正常高值血压人群血压进展及影响因素

Progress of blood pressure and influence factors in prehypertensives

目的探讨正常高值血压人群血压进展及其影响因素。方法选择2006-2007年开滦集团公司职工健康体检中符合2005年《中国高血压防治指南》正常高值诊断标准的人群作为观察队列。于2008-2009年对观察队列进行第二次健康体检,观察其进展成不同类型高血压的性别、年龄分布情况及影响因素。结果共入选正常高值血压人群33913例作为观察队列,排除复查期间发生心脑血管事件者、失访者及参数缺失者后,纳入最终统计的有效数据为25474例。该人群第二次体检时有8361例进展至高血压,占整个正常高值血压人群的32.82%。排除服降压药者,其余7775例按单纯收缩期高血压组(ISH)、单纯舒张期高血压组(IDH)和双期高血压组(SDH)分为3组。其中ISH组1615例(20.77%),IDH组2879例(37.03%),SDH组3281例(42.20%)。将高血压患者按年龄分为<40、40～<50、50～<60、≥60岁4组,ISH所占比例随年龄增加呈逐渐上升趋势,≥60岁时最高,达42.52%,而SDH组在60岁之前所占比例也随年龄上升,60岁后显著下降。IDH在<60岁,尤其是40～<50岁时所占比例较高(49.29%),60岁以后则下降至16.0%(P<0.05)。多因素logistic回归分析显示影响ISH的危险因素包括年龄、空腹血糖、低密度脂蛋白胆固醇(LDL-C)、收缩压、体质量指数(BMI)和吸烟;影响IDH的危险因素包括男性、年龄、三酰甘油、舒张压、收缩压、腰围、BMI和饮酒。影响SDH的危险因素包括男性、年龄、空腹血糖、LDL-C、三酰甘油、舒张压、收缩压、腰围、BMI、总胆固醇和饮酒。结论正常高值血压进展至高血压的人群中,ISH、IDH和SDH的构成比分别为20.77%、37.03%和42.20%,年龄、性别、腰围、总胆固醇等因素对正常高值血压进展成各型高血压的影响不同。

Objective To explore the relationship between blood pressure progression and risk factors in prehypertension populations.Methods A population-based cohort of 33 913 subjects with prehypertension diagnosed according to Guildlines for Prevention and Treatment of Hypertension in China 2005 in the health examination for the employees of Kailuan group were followed-up from 2006 to 2007.The population were followed up during the period of 2008 to 2009 again,in order to analysis the distribution of age and gender in different subtype of hypertension,to identify main determining risk factors promoting prehypertension to hypertension.Results During the 2-years follow-up period,8361 individuals developed into hypertension in all 25 474 cases with prehypertension,in which 1615 cases（20.77%）were isolated systolic hypertension（ISH）,2879 cases（37.03%）were isolated diastolic hypertension（IDH）,and 3281 cases（42.20%）were systolic and diastolic hypertension（SDH）.A total of 7775 patients were divided into 40,40-50,50-60 and ≥60 years four groups by age.The percentage of ISH increased in older patients.The percentage of SDH increased with age,but decreased in ≥60 years group.The percentage of IDH increased in the 60 years group,especially in 40-50 years group,and decreased to 16.0%（P0.05）in the group aged ≥60 years.Multiple logistic regression showed that risk factors for ISH were age,fasting plasma glucose（FPG）,low density lipoprotein-cholesterol（LDL-C）,systolic blood pressure（SBP）,body mass index（BMI）and cigarette.Risk factors for IDH were gender（male）,age,triglyeride（TG）,diastolic blood pressure（DBP）,SBP,waist circumference（WC）,BMI and alcohol.Gender（male）,age,FPG,LDL-C,TG,DBP,SBP,WC,BMI,TC and alcohol were risk factors for SDH.Conclusion The percentage of established hypertension developed from prehypertension were 20.77%,37.03% and 42.20% in ISH,IDH and SDH respectively.Age,gender,WC,TC have significant impact on the development from prehypertension to hypertension.