Gnatiuc Louisa, Alegre-Díaz Jesus, Halsey Jim, Herrington William G, López-Cervantes Malaquías, Lewington Sarah, Collins Rory, Tapia-Conyer Roberto, Peto Richard, Emberson Jonathan R, Kuri-Morales Pablo
From the Clinical Trial Service Unit and Epidemiological Studies Unit (L.G., J.H., W.G.H., S.L., R.C., R.P., J.R.E.) and Medical Research Council Population Health Research Unit (S.L., J.R.E.), Nuffield Department of Population Health, University of Oxford, United Kingdom; and School of Medicine, National Autonomous University of Mexico (Universidad Nacional Autónoma de México) (J.A.-D., M.L.-C., R.T.-C., P.K.-M.).
Hypertension. 2017 Apr;69(4):608-614. doi: 10.1161/HYPERTENSIONAHA.116.08791. Epub 2017 Feb 21.
Previous studies have reached differing conclusions about the importance of general versus central markers of adiposity to blood pressure, leading to suggestions that population-specific adiposity thresholds may be needed. We examined the relevance of adiposity to blood pressure among 111 911 men and women who, when recruited into the Mexico City Prospective Study, were aged 35 to 89 years, had no chronic disease, and were not taking antihypertensives. Linear regression was used to estimate the effects on systolic and diastolic blood pressure of 2 markers of general adiposity (body mass index and height-adjusted weight) and 4 markers of central adiposity (waist circumference, hip circumference, waist:hip ratio, and waist:height ratio), adjusted for relevant confounders. Mean (SD) adiposity levels were: body mass index (28.7±4.5 kg/m), height-adjusted weight (70.2±11.2 kg), waist circumference (93.3±10.6 cm), hip circumference (104.0±9.0 cm), waist:hip ratio (0.90±0.06), and waist:height ratio (0.60±0.07). Associations with blood pressure were linear with no threshold levels below which lower general or central adiposity was not associated with lower blood pressure. On average, each 1 SD higher measured adiposity marker was associated with a 3 mm Hg higher systolic blood pressure and 2 mm Hg higher diastolic blood pressure (SEs <0.1 mm Hg), but for the waist:hip ratio, associations were only approximately half as strong. General adiposity associations were independent of central adiposity, but central adiposity associations were substantially reduced by adjustment for general adiposity. Findings were similar for men and women. In Mexican adults, often overweight or obese, markers of general adiposity were stronger independent predictors of blood pressure than measured markers of central adiposity, with no threshold effects.
先前的研究对于总体肥胖指标与中心性肥胖指标对血压的重要性得出了不同结论，这导致有人建议可能需要特定人群的肥胖阈值。我们在111911名男性和女性中研究了肥胖与血压的相关性，这些人在被纳入墨西哥城前瞻性研究时年龄在35至89岁之间，没有慢性病，也未服用抗高血压药物。采用线性回归来估计2个总体肥胖指标（体重指数和身高校正体重）和4个中心性肥胖指标（腰围、臀围、腰臀比和腰高比）对收缩压和舒张压的影响，并对相关混杂因素进行了校正。平均（标准差）肥胖水平如下：体重指数（28.7±4.5kg/m²）、身高校正体重（70.2±11.2kg）、腰围（93.3±10.6cm）、臀围（104.0±9.0cm）、腰臀比（0.90±0.06）和腰高比（0.60±0.07）。与血压的关联呈线性，不存在低于该水平较低的总体或中心性肥胖与较低血压不相关的阈值水平。平均而言，每个测量的肥胖指标每高出1个标准差，收缩压就会高出3mmHg，舒张压高出2mmHg（标准误<0.1mmHg），但对于腰臀比，关联强度仅约为一半。总体肥胖关联独立于中心性肥胖，但在对总体肥胖进行校正后，中心性肥胖关联大幅减弱。男性和女性的结果相似。在经常超重或肥胖的墨西哥成年人中，总体肥胖指标比测量的中心性肥胖指标是更强的血压独立预测因素，且不存在阈值效应。
