糖代谢异常人群中不同高血压亚型的心脑血管疾病风险

doi:10.3969/j.issn.1006-7795.2023.01.007

首都医科大学学报 ›› 2023, Vol. 44 ›› Issue (1): 42-48.doi: 10.3969/j.issn.1006-7795.2023.01.007

• 临床流行病和临床试验 • 上一篇下一篇

糖代谢异常人群中不同高血压亚型的心脑血管疾病风险

左颖婷¹, 吴寿岭², 陈朔华², 田雪^3,4, 胥芹^3,4, 张怡君^3,4, 张晓丽^3,4, 王安心^3,4*

1.首都医科大学附属北京朝阳医院/北京市呼吸疾病研究所,临床流行病学研究室,北京 100020;
2.开滦总医院心内科,河北唐山 063000;
3.首都医科大学附属北京天坛医院神经病学中心,北京 100070;
4.首都医科大学附属北京天坛医院国家神经系统疾病临床医学研究中心,北京 100070

收稿日期:2022-10-24 出版日期:2023-02-21 发布日期:2023-01-13
基金资助:
北京市属医院科研培育计划(PX2020021),首都医科大学附属北京朝阳医院金种子基金项目(CYJZ202209)。

Cardiovascular risk of isolated systolic or diastolic hypertension in subjects with abnormal glucose metabolism

Zuo Yingting¹, Wu Shouling², Chen Shuohua², Tian Xue^3,4, Xu Qin^3,4, Zhang Yijun^3,4, Zhang Xiaoli^3,4, Wang Anxin^3,4*

1. Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
2. Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan 063000, Hebei Province, China;
3. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China;
4. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Received:2022-10-24 Online:2023-02-21 Published:2023-01-13
Contact: *E-mail: wanganxin@bjtth.org
Supported by:
Beijing Municipal Administration of Hospitals Incubating Program (PX2020021), Golden Seed Program of Beijing Chaoyang Hospital, Capital Medical University (CYJZ202209).

摘要/Abstract

摘要： 目的因糖代谢异常人群的孤立性收缩期高血压(isolated systolic hypertension,ISH)、孤立性舒张期高血压(isolated diastolic hypertension, IDH)及收缩期和舒张期高血压(systolic and diastolic hypertension, SDH)相关的心脑血管疾病风险证据较少,所以本研究将探索不同高血压亚型的心脑血管疾病风险,为进一步改善识别高危人群提供科学依据。方法本研究包括来自开滦社区队列研究的24 605例2006－2007年基线血压测量,没有服用高血压药物且没有心脑血管疾病病史的受试者。受试者根据基线血压水平分为8组:血压正常组[systolic blood pressure (SBP)<120 mmHg(1 mmHg=0.133 kPa) 并且 diastolic blood pressure (DBP )<80 mmHg)];血压高值组(120 mmHg≤SBP≤129 mmHg 并且 DBP<80 mmHg);Ⅰ期IDH组 (SBP<130 mmHg 并且 80 mmHg≤DBP≤89 mmHg);Ⅰ期ISH组(130 mmHg≤SBP≤139 mmHg 并且 DBP<80 mmHg);Ⅰ期SDH组(130 mmHg≤SBP≤139 mmHg 并且 80 mmHg≤DBP≤89 mmHg);Ⅱ期IDH组(130 mmHg≤SBP≤139 mmHg 并且 90 mmHg≤DBP);Ⅱ期ISH组(140 mmHg≤SBP 并且 DBP<90 mmHg);Ⅱ期SDH组(140 mmHg≤SBP 并且 90 mmHg≤DBP)。以心脑血管疾病为终点事件,研究随访至2019年12月31日。使用多因素Cox 比例风险模型来评估不同血压组与心脑血管疾病风险的关联性。结果在随访中位时间12.9(12.5,13.1)年期间,观察到2 406例心脑血管疾病。矫正了其他混杂因素后多因素Cox回归分析结果显示,与血压正常组相比,新发心脑血管疾病的风险比在Ⅰ期ISH中为1.31 (95%CI: 0.96~1.79),在Ⅰ期IDH中为1.15 (95%CI: 0.96~1.37),在Ⅰ期SDH中为1.30 (95%CI: 1.07~1.57)。Ⅱ期ISH、Ⅱ期IDH和Ⅱ期SDH都有较高的心脑血管疾病发生风险。Ⅱ期SDH的心脑血管疾病发生风险是血压正常组的2.24倍 (95%CI: 1.91~2.61)。结论将糖代谢异常人群Ⅰ期高血压进一步归类为Ⅰ期ISH、IDH和SDH可能会改善识别高危人群的风险分层。

