上海社区中老年人群正常高值血压水平与早期血管病变的相关性研究

The association between high normal blood pressure and early vascular dysfunction in middle-aged and elderly Chinese people

目的 ：探讨上海社区中老年人群血压的正常范围与早期血管病变间的相关性。方法 ：采取整群抽样的方法,对上海市宝山区淞南镇1 657名40岁及以上血压正常（收缩压〈140 mm Hg、舒张压〈90 mm Hg且未服用降压药物）的居民进行问卷调查和体格检查,并检测其血糖、血脂、肾功能、尿白蛋白及测量肱-踝脉搏波传导速度（brachialankle pulse wave velocity,Ba-PWV）。按血压将研究人群分为理想血压组（收缩压〈120 mm Hg且舒张压〈80 mm Hg）、单纯舒张压偏高组（收缩压〈120 mm Hg且舒张压80~89 mm Hg）、单纯收缩压偏高组（收缩压120~139 mm Hg且舒张压〈80 mm Hg）、收缩压和舒张压均偏高组（收缩压120~139 mm Hg且舒张压80~89 mm Hg）,分析4组间各项指标的差异。结果：理想血压组、单纯舒张压偏高组、单纯收缩压偏高组、收缩压和舒张压均偏高组的Ba-PWV升高患病率分别为10.2%、16.3%、35.9%、36.8%;尿白蛋白增加的患病率分别为25.0%、23.3%、30.2%、35.5%。单纯收缩压偏高组、收缩压和舒张压均偏高组的上述Ba-PWV升高、尿白蛋白增加的患病率均较理想血压组显著升高（P均〈0.001）。多元Logistic回归分析表明,以理想血压组作为参照,单纯收缩压偏高组、收缩压和舒张压均偏高组Ba-PWV升高的风险显著增加,比值比（odds ratios,OR）[95%可信区间（confidence interval,CI）]分别为3.47（2.41~5.03）和5.70（3.79~8.68）;而收缩压和舒张压均偏高组尿白蛋白增加的风险亦显著增加[OR（95%CI）为1.71（1.23~2.38）]。结论：上海社区中老年人群血压水平在正常范围内升高与早期血管病变风险增加显著相关。

Objectives： To investigate the association between blood pressure levels within the normal range and early vascular dysfunction in middle-aged and elderly Chinese people. Methods： A cross-sectional study was conducted in1 657 Chinese adults with systolic blood pressure（SBP） 〈140 mm Hg and diastolic blood pressure（DBP）〈90 mm Hg and without the use of anti-hypertensive medication from Songnan community, Baoshan district, Shanghai. Questionnaire interview, anthropometric measurements, biochemical evaluation, and brachial-ankle pulse wave velocity（Ba-PWV）measurement were performed in all the participants. Elevated Ba-PWV and urinary albumin-to-creatinine ratio（ACR） were used as the indicators of early vascular dysfunction. Increased Ba-PWV was defined as the highest quartile of Ba-PWV,and increased urinary ACR was defined as the highest quartile of normal ACR plus microalbuminuria（urinary ACR 〉8.3 mg/g and 〈300 mg/g）. Participants were divided into four groups according to their blood pressure levels： group 1（SBP120 mm Hg and DBP80 mm Hg）, group 2（SBP〈120 mm Hg and DBP〈 80-89 mm Hg）, group 3（SBP 〈120-139 mm Hg and DBP80 mm Hg）, and group 4（SBP 120-139 mm Hg and DBP 〈80-89 mm Hg）. Results： Compared with participants in group 1, individuals in group 3 and group 4 had significantly higher prevalence of both increased Ba-PWV and increased urinary ACR. When group 1 was used as the reference, group 3 and group 4 had an increased risk of increased Ba-PWV after adjustment for multiple covariates [odds ratios（OR）（95% confidence interval, CI） were 3.47（2.41-5.03） and 5.70（3.79-8.68）, respectively]. In addition, group 4 was associated with an increased risk of elevated urinary ACR（OR=1.71,95% CI 1.23-2.38）. Conclusions： Elevated blood pressure levels within the normal range are significantly and independently associated with higher prevalence of vascular dysfunction in middle-aged and elderly Chinese people.