Masrouri Soroush, Hasanpour Amirhossein, Molavizadeh Danial, Ebrahimi Navid, Azizi Fereidoun, Hadaegh Farzad
Prevention of Metabolic Disorders Research Center, Research Institute for Metabolic and Obesity Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Endocrine Research Center, Research Institute for Endocrine Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Hypertens Res. 2025 Jul 1. doi: 10.1038/s41440-025-02267-z.
Hypertension is defined as ≥130/80 mm Hg by ACC/AHA 2017, and ≥140/90 mm Hg by the ESC 2018 and NICE 2019. We examined the association between isolated diastolic hypertension (IDH, by both thresholds) and cardio-renal-metabolic (CRM) multimorbidity. From 1999 to 2018, we followed 7377 (mean age: 37.7 years) and 6717 (36.8 years) Tehran Lipid and Glucose Study (TLGS) participants, initially free of cardiovascular disease (CVD), type 2 diabetes (T2DM), and chronic kidney disease, with systolic blood pressure (SBP) <140 and <130 mm Hg based on ESC/NICE and ACC/AHA criteria, respectively. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CRM multimorbidity (coexistence of ≥2 of CVD, kidney function decline [KFD], and T2DM). IDH was identified in 28.2% of participants using ACC/AHA criteria and 5.9% using ESC/NICE criteria. Over a median 15.3-year follow-up (IQR: 12.1-16.6), 182 CRM multimorbidity events occurred per ACC/AHA IDH criteria and 241 per ESC/NICE criteria. In the fully adjusted model, IDH by ESC/NICE criteria was not significantly associated with CRM multimorbidity (HR: 1.45 [95% CI: 0.98-2.15]), while stage 2 IDH by ACC/AHA criteria showed a significant association (2.15 [1.21-3.82]). Similar associations of IDH with incident CRM multimorbidity were observed across age groups, sex, current smoking, obesity, dyslipidemia, and prediabetes. IDH was associated with increased risks of T2DM, CVD, and KFD as individual outcomes. In conclusion, stage 2 IDH per ACC/AHA criteria is linked to a higher risk of incident CRM multimorbidity, independent of SBP levels.
美国心脏病学会/美国心脏协会（ACC/AHA）2017年将高血压定义为收缩压≥130/舒张压≥80 mmHg，欧洲心脏病学会（ESC）2018年和英国国家卫生与临床优化研究所（NICE）2019年则将其定义为收缩压≥140/舒张压≥90 mmHg。我们研究了单纯舒张期高血压（IDH，采用上述两种阈值定义）与心脏-肾脏-代谢（CRM）多种合并症之间的关联。1999年至2018年，我们对德黑兰血脂与血糖研究（TLGS）的7377名参与者（平均年龄：37.7岁）和6717名参与者（36.8岁）进行了随访，这些参与者最初无心血管疾病（CVD）、2型糖尿病（T2DM）和慢性肾脏病，根据ESC/NICE和ACC/AHA标准，收缩压（SBP）分别<140 mmHg和<130 mmHg。采用多变量Cox回归模型估计CRM多种合并症（CVD、肾功能下降[KFD]和T2DM中≥2种并存）的风险比（HR）和95%置信区间（CI）。采用ACC/AHA标准时，28.2%的参与者被确定为IDH；采用ESC/NICE标准时，5.9%的参与者被确定为IDH。在中位15.3年的随访期内（四分位间距：12.1 - 16.6年），按照ACC/AHA的IDH标准，发生182例CRM多种合并症事件；按照ESC/NICE标准，发生241例。在完全调整模型中，ESC/NICE标准定义的IDH与CRM多种合并症无显著关联（HR：1.45 [95% CI：0.98 - 2.15]），而ACC/AHA标准定义的2期IDH显示出显著关联（2.15 [1.21 - 3.82]）。在各年龄组、性别、当前吸烟状况、肥胖、血脂异常和糖尿病前期中，均观察到IDH与CRM多种合并症的发生存在类似关联。IDH与T2DM、CVD和KFD作为单独结局的风险增加相关。总之，根据ACC/AHA标准的2期IDH与CRM多种合并症的发生风险较高相关，且独立于SBP水平。
