Liang D L, Li X Y, Wang L, Xu H, Tuo X P, Jian Z J
*Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Yi Xue Za Zhi. 2016 Sep 20;96(35):2830-2837. doi: 10.3760/cma.j.issn.0376-2491.2016.35.014.
To explore the influences of body mass index (BMI) on blood pressure control rate in elderly coronary heart disease (CHD) outpatients with hypertension. In this multicenter, non-intervention and cross-sectional survey, the elderly coronary heart disease patients with hypertension aged 60 years or over were recruited from 165 hospitals in 21 provinces or cities across China from April to July 2011, and 5 140 cases of elderly CHD patients with hypertension were finally included into the study. The cases were divided into low BMI group (=130 cases), normal body mass index (BMI) group (=1 390 cases), overweight (=2 418 cases), obesity group (=662 cases) according to the different levels of BMI. Clinical data and blood pressure control rate were compared among the groups, and relationships of different BMI levels with blood pressure control rate were analyzed by the binary classification unconditioned Logistic regression equation. There was a statistically significant difference in blood pressure control rate of general population, men and women patients among low BMI group, normal BMI group, overweight and obesity group (χ=66.346, 58.995, 26.044, respectively, <0.001), blood pressure failure rate in obesity group (73.7%) was higher than that in overweight group (65.8%) and normal BMI group (57.5%) (<0.05), and overweight group was also higher than normal BMI group (<0.05); blood pressure failure rate in obesity men was higher than that in normal BMI and low BMI group (<0.05), overweight group was higher than normal BMI group (<0.05); blood pressure failure rate in obesity women was higher than that in normal BMI and low BMI group (<0.05). There was a statistically significant difference in blood pressure control rate of different age groups (60-70, 71-80, >80 years old) among low BMI group, normal BMI group, overweight and obesity group (χ=37.729, 20.007, 15.538, respectively, <0.001). Blood pressure failure rate in obesity patients with 60-70 years old was higher than that in overweight and normal BMI group (<0.05), blood pressure failure rates in obesity and overweight patients with 71-80 and > 80 years old were also higher than those in normal BMI group (<0.05). Multivariable Logistic regression equation showed that overweight in overall population (=1.313, 95% 1.170-1.731, <0.05), obesity (=2.295, 95% 2.295-1.496, <0.05) were independent risk factors for blood pressure failure rate, in addition, obesity was also risk factor for blood pressure failure rate in men and women patients. Increased BMI has an adverse effect on blood pressure control rate in elderly CHD outpatients with hypertension, and may be the independent risk for blood pressure failure rate in those patients. Much more attention should be given to control BMI level so as to increase the blood pressure success rate and improve the patients' prognosis.
探讨体重指数（BMI）对老年冠心病（CHD）合并高血压门诊患者血压控制率的影响。在这项多中心、非干预性横断面调查中，于2011年4月至7月从中国21个省或直辖市的165家医院招募60岁及以上的老年冠心病合并高血压患者，最终纳入5140例老年冠心病合并高血压患者。根据BMI的不同水平将病例分为低BMI组（=130例）、正常体重指数（BMI）组（=1390例）、超重组（=2418例）、肥胖组（=662例）。比较各组的临床资料和血压控制率，并通过二元分类非条件Logistic回归方程分析不同BMI水平与血压控制率的关系。低BMI组、正常BMI组、超重组和肥胖组的总体人群、男性和女性患者的血压控制率差异有统计学意义（χ分别为66.346、58.995、26.044，P<0.001），肥胖组的血压未达标率（73.7%）高于超重组（65.8%）和正常BMI组（57.5%）（P<0.05），超重组也高于正常BMI组（P<0.05）；肥胖男性的血压未达标率高于正常BMI组和低BMI组（P<0.05），超重组高于正常BMI组（P<0.05）；肥胖女性的血压未达标率高于正常BMI组和低BMI组（P<0.05）。低BMI组、正常BMI组、超重组和肥胖组不同年龄组（60 - 70岁、71 - 80岁、>80岁）的血压控制率差异有统计学意义（χ分别为37.729、20.007、15.538，P<0.001）。60 - 70岁肥胖患者的血压未达标率高于超重组和正常BMI组（P<0.05），71 - 80岁和>80岁肥胖和超重患者的血压未达标率也高于正常BMI组（P<0.05）。多变量Logistic回归方程显示，总体人群中超重（β=1.313，95%CI 1.170 - 1.731，P<0.05）、肥胖（β=2.295，95%CI 2.295 - 1.496，P<0.05）是血压未达标率的独立危险因素，此外，肥胖也是男性和女性患者血压未达标率的危险因素。BMI升高对老年冠心病合并高血压门诊患者的血压控制率有不利影响，可能是这些患者血压未达标率的独立危险因素。应更加重视控制BMI水平，以提高血压达标率并改善患者预后。
