绝经后高血压危险因素的Meta分析

Risk Factors for Postmenopausal Hypertension:a Meta-analysis

背景流行病学研究表明,绝经后女性的高血压患病率高于老年男性。近年来,有关绝经后高血压的临床表现、病理特征、发病机制、治疗方法等受到越来越多的关注,但由于受到研究设计、样本量、人群特征、资源不足等因素的影响,其危险因素的研究结果不一致且缺乏全面报道。目的运用系统评价方式探讨女性绝经后高血压的危险因素,为更好地预防和管理绝经后高血压提供循证证据。方法于2022年1—5月,计算机检索中国知网、万方数据知识服务平台、中国生物医学文献服务系统、PubMed、EmBase、the Cochrane Library、Web of Science电子数据库,获取与绝经后高血压危险因素相关的队列及病例对照研究。检索时限为建库起至2022-05-20。由2名研究者独立根据纳入和排除标准筛选文献、提取资料,采用纽卡斯尔-渥太华量表(NOS)对所提取的文献进行偏倚风险评估,将得分≥6分(高质量)的文献纳入研究,最后采用RevMan 5.3对其进行Meta分析。结果共纳入10篇文献,5篇为队列研究,5篇为病例对照研究,共涉及16个危险因素,总样本量为34864,且均为高质量文献。Meta分析结果显示,绝经后高血压的危险因素包括高高敏C反应蛋白水平(hs-CRP)〔RR(95%CI)=1.38(1.04,1.83)〕、高龄〔OR(95%CI)=1.39(1.11,1.74)〕、高体质指数(BMI)〔OR(95%CI)=1.61(1.19,2.18)〕、高胆固醇水平〔OR(95%CI)=1.35(1.14,1.59)〕、高三酰甘油水平〔OR(95%CI)=2.17(1.03,4.59)〕、糖尿病史〔OR(95%CI)=1.70(1.27,2.27)〕,保护因素包括高脂联素水平〔RR(95%CI)=0.83(0.70,0.99)〕、高绝经年龄〔OR(95%CI)=0.90(0.82,0.98)〕(P<0.05)。结论高hs-CRP、高龄、高BMI、高胆固醇、高三酰甘油、患有糖尿病是绝经后高血压的独立危险因素,控制其中可控的危险因素可有效降低绝经后高血压的发生风险。

Background Epidemiological studies have demonstrated that the prevalence of hypertension is higher in postmenopausal women than in elderly men.Increasing attention has been paid to postmenopausal hypertension recently,involving its clinical manifestations,pathological features,pathogenesisand treatment.However,due to disparities in study design,sample size and population characteristics,as well as insufficient resources,the research results of risk factors for postmenopausal hypertension are inconsistent and incomprehensive.Objective To perform a systematic review of risk factors for postmenopausal hypertension,so as to provide evidence-based basis for better prevention and management of the disease.Methods From January to May 2022,the databases of CNKI,WanfangData,SinoMed,PubMed,EmBase,the Cochrane Library,and Web of Science were searched for cohort and case-control studies related to risk factors for postmenopausal hypertension from the establishment of the databases to May 20,2022.Studies were identified using the inclusion and exclusion criteria,then assessed in terms of quality using the Newcastle-Ottawa Scale(NOS),and those with NOS score≥6(high quality)were included.RevMan 5.3 was used for meta-analysis.Results Ten high-quality studies were included,5 of which were cohort studies,and the other 5 were case-control studies.Overall,16 potential risk factors for postmenopausal hypertension were identified in a total sample size of 34864.Meta-analysis showed that the risk factors for postmenopausal hypertension included elevated hs-CRP〔RR(95%CI)=1.38(1.04,1.83)〕,older age〔OR(95%CI)=1.39(1.11,1.74)〕,elevated BMI〔OR(95%CI)=1.61(1.19,2.18)〕,elevated total cholesterol〔OR(95%CI)=1.35(1.14,1.59)〕,elevated triglyceride〔OR(95%CI)=2.17(1.03,4.59)〕,history of diabetes〔OR(95%CI)=1.70(1.27,2.27)〕.The risk-reducing factors included high adiponectin〔RR(95%CI)=0.83(0.70,0.99)〕and advanced menopausal age〔OR(95%CI)=0.90(0.82,0.98)〕.Conclusion Older age,high levels of hs-CRP,BMI,total cholesterol,and triglyceride,and diabetes are independent risk factors for postmenopausal hypertension.Thus,controlling some of the above controllable factors may effectively decrease the risk of postmenopausal hypertension.