老年男性高血压患者体质指数对心血管事件的影响  

Association between body mass index and cardiovascular events in male elderly hypertensive patients

作　　者：张金霞[1] 龚志华[1] 冯颖青[2] 杨峻青[2] 周颖玲[2] 向定成[1] 

机构地区：[1]广州军区广州总医院心血管内科,510010 [2]广东省人民医院心血管病研究所

出　　处：《中华心血管病杂志》2015年第3期239-243,共5页Chinese Journal of Cardiology

基　　金：广东省科技计划（2011B03180007）;广州市科技计划（2014Y2-00068）

摘　　要：目的 分析老年男性高血压患者的体质指数（BMI）对心血管事件的影响,探讨老年男性高血压患者中的肥胖矛盾现象.方法 本研究为回顾性队列研究.从2004年1月至2014年1月,纳入老年男性高血压患者839例,根据BMI指数分为3组：正常组（18.5 kg/m2≤BMI＜ 24.0 kg/m2）274例,超重组（24.O kg/m2≤BMI＜ 28.0 kg/m2） 430例,肥胖组（BMI≥28.0 kg/m2） 135例.统计所有患者10年间的心血管事件情况,分析不同BMI水平的全因死亡及心血管事件的差异,采用Cox比例风险回归模型分析全因死亡及心血管事件（心脑血管死亡、新发或再发心肌梗死、卒中和脑梗死）的危险因素.结果 纳入的839例男性高血压的平均年龄为（75.4±4.8）岁,基线收缩压（133.7±14.6）mmHg（1 mmHg =0.133 kPa）,舒张压（74.3±9.3）mmHg.839例患者均获得完整随访,3组间的基线收缩压及舒张压差异无统计学意义.839例患者中共发生全因死亡178例,心脑血管死亡54例,新发/再发心肌梗死51例,新发/再发脑梗死105例.其中,超重组的全因死亡发生率为16.74％（72/430）,低于正常组的27.01％（74/274）（P＜0.05）.Kaplan-Meier曲线显示体质量正常组的全因死亡及心血管死亡率均高于其余两组（P均＜ 0.05）.根据Cox比例风险回归模型,BMI≥24.0 kg/m2患者的全因死亡及心脑血管死亡的风险分别为BMI＜ 24.0 kg/m2的86.7％（RR=0.867,95％ CI：0.792～0.949）和17.9％（RR=0.179,95％CI：0.05 ～0.645）.结论 在老年男性高血压患者中,体质量超常的患者显示出更好的心血管预后,存在肥胖矛盾现象.Objective To observe the long-term relationship between body mass index （BMI） and cardiovascular events in male elderly hypertensive patients.Methods A total of 839 male elderly （＞ 65 years old） hypertensive patients were included in this prospective study.Baseline data were obtained on January 2004 and participants were followed up yearly till January 2014.Patients were divided into 3 groups according to their BMI：normal weight group （18.5 kg/m2 ≤BMI ＜24.0 kg/m2）,overweight group （24.0 kg/m2 ≤ BMI ＜ 28.0 kg/m2）,obese group （BMI ≥ 28.0 kg/m2）.All-cause death and cardiovascular events were compared.Results The average age of all 839 hypertension men was （75.4 ± 4.8） years at baseline.Baseline systolic blood pressure was （133.7 ± 14.6） mmHg（1 mmHg =0.133 kPa）,diastolic blood pressure was （74.3 ± 9.3） mmHg.Baseline systolic and diastolic blood pressure was similar among the three groups.All 839 patients completed follow-up.There were 178 all-cause deaths,54 cardiovascular deaths,51 new/recurrent myocardial infarctions and 105 new/recurrent strokes during follow up.Incidence of all-cause mortality in overweight group （16.74％,72/430） was significantly lower than in normal weight group （27.01％ （74/274）,P ＜ 0.05）.Kaplan-Meier curves showed the all-cause mortality and cardiovascular mortality were higher in normal weight group than in the other two groups.According to the Cox proportional hazards regression model,the risk of all-cause mortality （RR =0.867,95％ CI：0.792-0.949） and cardiovascular death （RR =0.179,95 ％ CI：0.05-0.645） in patients with a BMI ≥ 24.0 kg/m2 were lower than in the group with BMI ＜ 24.0 kg/m2.Conclusion Obesity paradox phenomenon is observed in elderly male hypertensive patients in that higher BMI is associated with lower mortality risks in elderly male hypertensive patients during the 10 years follow-up.

关 键 词：高血压 老年 男性 预后 

分 类 号：R544.1[医药卫生—心血管疾病]