Huang Z, Willett W C, Manson J E, Rosner B, Stampfer M J, Speizer F E, Colditz G A
Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Ann Intern Med. 1998 Jan 15;128(2):81-8. doi: 10.7326/0003-4819-128-2-199801150-00001.
Obesity increases the risk for hypertension, but the effects of modest long-term weight changes have not been precisely quantified.
To investigate body mass index (BMI) and weight change in relation to risk for hypertension.
Cohort study.
General community.
Cohort of 82,473 U.S. female nurses 30 to 55 years of age followed every 2 years since 1976. The follow-up rate was 95%.
Primary risk factors examined were 1) BMI at age 18 years and midlife and 2) long-term and medium-term weight changes. The outcome was incident cases of hypertension.
By 1992, 16,395 incident cases of hypertension had been diagnosed. After adjustment for multiple covariates, BMI at 18 years of age and midlife were positively associated with occurrence of hypertension (P for trend < 0.001). Long-term weight loss after 18 years of age was related to a significantly lower risk for hypertension, and weight gain dramatically increased the risk for hypertension (compared with weight change < or = 2 kg, multivariate relative risks were 0.85 for a loss of 5.0 to 9.9 kg, 0.74 for a loss > or = 10 kg, 1.74 for a gain of 5.0 to 9.9 kg, and 5.21 for a gain > or = 25.0 kg). Among women in the top tertile of baseline BMI at age 18 years, weight loss had a greater apparent benefit. The association between weight change and risk for hypertension was stronger in younger (< 45 years of age) than older women (> or = 55 years of age). Medium-term weight changes after 1976 showed similar relations to risk for hypertension.
Excess weight and even modest adult weight gain substantially increase risk for hypertension. Weight loss reduces the risk for hypertension.
肥胖会增加患高血压的风险，但适度的长期体重变化的影响尚未得到精确量化。
研究体重指数（BMI）和体重变化与高血压风险的关系。
队列研究。
普通社区。
自1976年起，对82473名年龄在30至55岁的美国女性护士进行队列研究，每两年随访一次，随访率为95%。
主要研究的风险因素为：1）18岁和中年时的BMI；2）长期和中期体重变化。观察指标为高血压发病病例。
到1992年，共诊断出16395例高血压发病病例。在对多个协变量进行调整后，18岁和中年时的BMI与高血压的发生呈正相关（趋势P<0.001）。18岁后长期体重减轻与显著降低的高血压风险相关，而体重增加则显著增加高血压风险（与体重变化≤2kg相比，体重减轻5.0至9.9kg的多变量相对风险为0.85，体重减轻≥10kg的为0.74，体重增加5.0至9.9kg的为1.74，体重增加≥25.0kg的为5.21）。在18岁时BMI处于最高三分位数的女性中，体重减轻的益处更为明显。体重变化与高血压风险之间的关联在年轻女性（<45岁）中比老年女性（≥55岁）中更强。1976年后的中期体重变化与高血压风险呈现相似的关系。
超重甚至适度的成年体重增加都会大幅增加高血压风险。体重减轻可降低高血压风险。
