Department of Cardiology, West China Hospital, Sichuan University, No.37, Guo Xue Xiang, Chengdu, 610041, China.
Intern Emerg Med. 2018 Jun;13(4):509-516. doi: 10.1007/s11739-018-1836-8. Epub 2018 Mar 22.
Prehypertension (defined by The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, JNC-7) is relevant to a higher cardiovascular risk than normotensives. Early intervention in this particular population is essential to avoid progression into hypertension (HTN). This study is to explore whether visceral adiposity index (VAI) can strongly predict the incidence of HTN in community-based prehypertensives. A prospective observational cohort study was conducted from September 2011 to June 2012 in urban communities of Chengdu, Sichuan Province, China. 780 subjects (male 320, female 460) were evaluated on anthropometrical indices, blood pressure, blood samples, brachial-ankle pulse wave velocity, of whom 360 prehypertensives (male 160, female 200) were recruited for a 5-year follow-up. Overall, 97 subjects (male 37, female 60) developed HTN. The risk for developing HTN in the future increases with increasing VAI levels. The OR of the upper quartile is 3.719 (95% CI 1.481-9.338, P = 0.005) after adjusting for confounders. The ROC results reveal that VAI is not considered superior to other indices on account of the significant overlapping confidence intervals. The area under the curves (AUC) of Model 5 (combination of VAI and WC) is significantly higher than BMI, WC and WHR (P < 0.05). The AUC of Model 4 (combination of VAI and BMI) is found to be significantly higher than BMI and WHR (P < 0.05), and is also higher than WC in all subject groups and in the male subgroup, but not in the female subgroup. VAI at baseline is an independent risk factor and early predictor of incident HTN in prehypertensives. The predictive value is not stronger than other traditional obesity indices (BMI, WC and WHR); however, it is superior to the latter by combining VAI and WC. Namely, VAI may help identify individuals at high risk of evolving into HTN in this particular population.
高血压前期（定义为第七次美国国家联合委员会报告，即 JNC-7）与正常血压人群相比，心血管风险更高。在该人群中早期干预对于避免进展为高血压（HTN）至关重要。本研究旨在探讨内脏脂肪指数（VAI）是否能强烈预测社区高血压前期人群的 HTN 发病率。一项前瞻性观察性队列研究于 2011 年 9 月至 2012 年 6 月在中国四川省成都市的城市社区进行。对 780 名受试者（男性 320 名，女性 460 名）进行了人体测量指标、血压、血液样本、臂踝脉搏波速度的评估，其中 360 名高血压前期患者（男性 160 名，女性 200 名）进行了 5 年随访。总体而言，97 名受试者（男性 37 名，女性 60 名）发展为 HTN。随着 VAI 水平的升高，未来发生 HTN 的风险增加。调整混杂因素后，上四分位数的 OR 为 3.719（95%CI 1.481-9.338，P=0.005）。ROC 结果表明，由于置信区间显著重叠，VAI 并不优于其他指数。模型 5（VAI 和 WC 的组合）的曲线下面积（AUC）明显高于 BMI、WC 和 WHR（P<0.05）。模型 4（VAI 和 BMI 的组合）的 AUC 明显高于 BMI 和 WHR（P<0.05），并且在所有受试者组和男性亚组中均高于 WC，但在女性亚组中则不然。基线时的 VAI 是高血压前期人群发生 HTN 的独立危险因素和早期预测因子。预测价值并不强于其他传统肥胖指数（BMI、WC 和 WHR）；然而，通过将 VAI 与 WC 相结合，其预测价值优于后者。即 VAI 可能有助于识别该特定人群中发生 HTN 的高危个体。
