体重指数对老年高血压患者心血管事件的影响

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

目的探讨老年高血压病患者体重指数(BMI)与心血管事件的关系。方法连续入选2005年1月~2014年12月在我院就诊我院符合条件的老年高血压病患者724例,根据BMI将患者分为三组:BMI正常组(<24 kg/m^2,n=238)、超重组[(24~27.9)kg/m^2,n=368]和肥胖组(≥28 kg/m^2,n=118)。主要随访终点为复合心血管事件,包括全因死亡、脑卒中及非致死性心肌梗死。结果所有患者均完成临床随访,中位随访事件32个月(四分位随访时间分别为6个月和40个月)。与正常体重的患者相比,肥胖组和超重组的复合终点事件发生率均明显降低(10.2%vs 10.9%vs 17.6%,P=0.032)。全因死亡率、脑卒中和心肌梗死的发生率三组间并未见显著差异。Cox多因素回归分析显示,超重(HR=0.62,95%CI 0.40~0.96,P=0.036)和肥胖(HR=0.58,95%CI 0.34~0.98,P=0.043)均是复合心血管事件的独立预测因素。结论老年高血压患者中,超重和肥胖者表现出更好的心血管预后。

Objective To observe the relationship between body mass index（BMI） and cardiovascular events in elderly hypertensive patient. Methods A total of 724 cases elderly hypertensive patients were included in this prospective study, who were in our hospital from January 2005 to December 2014. According to their BMI, patients were divided into normal weight group（BMI 〈24 kg/m^2, n=238）,overweight group [BMI（24-27.9）kg/m^2, n=368] and obese group（≥28 kg/m^2, n=118）. The composite of cardiovascular events, including all-cause mortality, stroke and myocardial infarction were seen as the primary outcome. Results Follow-up of all patients were completed. Median follow-up was 32months（interquatile 6-40 months）. Compared with the normal weight patients, the incidence of composite end points in obesity group and overweight group was significantly lower（10.2% vs 10.9% vs 17.6%,P=0.032）. The incidence of allcause mortality, stroke and myocardial infarction were all similar among the three groups. Cox multiple regression analysis showed that overweight（HR=0.62,95%CI 0.40-0.96, P=0.036） and obesity（HR=0.58, 95%CI 0.34-0.98, P=0.043） were independent predictors of cardiovascular events. Conclusion Overweight and obesity in the elderly with hypertension showed a better cardiovascular prognosis.