Nanjing Medical University, Nanjing, China.
Department of Anatomy, Histology, and Embryology, Nanjing Medical University, Nanjing, China.
J Clin Hypertens (Greenwich). 2024 Jan;26(1):24-35. doi: 10.1111/jch.14739. Epub 2023 Oct 21.
We aim to investigate the influence of waist circumference and body mass index (BMI) on all-cause death and cardiovascular-specific death in patients with hypertension. This prospective cohort study, based on waist circumference and body mass index measurements in patients with hypertension, provided risk estimates of all-cause mortality and cardiovascular events. The waist circumference-to-BMI ratio (WtBR) is an anthropometric measure integrating waist circumference and BMI. We utilized multivariable Cox regression analysis, restricted cubic spline model, Kaplan-Meier plot, random forest analysis, and sensitivity analysis to assess the relationship of WtBR with all-cause mortality. Subsequently, Fine-Gray competing risk regression models were applied to precisely evaluate the probability of cardiovascular-specific death attributed to high WtBR. The results indicate that thea deceased group showed significantly higher WtBR and lower BMI compared with the alive groups (P < .05), while no significant difference was observed in waist circumference (P = .373). When analyzed as continuous, the risk of all-cause death elevated with increasing WtBR in the adjusted model with an HR of 2.42 (95% CI, 2.06-2.85). The restricted cubic spline illustrated an elevated risk of all-cause mortality as WtBR increased (J-shaped curve). Nevertheless, WtBR showed no significant association with cardiovascular-specific death and the prediction model exhibited a reliable performance in the testing set. This study supported that WtBR, an anthropometric measure, is independently associated with all-cause death in hypertensive patients. It's advisable to routinely assess waist circumference in hypertensive patients regardless of BMI, in order to more effectively manage the risk of obesity-related health.
我们旨在探讨腰围和体重指数（BMI）对高血压患者全因死亡和心血管特定死亡的影响。这项基于高血压患者腰围和 BMI 测量的前瞻性队列研究，提供了全因死亡率和心血管事件的风险估计。腰围与 BMI 的比值（WtBR）是一种综合了腰围和 BMI 的人体测量指标。我们使用多变量 Cox 回归分析、限制立方样条模型、Kaplan-Meier 图、随机森林分析和敏感性分析来评估 WtBR 与全因死亡率的关系。随后，使用 Fine-Gray 竞争风险回归模型精确评估高 WtBR 与心血管特定死亡的概率。结果表明，死亡组的 WtBR 明显高于存活组，BMI 明显低于存活组（P<.05），而腰围无明显差异（P=.373）。在调整后的模型中，作为连续变量进行分析时，WtBR 每增加 1 个单位，全因死亡的风险增加 2.42 倍（95%CI，2.06-2.85）。限制立方样条图表明，随着 WtBR 的增加，全因死亡率的风险升高（J 形曲线）。然而，WtBR 与心血管特定死亡无显著关联，且预测模型在测试集中表现出可靠的性能。本研究支持体重指数作为一种人体测量指标，与高血压患者的全因死亡独立相关。建议常规评估高血压患者的腰围，无论 BMI 如何，以更有效地管理肥胖相关健康风险。