关键词: 血压, 心脑血管疾病, 高血压, 糖代谢异常

Abstract: Objective To explore whether cardiovascular risk differ among the subgroups of abnormal glucose metabolism adults with isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) or systolic and diastolic hypertension(SDH). Methods This study included 24 605 participants from Kailuan Study during 2006 and 2007, without taking antihypertensive medication and free of a history of cardiovascular disease (CVD). The baseline blood pressure (BP) was measured. The participants were categorized as having normal BP [systolic BP(SBP)<120 mmHg(1 mmHg=0.133 kPa)/diastolic BP (DBP)<80 mmHg], elevated BP (SBP 120－129 mmHg/DBP<80 mmHg), stage 1 IDH (SBP<130 mmHg/DBP 80－89 mmHg), stage 1 ISH (SBP 130－139 mmHg/DBP<80 mm Hg); stage 1 SDH (SBP 130－139 mmHg/DBP 80－89 mmHg), stage 2 IDH (SBP<140 mmHg/DBP≥90 mm Hg), stage 2 ISH (SBP≥140 mmHg/DBP<90 mm Hg), and stage 2 SDH (SBP≥140 mmHg/DBP≥90 mmHg). The outcome was the first occurrence of CVD from baseline to the end of follow-up (December 31, 2019). Multivariable-adjusted Cox proportional hazards models were performed to evaluate the associations. Results During a median follow-up of 12.9 (interquartile range: 12.5－13.1) years, we observed 2,406 incident CVD events. With normal BP as the reference, multivariable-adjusted hazard ratios for CVD events were 1.31 (95%CI 0.96－1.79) for stage 1 ISH, 1.15 (95%CI 0.96－1.37) for stage 1 IDH, and 1.30 (95%CI 1.07－1.57) for stage 1 SDH. Furthermore, stage 2 ISH, stage 2 IDH and stage 2 SDH all had a higher risk of CVD than the normal BP. The risk of CVD in stage 2 SDH was 2.24 times higher than normal BP (95% CI 1.91－2.61). Conclusions Categorizing abnormal glucose metabolism adults with stage 1 hypertension further into stage 1 ISH, IDH, and SDH may improve risk stratification for identifying high-risk individuals.

Key words: blood pressure, cardiovascular disease, hypertension, abnormal glucose metabolism

中图分类号:

左颖婷, 吴寿岭, 陈朔华, 田雪, 胥芹, 张怡君, 张晓丽, 王安心. 糖代谢异常人群中不同高血压亚型的心脑血管疾病风险[J]. 首都医科大学学报, 2023, 44(1): 42-48.

Zuo Yingting, Wu Shouling, Chen Shuohua, Tian Xue, Xu Qin, Zhang Yijun, Zhang Xiaoli, Wang Anxin. Cardiovascular risk of isolated systolic or diastolic hypertension in subjects with abnormal glucose metabolism[J]. Journal of Capital Medical University, 2023, 44(1): 42-48.

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糖代谢异常人群中不同高血压亚型的心脑血管疾病风险

Cardiovascular risk of isolated systolic or diastolic hypertension in subjects with abnormal glucose metabolism

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