Barrett-Connor E, Khaw K T
Circulation. 1985 Jul;72(1):53-60. doi: 10.1161/01.cir.72.1.53.
To determine the effect of obesity on prognosis in hypertensive subjects, a population of 1727 men 50 to 79 years of age was dichotomized by baseline body mass index (less than 27 and greater than or equal to 27 kg/m2) and systolic blood pressure (less than 160 and greater than or equal to 160 mm Hg). After 9 years of follow-up, age-adjusted all-cause, cardiovascular, and ischemic heart disease mortality rates were highest in the nonobese hypertensive subjects. The relative risk for mortality associated with a systolic blood pressure of 160 mm Hg or higher was significantly increased only in the nonobese group, with the largest difference in relative risk between obese and nonobese for ischemic heart disease. Results were consistent after separately excluding those with a history of heart disease, diabetes, current use of antihypertensive medication, and cigarette smoking, and those who died within 2 years of the baseline examination. When the independent effect of risk factors, including age, plasma cholesterol level, cigarette smoking, use of antihypertensive medication, and personal history of heart disease or diabetes was assessed with the Cox model, systolic blood pressure was a significant independent predictor of all-cause, cardiovascular, and ischemic heart disease death only in the nonobese subjects. We do not exclude an adverse effect of raised blood pressure in the obese. However, these data suggest that the prognosis is poorer in leaner hypertensive patients than in those who are overweight.
为了确定肥胖对高血压患者预后的影响，将1727名年龄在50至79岁之间的男性按基线体重指数（小于27和大于或等于27kg/m²）和收缩压（小于160和大于或等于160mmHg）进行二分法分类。经过9年的随访，年龄调整后的全因死亡率、心血管疾病死亡率和缺血性心脏病死亡率在非肥胖高血压患者中最高。仅在非肥胖组中，收缩压为160mmHg或更高时的死亡相对风险显著增加，缺血性心脏病在肥胖和非肥胖患者之间的相对风险差异最大。在分别排除有心脏病史、糖尿病史、当前正在使用抗高血压药物、吸烟的患者以及在基线检查后2年内死亡的患者后，结果仍然一致。当使用Cox模型评估包括年龄、血浆胆固醇水平、吸烟、使用抗高血压药物以及心脏病或糖尿病个人史等危险因素的独立作用时，收缩压仅在非肥胖患者中是全因死亡、心血管疾病死亡和缺血性心脏病死亡的显著独立预测因素。我们并不排除肥胖者血压升高的不良影响。然而，这些数据表明，较瘦的高血压患者的预后比超重患者更差。
