Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Curr Cardiol Rev. 2024;20(4):e270324228382. doi: 10.2174/011573403X290574240322041356.
As a major cause of various cardiovascular diseases, the prevalence of hypertension has been increasing in the past 30 years, leading to significant socioeconomic and health burdens. Obesity is one of the major risk factors for hypertension. Body mass index (BMI) is the most used anthropometric index to measure obesity in clinical practice and to assess the risk of obesity-related diseases. However, obesity is a heterogeneous disease, and the accumulation of fat in different body regions leads to differences in cardiovascular and metabolic risks. BMI only reflects the overall obesity but does not consider the distribution of fat and muscle mass. The limitation of BMI makes it insufficient to assess the risk of hypertension attributed to obesity. In addition, waist circumference is an easily obtainable anthropometric index to evaluate abdominal fat distribution. High waist circumference is an independent risk factor for various cardiovascular diseases and all-cause mortality regardless of BMI. Preliminary data indicate that waist circumference is significantly associated with the risk of hypertension at different BMI levels. However, routine measurement of waist circumference is currently not required in current clinical guidelines or is only recommended for obese populations, indicating an insufficient understanding of waist circumference. In this review, we summarize the measurement methods and diagnostic thresholds of waist circumference for abdominal obesity, the trend of central obesity prevalence, the superiority of waist circumference over other anthropometric indices, and recent cross-sectional and longitudinal studies on the association between obesity and hypertension.
高血压作为多种心血管疾病的主要病因之一，其患病率在过去 30 年呈上升趋势，给社会经济和民众健康带来了沉重负担。肥胖是高血压的主要危险因素之一。体重指数（BMI）是临床实践中最常用的人体测量指标，用于衡量肥胖程度和评估肥胖相关疾病的风险。然而，肥胖是一种异质性疾病，不同身体部位脂肪的堆积导致心血管代谢风险存在差异。BMI 仅反映了整体肥胖程度，但并未考虑脂肪和肌肉量的分布。BMI 的局限性使其不足以评估肥胖引起的高血压风险。此外，腰围是评估腹部脂肪分布的一种易于获得的人体测量指标。高腰围是各种心血管疾病和全因死亡率的独立危险因素，与 BMI 无关。初步数据表明，腰围与不同 BMI 水平的高血压风险显著相关。然而，目前临床指南并未常规要求测量腰围，或仅建议肥胖人群测量腰围，这表明人们对腰围的认识不足。在本综述中，我们总结了腰围用于诊断腹型肥胖的测量方法和诊断界值、中心性肥胖流行趋势、腰围优于其他人体测量指标的优势，以及近期关于肥胖与高血压相关性的横断面和纵向研究。
