年度间收缩压变异性的分布及其主要影响因素分析

Distribution and major influencing factors of annual systolic blood pressure variability： results from a large cohort study

目的 探讨年度间收缩压变异性的分布情况及其主要影响因素.方法 采用前瞻性队列研究设计,以开滦研究中同时参加过2006年6月至2007年10月、2008年6月至2009年10月、2010年6月至2011年10月、2012年6月至2013年10月4次查体的开滦集团职工作为研究对象.收缩压变异性定义为收缩压标准差（SSD）和变异系数（SCV）.采用多因素线性回归分析不同指标对SSD和SCV的影响.结果 （1）完成4次查体并且血压资料完整的职工共43 360例（男性32 959例,女性10 401例）,年龄（48.2±11.5）岁.总人群的SSD和SCV均值分别为10.91 mmHg（1 mmHg=0.133 kPa）和8.34％.不论男性还是女性,SSD和SCV均随着年龄的增长而增大（P均＜0.001）.（2）多因素线性回归分析显示：SSD的影响因素包括收缩压（β=0.225,P＜0.001）、年龄（β=0.163,P ＜0.001）、空腹血糖（β=0.038,P＜0.001）、服用降压药（β=0.038,P＜0.001）、性别（β=0.038,P＜0.001）、吸烟（β=0.025,P＜0.001）、饮酒（β=-0.022,P＜0.001）、经常锻炼（β=-0.018,P=0.001）、高敏C反应蛋白（β=0.016,P=0.001）和体质指数（β=-0.011,P=0.018）;SCV的影响因素包括年龄（β =0.139,P＜0.001）、性别（β=0.055,P＜0.001）、收缩压（β=0.047,P＜0.001）、空腹血糖（β=0.033,P＜0.001）、饮酒（β=-0.030,P＜0.001）、体质指数（β=-0.026,P＜0.001）、服用降压药（β=0.026,P＜0.001）、吸烟（β=0.024,P＜0.001）、经常锻炼（β=-0.015,P=0.001）和高敏C反应蛋白（β=0.014,P=0.001）.结论 SSD、SCV随着年龄增长而增大.SSD的影响因素主要有收缩压、年龄、空腹血糖、服用降压药、性别、吸烟、饮酒、经常锻炼、高敏C反应蛋白和体质指数;SCV的影响因素主要有年龄、性别、收缩压、空腹血糖、饮酒、体质指数、服用降压药、吸烟、经常锻炼和超敏C反应蛋白.

Objective To investigate the distribution and major influencing factors of annual systolic blood pressure variability from a large population cohort.Methods In this prospective cohort study,data from Kailuan Group employees who attended all 4 physical examinations （taken in June 2006 to October 2007,June 2008 to October 2009,June 2010 to October 2011,June 2012 to October 2013,respectively） were analyzed （32 959 males and 10 401 females,mean age：（48.2 ± 11.5） years old）.Systolic blood pressure variability was defined as the standard deviation （SSD） and the coefficient of variation（SCV） of systolic blood pressure of 4 physical examinations.Multivariate linear regression analysis was used to determine the related influencing factors of SSD and SCV.Results （1） The mean of SSD and SCV for this cohort was 10.91 mmHg（1 mmHg =0.133 kPa） and 8.34%,respectively.SSD and SCV increased in male and female with increasing age（both P 〈0.001）.（2） Multiple linear regression analysis showed that systolic blood pressure （β =0.225,P 〈 0.001）,age （β =0.163,P 〈 0.001）,fasting blood glucose（β =0.038,P 〈 0.001）,the use of anti-hypertensive drugs （β =0.038,P 〈 0.001）,sex （β =0.038,P 〈 0.001）,smoking （β =0.025,P 〈 0.001）,alcohol drinking （β =-0.022,P 〈 0.001）,physical exercise（β =-0.018,P =0.001）,high-sensitivity c-reactive protein （β =0.016,P =0.001）,body mass index（β =-0.011,P =0.018） were related to SSD.Age （β =0.139,P 〈 0.001）,sex （β =0.055,P 〈0.001）,systolic blood pressure（β =0.047,P 〈0.001）,fasting blood glucose（β =0.033,P 〈0.001）,drinking（β =-0.030,P 〈 0.001）,body mass index （β =-0.026,P 〈 0.001）,the use of anti-hypertensive drugs（β =0.026,P 〈 0.001）,smoking （β =0.024,P 〈 0.001）,physical exercise （β =-0.015,P =0.001）,high-sensitivity c-reactive protein （β =0.014,P =0.001） were related to SCV.Conclusions SSD and SCV increase with increasing age.Systolic blood pressure,age,fasting blood glucose,the use of anti-hypertensive drugs,sex,smoking,drinking,physical exercise,high-sensitivity c-reactive protein,body mass index are major influencing factors for SSD.Age,sex,systolic blood pressure,fasting blood glucose,alcohol drinking,body mass index,the use of anti-hypertensive drugs,smoking,physical exercise,high-sensitivity c-reactive protein are major influencing factors for SCV.