Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Yale University, New Haven, Connecticut.
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
JAMA Netw Open. 2018 Aug 3;1(4):e181271. doi: 10.1001/jamanetworkopen.2018.1271.
Body mass index (BMI) is positively associated with blood pressure (BP); this association has critical implications for countries like China, where hypertension is highly prevalent and obesity is increasing. A greater understanding of the association between BMI and BP is required to determine its effect and develop strategies to mitigate it.
To assess the heterogeneity in the association between BMI and BP across a wide variety of subgroups of the Chinese population.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, data were collected at 1 time point from 1.7 million adults (aged 35-80 years) from 141 primary health care sites (53 urban districts and 88 rural counties) from all 31 provinces in mainland China who were enrolled in the China PEACE (Patient-Centered Evaluative Assessment of Cardiac Events) Million Persons Project, conducted between September 15, 2014, and June 20, 2017. A comprehensive subgroup analysis was performed by defining more than 22 000 subgroups of individuals based on covariates, and within each subgroup, linearly regressing BMI to BP.
Systolic BP was measured twice with the participant in a seated position, using an electronic BP monitor.
The study included 1 727 411 participants (1 027 711 women and 699 700 men; mean [SD] age, 55.7 [9.8] years). Among the study sample, the mean (SD) BMI was 24.7 (3.5), the mean (SD) systolic BP was 136.5 (20.4) mm Hg, and the mean (SD) diastolic BP was 81.1 (11.2) mm Hg. The increase of BP per unit BMI ranged from 0.8 to 1.7 mm Hg/(kg/m2) for 95% of the subgroups not taking antihypertensive medication. The association between BMI and BP was substantially weaker in subgroups of patients taking antihypertensive medication compared with those who were untreated. In untreated subgroups, 95% of the coefficients varied by less than 1 mm Hg/(kg/m2).
The association between BMI and BP is positive across tens of thousands of individuals in population subgroups, and, if causal, given its magnitude, would have significant implications for public health.
体重指数（BMI）与血压（BP）呈正相关；这种关联对中国等国家具有重要意义，因为中国高血压患病率高，肥胖率正在上升。为了确定其影响并制定减轻其影响的策略，需要更深入地了解 BMI 与 BP 之间的关联。
评估 BMI 与 BP 在广泛的中国人群亚组中的异质性。
设计、地点和参与者：这是一项横断面研究，于 2014 年 9 月 15 日至 2017 年 6 月 20 日期间，从中国内地 31 个省的 141 个基层医疗点（53 个城区和 88 个农村县）收集了 1727411 名年龄在 35-80 岁之间的成年人（China PEACE Million Persons Project）的单次数据，这些参与者均参加了“以患者为中心的心脏事件评估”项目。通过基于协变量定义超过 22000 个个体亚组进行了全面的亚组分析，并在每个亚组内，线性回归 BMI 与 BP。
使用电子血压计在参与者坐姿时测量两次收缩压。
该研究共纳入 1727411 名参与者（1027711 名女性和 699700 名男性；平均[标准差]年龄为 55.7[9.8]岁）。在研究样本中，平均（标准差）BMI 为 24.7（3.5），平均（标准差）收缩压为 136.5（20.4）mmHg，平均（标准差）舒张压为 81.1（11.2）mmHg。在未服用降压药物的 95%的亚组中，BP 随 BMI 每单位增加 0.8 至 1.7mmHg/（kg/m2）。与未接受治疗的患者相比，服用降压药物的患者亚组中 BMI 与 BP 之间的关联要弱得多。在未接受治疗的亚组中，95%的系数变化小于 1mmHg/（kg/m2）。
在人群亚组的数万人中，BMI 与 BP 之间存在正相关，如果存在因果关系，鉴于其幅度，将对公共卫生产生重大影响。
