Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University.
National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan.
J Hypertens. 2020 Jul;38(7):1271-1277. doi: 10.1097/HJH.0000000000002404.
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for high blood pressure (BP) in adults redefined hypertension as SBP at least 130 mmHg or DBP at least 80 mmHg. However, the optimal BP for different BMI population to reduce stroke incidence is uncertain.
A prospective cohort study was designed by four examinations: baseline (2004-2006), 2008, 2010 and 2017 follow-up. The study group composed of 36 352 individuals, to determine the ideal BP range to reduce stroke incidence of two BMI level, adjusted Cox proportional hazards models were utilized to establish the associations between SBP/DBP and the risk of stroke incident. Then, the restricted cubic spline regression was applied to find the ideal range of SBP/DBP values for two kinds of BMI categories definitions.
During a median follow-up period of 12.5 years, 2548 (7.0%) nonstroke individuals at baseline developed incident stroke. After fully adjusting confounding factors, SBP (per 20 mmHg increase) and DBP (per 10 mmHg increase) are independently associated with the risk of stroke incidence [SBP, hazard ratio = 1.277, 95% confidence interval (95% CI), 1.217-1.340, P < 0.001; DBP, hazard ratio = 1.138, 95% CI, 1.090-1.189, P < 0.001].
Our study revealed that the ideal BP for a population with BMI less than 24 kg/m was less than 130/80 mmHg, whereas the ideal BP for BMI at least 24 kg/m was less than 120/80 mmHg. The sensitivity analyses between BMI less than 25 kg/m and BMI at least 25 kg/m showed similar findings. This finding provides more accurate primary prevention strategies based on various BMI populations.
2017 年美国心脏病学会/美国心脏协会（ACC/AHA）高血压成人指南将高血压重新定义为收缩压至少 130mmHg 或舒张压至少 80mmHg。然而，不同 BMI 人群降低中风发病率的最佳血压值尚不确定。
通过四次检查设计了一项前瞻性队列研究：基线（2004-2006 年）、2008 年、2010 年和 2017 年随访。研究组由 36352 人组成，以确定两个 BMI 水平降低中风发病率的理想血压范围，采用调整后的 Cox 比例风险模型建立 SBP/DBP 与中风事件风险之间的关系。然后，应用限制三次样条回归来寻找两种 BMI 分类定义的理想 SBP/DBP 值范围。
在中位随访 12.5 年期间，基线时无中风的 2548 例（7.0%）非中风患者发生了中风事件。在充分调整混杂因素后，SBP（每增加 20mmHg）和 DBP（每增加 10mmHg）与中风发病风险独立相关[SBP，风险比=1.277，95%置信区间（95%CI）为 1.217-1.340，P<0.001；DBP，风险比=1.138，95%CI 为 1.090-1.189，P<0.001]。
本研究表明，BMI 低于 24kg/m2 的人群的理想血压应低于 130/80mmHg，而 BMI 至少 24kg/m2 的人群的理想血压应低于 120/80mmHg。BMI 低于 25kg/m2 和 BMI 至少 25kg/m2 之间的敏感性分析显示出类似的结果。这一发现为基于不同 BMI 人群提供了更准确的一级预防策略。
