School of public health, Bengbu medical college, Bengbu, 233000, Anhui Province, China.
Department of general medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, Anhui Province, China.
BMC Cardiovasc Disord. 2020 May 12;20(1):218. doi: 10.1186/s12872-020-01501-5.
Abnormal glucose metabolism has been suggested to be involved in the development of hypertension. This study investigated the effect of the association and potential interaction of glycosylated hemoglobin (HbA1c) and other factors on the risk of hypertension among Chinese nondiabetic adults.
As a cross-sectional survey, the current work deployed a questionnaire survey, anthropometric tests, and biochemical measures for each of the eligible participants. The HbA1c levels were quantified and grouped by quartiles. Correlations between HbA1c and hypertension, isolated systolic hypertension (ISH), and isolated diastolic hypertension (IDH) risk were investigated by logistic analyses. For evaluating the interactive effects, the parameters of relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were calculated, respectively.
In the current study, 1462 nondiabetic subjects were enrolled. In total, the prevalence rates of hypertension, ISH and IDH were 22.4, 9.6 and 4.5%, respectively. When HbA1c levels were grouped by quartile, it was revealed that the prevalence rates of hypertension and ISH were substantially elevated across groups (P < 0.001). In the multivariable logistic regression analyses, in comparison with the first quartile of HbA1c, the normalized OR for hypertension risk was 1.90 (95% CI: 1.28-2.80) for the highest quartile. Also, the risk of ISH was significantly increased with HbA1c level in the highest quartile relative to in the bottom quartile (OR: 2.23,95% CI:1.47-3.71). However, no significant relationship between the HbA1c level and IDH risk was observed (OR: 1.78, 95% CI: 0.82-3.84). Eventually, it was demonstrated from the interactive effect analysis that HbA1c significantly interacted with abdominal obesity (RERI: 1.48, 95% CI: 0.38-2.58; AP: 0.37, 95% CI: 0.14-0.60 and SI: 1.96, 95% CI: 1.06-3.62) and family history of hypertension (AP: 0.37, 95% CI: 0.05-0.70) in influencing the risk of hypertension in nondiabetic participants.
Higher HbA1c levels significantly enhanced the risk of hypertension and ISH, but not IDH among Chinese nondiabetic adults. Moreover, the risk of hypertension was also aggravated by the upregulated HbA1c in a synergistic manner alongside abdominal obesity and family history of hypertension.
异常的葡萄糖代谢被认为与高血压的发生有关。本研究旨在探讨糖化血红蛋白（HbA1c）与其他因素的关联及其潜在交互作用对中国非糖尿病成年人高血压发病风险的影响。
本研究采用横断面调查设计，对每个符合条件的参与者进行问卷调查、人体测量测试和生化指标检测。HbA1c 水平进行四分位分组。采用 logistic 分析探讨 HbA1c 与高血压、单纯收缩期高血压（ISH）和单纯舒张期高血压（IDH）风险之间的相关性。为了评估交互作用的效果，分别计算了归因超额危险度（RERI）、归因危险度比（AP）和协同指数（SI）等参数。
本研究共纳入了 1462 名非糖尿病患者。研究对象中高血压、ISH 和 IDH 的患病率分别为 22.4%、9.6%和 4.5%。当按四分位分组时，HbA1c 水平越高，高血压和 ISH 的患病率显著升高（P<0.001）。在多变量 logistic 回归分析中，与 HbA1c 最低四分位组相比，HbA1c 最高四分位组的高血压发病风险归一化比值比（OR）为 1.90（95%可信区间：1.28-2.80）。同样，与最低四分位组相比，HbA1c 最高四分位组的 ISH 发病风险显著增加（OR：2.23，95%可信区间：1.47-3.71）。然而，HbA1c 水平与 IDH 风险之间未见显著相关性（OR：1.78，95%可信区间：0.82-3.84）。最后，通过交互作用分析表明，HbA1c 与腹型肥胖（RERI：1.48，95%可信区间：0.38-2.58；AP：0.37，95%可信区间：0.14-0.60；SI：1.96，95%可信区间：1.06-3.62）和高血压家族史（AP：0.37，95%可信区间：0.05-0.70）之间存在显著交互作用，从而影响非糖尿病参与者的高血压发病风险。
较高的 HbA1c 水平显著增加了中国非糖尿病成年人高血压和 ISH 的发病风险，但不增加 IDH 的发病风险。此外，HbA1c 水平的升高与腹型肥胖和高血压家族史协同作用，进一步加重了高血压的发病风险。
