Department of Orthopedics, Pediatric Orthopedics and Traumatology, Centre of Postgraduate Medical Education, Warsaw, Poland.
Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland.
PLoS One. 2023 Jan 31;18(1):e0281151. doi: 10.1371/journal.pone.0281151. eCollection 2023.
Loss of physiological nocturnal blood pressure (BP) decline is an independent predictor of cardiovascular risk and mortality. The aim of the study was to investigate the influence of body composition and fat distribution on 24-hour BP pattern and nocturnal dipping of mean arterial pressure (MAP) in patients with obesity. The study comprised 436 patients, 18 to 65 years old (306 women), with BMI ≥30 kg/m2. Body composition was assessed with dual-energy X-ray absorptiometry (DXA) and blood pressure was assessed by 24-hour BP monitoring. The prevalence of hypertension was 64.5% in patients with BMI <40 kg/m2 and increased to 78.7% in individuals with BMI ≥50 kg/m2 (p = 0.034). The whole-body DXA scans showed that the hypertensive patients were characterized by a greater lean body mass (LBM) and a higher abdominal-fat-to-total-fat-mass ratio (AbdF/FM), while the normotensive participants had greater fat mass, higher body fat percentage and more peripheral fat. Loss of physiological nocturnal MAP decline was diagnosed in 50.2% of the patients. The percentage of non-dippers increased significantly: from 38.2% in patients with BMI <40 kg/m2 to 50.3% in those with BMI 40.0-44.9 kg/m2, 59.0% in patients with BMI 45.0-49.9 kg/m2, 71.4% in those with BMI 50.0-54.9 kg/m2 and 83.3% in patients with BMI ≥55 kg/m2 (p = 0.032, p = 0.003, p<0.001, and p = 0.002 vs. BMI <40 kg/m2, respectively). The multivariable regression analysis showed that patients at the highest quartiles of body weight, BMI, LBM and AbdF/FM had significantly reduced nocturnal MAP dipping compared with patients at the lowest quartiles, respectively.
生理夜间血压下降的丧失是心血管风险和死亡率的独立预测因素。本研究旨在探讨体成分和脂肪分布对肥胖患者 24 小时血压模式和平均动脉压（MAP）夜间下降的影响。该研究纳入了 436 名年龄在 18 至 65 岁之间（306 名女性）、BMI≥30kg/m2 的患者。通过双能 X 射线吸收法（DXA）评估体成分，通过 24 小时血压监测评估血压。BMI<40kg/m2 的患者中高血压患病率为 64.5%，而 BMI≥50kg/m2 的患者中高血压患病率增至 78.7%（p=0.034）。全身 DXA 扫描显示，高血压患者的瘦体重（LBM）更大，腹部脂肪与总脂肪质量比（AbdF/FM）更高，而血压正常的患者则具有更大的脂肪质量、更高的体脂百分比和更多的外周脂肪。50.2%的患者被诊断为生理性夜间 MAP 下降丧失。非杓型患者的比例显著增加：从 BMI<40kg/m2 的患者的 38.2%增加到 BMI 为 40.0-44.9kg/m2 的患者的 50.3%、BMI 为 45.0-49.9kg/m2 的患者的 59.0%、BMI 为 50.0-54.9kg/m2 的患者的 71.4%和 BMI≥55kg/m2 的患者的 83.3%（p=0.032，p=0.003，p<0.001，和 p=0.002 分别与 BMI<40kg/m2 相比）。多变量回归分析显示，与体重、BMI、LBM 和 AbdF/FM 最低四分位数的患者相比，体重、BMI、LBM 和 AbdF/FM 最高四分位数的患者夜间 MAP 下降明显减少。
