不同肥胖检测指标与原发性高血压患者血压变异性的相关性

The correlation between different obesity indexes and blood pressure variability in patients with essential hypertension

目的分析不同肥胖检测指标、不同肥胖类型与血压变异性(BPV)的关系,旨在阐明肥胖及肥胖类型对高血压患者BPV的影响。方法入选2018年11月至2019年11月于大连市友谊医院内科住院的符合入选标准的原发性高血压(EH)患者共284例,男147例、女137例,平均年龄(70.7±14.2)岁。收集患者的体质量指数(BMI)、腰围、臀围、体脂百分比(BF%)等。按照BMI和腰围对患者进行分组。依据BMI分三组,BMI 18.5~<24.0 kg/m^(2)为对照组,24.0~<28.0 kg/m^(2)为超重组,≥28.0 kg/m^(2)为肥胖组;依据腰围分两组,腰围<90(男性)、<85 cm(女性)为对照组;腰围≥90(男性)、≥85 cm(女性)为肥胖组;依据肥胖类型分四组,BMI和腰围均正常为对照组,BMI正常且腰围增加为单纯腹型肥胖组,BMI增加(≥24.0 kg/m^(2))且腰围正常为单纯超重肥胖组,BMI增加且腰围增加为超重肥胖合并腹型肥胖组。各组行24 h动态血压检查,以动态血压标准差和变异系数作为BPV的指标。结果按BMI分组,肥胖组的白天收缩压标准差(dSBPSD)、夜间舒张压标准差(nDBPSD)、白天收缩压变异系数(dSBPCV)、夜间收缩压标准差(nSBPSD)较大(均P<0.05)。按腰围分组,腹型肥胖组的dSBPSD、白天舒张压标准差(dDBPSD)、dSBPCV高于对照组(均P<0.05)。按肥胖类型分组,与对照组相比,单纯腹型肥胖组、超重肥胖组和超重肥胖合并腹型肥胖组的24 h舒张压(24hDBP)、夜间舒张压(nDBP)较大(均P<0.05),超重肥胖合并腹型肥胖组的白天收缩压(dSBP)和dSBPSD较大[dSBP:超重肥胖合并腹型肥胖组(137.0±15.5)比单纯超重肥胖组(136.7±16.0)比单纯腹型肥胖组(132.5±11.0)比对照组(131.9±13.2)mm Hg,F=3.482,P=0.016;dSBPSD:超重肥胖合并腹型肥胖组(14.0±3.7)比单纯超重肥胖组(12.7±3.5)比单纯腹型肥胖组(13.4±4.6)比对照组(12.2±3.0)mm Hg,F=3.849,P=0.010]。相关性分析显示,BMI与dSBPSD、nSBPSD、nDBPSD呈正相关(r=0.160、0.136、0.163),BF%与nSBPSD、nDBPSD、夜间收缩压变异系数(nSBPCV)呈正相关(r=0.175、0.128、0.153),腰围与dSBPSD呈正相关(r=0.138)。进一步多元线性回归分析显示,dSBPSD与BMI、腰围、腰臀比呈正相关(均P<0.05);nSBPSD、nDBPSD与BMI、BF%呈正相关(均P<0.05);nSBPCV与BF%呈正相关(均P<0.05)。结论不同肥胖检测指标与EH患者BPV存在正相关,提示肥胖导致高血压患者BPV增大。

Objective To analyze the relationship between different obesity indexes,different types of obesity and blood pressure variability(BPV),so as to clarify the impact of obesity and obesity types on BPV in patients with hypertension.Methods A total of 284 patients(147 males,137 females)with essential hypertension(EH)who were hospitalized in the Department of Internal Medicine of Dalian Friendship Hospital from November 2018 to November 2019 were enrolled.The average age of enrolled patients was(70.7±14.2)years.The patients’body mass index(BMI),waist circumference,hip circumference,and body fat percentage(BF%)were collected.Patients were grouped by BMI and waist circumference,respectively.According to BMI,patients were divided into 3 groups:control group(BMI 18.5-<24.0),overweight group(BMI 24.0-<28.0)and obesity group(BMI≥28.0 kg/m^(2)).According to waist circumference,patients were divided into the control group(<90 for male and<85 cm for female),and the obesity group(≥90 for male and≥85 cm for female).According to obesity type,patients were divided into 4 groups:control group(normal BMI and waist circumference),simple abdominal obesity group(normal BMI and increased waist circumference),simple overweight group(BMI≥24.0 and normal waist circumference)and combined obesity group(BMI≥24.0 kg/m^(2) and increased waist circumference).A 24-hour ambulatory blood pressure monitoring was carried out in each group.The standard deviation and coefficient of variation of ambulatory blood pressure were used as indicators of BPV.Results When divided by BMI,the daytime systolic blood pressure standard deviation(dSBPSD),nighttime diastolic blood pressure standard deviation(nDBPSD),daytime systolic blood pressure variation coefficient(dSBPCV),and nighttime systolic blood pressure standard deviation(nSBPSD)of obesity group were larger(all P<0.05).When divided by waist circumference,the dSBPSD,the standard deviation of daytime diastolic blood pressure(dDBPSD),and dSBPCV in the abdominal obesity group were higher than the control group(all P<0.05).When divided by obesity type,the simple abdominal obesity group,simple overweight obesity group,and combined obesity group had higher 24-hour diastolic blood pressure(24 hDBP)and nighttime diastolic blood pressure(nDBP)than the control group(P<0.05),and the combined obesity group had higher daytime systolic blood pressure(dSBP)and dSBPSD[dSBP:combined obesity group(137.0±15.5)vs simple overweight obesity group(136.7±16.0)vs simple abdominal obesity group(132.5±11.0)vs control group(131.9±13.2)mm Hg,F=3.482,P=0.016;dSBPSD:combined obesity group(14.0±3.7)vs simple overweight obesity group(12.7±3.5)vs simple abdominal obesity group(13.4±4.6)vs control group(12.2±3.0)mm Hg,F=3.849,P=0.010].Correlation analysis showed that BMI was positively correlated with dSBPSD,nSBPSD,and nDBPSD(r=0.160,0.136,0.163).BF% was positively correlated with nSBPSD,nDBPSD,and nighttime systolic blood pressure coefficient of variation(nSBPCV)(r=0.175,0.128,0.153).Waist circumference was positively correlated with dSBPSD(r=0.138)(all P<0.05).Multiple linear regression analysis showed that dSBPSD was positively correlated with BMI,waist circumference,and waist to hip ratio(WHR)(all P<0.05),while nSBPSD,nDBPSD were positively correlated with BMI and BF%(all P<0.05),and nSBPCV was positively correlated with BF%(all P<0.05).Conclusion There is a positive correlation between different obesity indexes and BPV in patients with essential hypertension,suggesting that obesity may increase BPV in EH patients.