单纯舒张期高血压人群的血压转归和影响因素

Prevalence of isolated diastolic hypertension and associated cardiovascular risk： four years follow up results

目的 探讨单纯舒张期高血压（IDH）人群的血压转归和影响因素.方法 采用队列研究方法,以参加2006至2007年度开滦集团公司职工健康体检的101 510名职工中符合2005年世界卫生组织/国际高血压协会高血压治疗指南IDH诊断标准、既往无高血压病史、未服用抗高血压药物、无心脑血管疾病史的6778名职工作为观察队列.排除未参加2008至2009年度、2010至2011年度体检以及随访期间新发心脑血管疾病、服用降压药物者,最终纳入统计分析的职工共4 600例.观察2010至2011年度查体结束时IDH人群的血压转归情况.参照2006年中国人口统计学资料,采用直接法标化年龄和性别.采用多因素logistic逐步回归模型分析影响IDH人群转归的因素.结果 （1）随访（4.03 ±0.26）年后,IDH人群转归为正常血压、单纯收缩期高血压（ISH）、收缩期-舒张期双期高血压（SDH）的标准化转归率分别为51.4％、3.5％、18.3％.其中,男性分别为45.6％、3.6％、22.0％,女性分别为57.4％、3.3％、14.7％.（2）多因素logistic逐步回归模型分析显示：影响IDH转归为正常血压的因素为基线年龄小、舒张压低、体质指数低、尿酸低、体育锻炼、不饮酒（P＜0.01或0.05）;影响IDH转归为ISH的因素为基线年龄大、收缩压高、高敏C反应蛋白高（P均＜0.01）;影响IDH转归为SDH的因素为基线年龄大、收缩压高、喜盐（P＜0.01或0.05）.结论 未经治疗的IDH人群可转归为正常血压、ISH和SDH,且转归为正常血压的比例很高.多种因素影响单纯舒张期高血压的血压转归.

Objective To explore the prevalence of isolated diastolic hypertension and associated cardiovascular risk and blood pressure changes during follow up.Methods This cohort study screened 101 510 participants who were employees of the Kailuan Group,a state-run coal mining company in 2006 and 2007.Among them,6 778 subjects were diagnosed with isolated diastolic hypertension （IDH）.IDH subjects without history of cardiovascular disease and not treated with antihypertensive drugs were included in this analysis.Participants without health examination between 2008 to 2009 or 2010 to 2011 were excluded.A total of 4 600 participants were included in the final analysis.At the end of the third health examination,the conversion rate of different blood pressure turnover was calculated after standardizing age and gender according to demographic data of China in 2006.Multivariate logistic regression analysis was applied to analyze the risk factors of blood pressure turnover in IDH population.Results （1） Participants were followed up for （4.03 ± 0.26） years and the rates of turnover from IDH to normotension,isolated systolic hypertension （ISH） and systolic diastolic hypertension （SDH） were 51.4%,3.5%,18.3%,respectively （45.6%,3.6%,22.0% in male,57.4%,3.3%,14.7% in female）.（2） Multivariate logistic regression analysis showed that low baseline age,low diastolic pressure,low body mass index,low uric acid,physical exercise and low alcohol intake were associated with turnover from IDH to normotension; the risk factors of turnover from IDH to ISH were older age at baseline,higher systolic pressure and higher sensitivity C-reactive protein; the risk factors of turnover from IDH to SDH were older baseline age,high systolic pressure and excessive salt intake.Conclusions Untreated subjects with IDH can transform from IDH to normotension,ISH,SDH,and the rate of turnover from IDH to normotension is higher than others during follow up.Aging,higher systolic pressure,higher sensitivity C-reactive protein and excessive salt intake are risk factors for IDH subjects to suffer from ISH and SDH.