0-4.9kg) compared to no significant weight loss (<2kg).
Of the 2,906 obese patients who achieved hypertension control, 72% (n = 2,089) did not achieve at least 2.0kg weight loss. Overall, 12% (n = 351) achieved ≥5kg weight loss. Young adults (18-39 year olds; odds ratio (OR): 2.47, 95% confidence interval (CI): 1.63-3.47), middle-aged adults (40-59 year olds; OR: 2.32, 95% CI: 1.59-3.37), and patients prescribed antihypertensive medication (OR: 1.37, 95% CI: 1.07-1.76) were more likely to achieve clinically significant weight loss and hypertension control. Age remained a significant predictor for 2.0-4.9kg weight loss.
Despite achieving hypertension control, the majority of obese patients did not achieve clinically significant weight loss. Effective weight loss interventions with dedicated hypertension treatment are needed to decrease cardiovascular events in this high-risk population.
在患有高血压的成年人中，肥胖独立地导致心血管疾病。体重减轻和高血压控制对于减少心血管事件至关重要。本研究的目的是评估在新发高血压1年内实现高血压控制的成年人中实现体重减轻的比例和预测因素。
对年龄≥18岁、体重指数≥30.0kg/m²、在2008年至2011年期间接受常规初级保健并实现高血压控制的患者进行回顾性电子健康记录分析。排除标准为随访时间少于60天、既往高血压诊断、既往抗高血压药物处方或妊娠。主要结局是临床上显著的体重减轻（≥5kg）；次要结局是适度（2.0 - 4.9kg）的体重减轻。多项逻辑回归确定了与无显著体重减轻（<2kg）相比实现体重减轻（≥5kg或2.0 - 4.9kg）的预测因素。
在2906名实现高血压控制的肥胖患者中，72%（n = 2089）未实现至少2.0kg的体重减轻。总体而言，12%（n = 351）实现了≥5kg的体重减轻。年轻人（18 - 39岁；优势比（OR）：2.47，95%置信区间（CI）：1.63 - 3.47）、中年人（40 - 59岁；OR：2.32，95% CI：1.59 - 3.37）以及开具抗高血压药物的患者（OR：1.37，95% CI：1.07 - 1.76）更有可能实现临床上显著的体重减轻和高血压控制。年龄仍然是2.0 - 4.9kg体重减轻的显著预测因素。
尽管实现了高血压控制，但大多数肥胖患者并未实现临床上显著的体重减轻。需要有效的体重减轻干预措施并专门进行高血压治疗，以减少这一高危人群的心血管事件。
