Chen Bo, Cui Yuze, Lei Mengyun, Xu Wenlei, Yan Qiongjie, Zhang Xiaotong, Qin Minghui, Xu Shaoyong
Evidence-Based Medicine Centre, Office of Academic Research, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
Int J Hypertens. 2021 Dec 10;2021:3326349. doi: 10.1155/2021/3326349. eCollection 2021.
To explore the association between high sensitivity C-reactive protein (hs-CRP) levels and incident hypertension, as well as the association between hs-CRP levels and related covariates, in a Chinese adult population.
This study was based on the China Health and Nutrition Survey, a continuing open, large-scale prospective cohort study. Adult participants who were free of hypertension were included at baseline survey in 2009 and were followed up in 2015 (follow-up rate: 77.45%). The hs-CRP was measured using the immunoturbidimetric method and divided into three groups: low-risk group (0 ≤ hs-CRP <1 mg/L), average-risk group (1 ≤ hs-CRP <3 mg/L), and high-risk group (3 ≤ hs-CRP ≤10 mg/L). Definite diagnosis of hypertension in the follow-up survey in 2015 was the endpoint event of this study. The areas under the curve (AUC) of the receiver operating characteristic (ROC) curve analyses were used to evaluate the predictive value of the hs-CRP.
3794 participants were finally included as study sample, of whom 912 developed hypertension during a 6-year follow-up period (incidence: 24.1%). The incidences of hypertension in hs-CRP low-risk, average-risk, and high-risk groups were 17.6% (200/1135), 25.9% (521/2015), and 29.7% (191/644), respectively. Spearman's correlation analyses showed that there was significant positive correlation between hs-CRP levels and waist circumference, total triglycerides, total cholesterol, age, body mass index, and homeostasis model assessment of insulin resistance index. Stepwise regression analyses showed that participants in the hs-CRP high-risk group had a 46.2% higher risk of developing hypertension compared with those in the hs-CRP low-risk group (odds ratio: 1.462, 95% confidence interval: 1.018-2.101). Baseline systolic and diastolic blood pressure levels and waist circumference contributed the most to the development of hypertension with of 0.076, 0.052, and 0.039, respectively, while hs-CRP had lower area under the curve (AUC) for hypertension, adding baseline BP and WC to the prediction model increased the AUC to 0.708 (95% CI: 0.681-0.735).
This study revealed a weak positive association between CRP levels and future incidence of hypertension in the Chinese population. The combination of hs-CRP with baseline BP and waist circumference (WC) had a higher predictive value for hypertension (AUC: 0.708), but the predictive value was still limited.
探讨中国成年人群中高敏C反应蛋白（hs-CRP）水平与高血压发病之间的关联，以及hs-CRP水平与相关协变量之间的关联。
本研究基于中国健康与营养调查，这是一项持续开放的大规模前瞻性队列研究。2009年基线调查纳入无高血压的成年参与者，并于2015年进行随访（随访率：77.45%）。采用免疫比浊法测定hs-CRP，并分为三组：低风险组（0≤hs-CRP＜1mg/L）、中风险组（1≤hs-CRP＜3mg/L）和高风险组（3≤hs-CRP≤10mg/L）。2015年随访调查中确诊高血压为该研究的终点事件。采用受试者工作特征（ROC）曲线分析的曲线下面积（AUC）评估hs-CRP的预测价值。
最终纳入3794名参与者作为研究样本，其中912人在6年随访期间发生高血压（发病率：24.1%）。hs-CRP低风险、中风险和高风险组的高血压发病率分别为17.6%（200/1135）、25.9%（521/2015）和29.7%（191/644）。Spearman相关性分析显示，hs-CRP水平与腰围、总甘油三酯、总胆固醇、年龄、体重指数和胰岛素抵抗指数的稳态模型评估之间存在显著正相关。逐步回归分析显示，hs-CRP高风险组参与者发生高血压的风险比hs-CRP低风险组高46.2%（比值比：1.462，95%置信区间：1.018-2.101）。基线收缩压和舒张压水平以及腰围对高血压发生的贡献最大，分别为0.076、0.052和0.039，而hs-CRP对高血压的曲线下面积（AUC）较低，将基线血压和腰围纳入预测模型可使AUC提高至0.708（95%CI：0.681-0.735）。
本研究揭示了中国人群中CRP水平与未来高血压发病率之间存在弱正相关。hs-CRP与基线血压和腰围（WC）联合对高血压具有较高的预测价值（AUC：0.708），但预测价值仍有限。
