Department of Endocrinology, Affiliated Hospital of Yan'an Medical University, Yan'an, Shaanxi.
Department of Endocrinology, Jinshan Hospital of Fudan University.
J Hypertens. 2019 Jan;37(1):144-153. doi: 10.1097/HJH.0000000000001826.
The adverse impact of thyroid dysfunction on cardiovascular system is well established, but the relationship between the level of thyroid stimulating hormone (TSH) and the risk of hypertension in euthyroid individuals is still inconclusive.
We carried out a population-based, cross-sectional study to evaluate the relationship between TSH and hypertension risk in euthyroid individuals, and logistic regression analysis was utilized. In addition, a dose-response meta-analysis of relevant cohort or cross-sectional studies was carried out to further assess the impact of TSH on hypertension risk among euthyroid individuals.
A total of 2289 euthyroid individuals without thyroid diseases were recruited in our cross-sectional study. Serum TSH level within the upper reference range was associated with higher risk of hypertension [odds ratio (OR) = 1.29, 95% confidence interval (CI) 1.04-1.61, P = 0.023], and the OR for hypertension was still statistically significant after adjustment for confounding factors (OR = 1.32, 95% CI 1.01-1.72, P = 0.041). Moreover, meta-analysis suggested an obvious dose-response relationship between TSH and hypertension risk in euthyroid individuals, and the OR for hypertension associated with per 1 mIU/l increase in TSH level was 1.09 (95% CI 1.04-1.14, P < 0.001). Meta-analysis also showed that the β-coefficients of SBP and DBP associated with per 1 mIU/l increase in TSH level were 0.78 (95% CI 0.37-1.18, P < 0.001) and 0.45 (95% CI 0.15-0.76, P = 0.004), respectively.
The current study provides strong evidence for the dose-response relationship between serum TSH level and hypertension risk in euthyroid individuals. Euthyroid individuals with higher normal TSH level are at higher risk of developing hypertension than those with lower normal TSH level.
甲状腺功能障碍对心血管系统的不良影响已得到充分证实，但甲状腺刺激激素（TSH）水平与甲状腺功能正常个体高血压风险之间的关系仍不确定。
我们进行了一项基于人群的横断面研究，以评估甲状腺功能正常个体中 TSH 与高血压风险之间的关系，并采用逻辑回归分析。此外，还对相关队列或横断面研究进行了剂量-反应荟萃分析，以进一步评估 TSH 对甲状腺功能正常个体高血压风险的影响。
在我们的横断面研究中，共纳入了 2289 例无甲状腺疾病的甲状腺功能正常个体。血清 TSH 水平在上限参考范围内与高血压风险升高相关[比值比（OR）=1.29，95%置信区间（CI）1.04-1.61，P=0.023]，且在调整混杂因素后，高血压的 OR 仍具有统计学意义（OR=1.32，95% CI 1.01-1.72，P=0.041）。此外，荟萃分析表明 TSH 与甲状腺功能正常个体高血压风险之间存在明显的剂量-反应关系，TSH 水平每增加 1 mIU/L，高血压的 OR 为 1.09（95% CI 1.04-1.14，P<0.001）。荟萃分析还显示，TSH 水平每增加 1 mIU/L，与 SBP 和 DBP 相关的β系数分别为 0.78（95% CI 0.37-1.18，P<0.001）和 0.45（95% CI 0.15-0.76，P=0.004）。
本研究为甲状腺功能正常个体血清 TSH 水平与高血压风险之间的剂量-反应关系提供了有力证据。TSH 水平较高的甲状腺功能正常个体发生高血压的风险高于 TSH 水平较低的个体。
