《国民体质测定标准》中肥胖参数与高血压风险关系

Relationship between obesity index of National Physical Fitness Evaluation Standard and hypertension risk

目的评价《国民体质测定标准》中肥胖指标与正常偏高血压及高血压风险关系,并确定判定切点,为高血压的预防控制提供参考依据。方法采用分层整群抽样方法对在辽宁省沈阳、丹东、朝阳市3个国民体质监测点抽取的5 809名20～69岁未接受高血压药物治疗的居民进行体格检查。结果 5 809名居民的正常偏高血压率和高血压率分别为16.92%和24.89%,其中男性居民正常偏高血压率和高血压率分别为20.98%和31.57%,均高于女性居民的12.94%和18.33%,差异均有统计学意义(P<0.01);多因素logistic回归分析结果表明,年龄≥40岁和体质指数(BMI)是正常偏高血压的危险因素,女性是正常偏高血压的保护因素;年龄≥30岁、BMI和腰围是高血压的危险因素,女性是高血压的保护因素;控制年龄、性别的影响后,BMI每升高1个标准差,正常偏高血压和高血压的风险分别增大1.38倍(95%CI=1.28～1.50)和1.57倍(95%CI=1.39～1.78);腰围每升高1个标准差,高血压的风险增大1.37倍(95%CI=1.20～1.56);以约登指数最大确定切点,BMI判定正常偏高血压的切点为男性24.0 kg/m2、女性24.3 kg/m2,BMI判定高血压的切点为男性25.1 kg/m2、女性24.3 kg/m2,腰围判定高血压的切点为男性87.0 cm,女性80.6 cm;以灵敏度≥80%确定切点,BMI判定正常偏高血压的切点为男性23.0 kg/m2、女性22.3 kg/m2,BMI判定高血压的切点为男性23.4 kg/m2、女性22.8 kg/m2,腰围判定高血压的切点为男性82.0 cm、女性76.9 cm。结论高血压的风险随BMI及腰围的增加而增大,BMI与高血压的关联强度大于腰围。

Objective To evaluate the relationship between obesity index and hypertension risk and to identify the cut-off point for the prevention of hypertension.Methods Stratified cluster random sampling method was used to select a total of 5 809 adults aged 20-69 years from three settings of the Third China′s National Physical Fitness Surveillance of Liaoning province including Shenyang,Dandong and Chaoyang city.Physical examination was conducted for the subjects without antihypertensive medications.Results Among the 5 809 subjects,the prevalence of high normal blood pressure and hypertension was 16.92% and 24.89%,respectively.The prevalences of high normal blood pressure and hypertension in men（20.98%,31.57%） were significantly higher than those in women（12.94%,18.33%）（P0.01）.Multivariate logistic regression results showed that older than 40 years and body mass index（BMI） were risk factors,and female gender was a protective factor for high normal blood pressure.For hypertension,older than 30 years,BMI and waist circumference were risk factors,and female gender was a protective factor.After adjusted for age and gender,risks of high normal blood pressure and hypertension increased by 1.38（95% confidence interval：1.28-1.50） and 1.57（95% CI：1.39-1.78） times with the increase of per standard deviation of BMI.The risk of hypertension increased by 1.37（95% CI：1.20-1.56） times with the increase of per standard deviation of waist circumference.Based on the maximal Youden′s index,the cut-off points of BMI to identify high normal blood pressure were 24.0 kg/m2 for men and 24.3 kg/m2 for women,and the cut-off points to identify hypertension were 25.1 kg/m2 for men and 24.3 kg/m2 for women.The cut-off points of waist circumference to identify hypertension were 87.0 cm for men and 80.6 cm for women.On the basis of sensitivity higher than 80%,the cut-off points of BMI to identify high normal blood pressure were 23.0 kg/m2 for men and 22.3 kg/m2 for women,and the cut-off points of BMI to identify hypertension were 23.4 kg/m2 for men and 22.8 kg/m2 for women.The cut-off points of waist circumference to identify hypertension were 82.0 cm for men and 76.9 cm for women.Conclusion Risk of hypertension increases with the increments of BMI and waist circumference,and BMI is more strongly associated with hypertension than waist circumference.