新发舒张期和收缩期高血压的预测因素:Framing-han心脏研究

Background-Factors leading differentially to the development of isolated diastolic(IDH), systolic-diastolic(SDH), and isolated systolic(ISH) hypertension are poorly understood. We examined the relations of blood pressure(BP) and clinical risk factors to the new onset of the 3 forms of hypertension. Methods and Results-Participants in the Framingham Heart Study were included if they had undergone 2 biennial examinations between 1953 and 1957 and were free of antihypertensive therapy and cardiovascular disease. Compared with optimal BP(SBP< 120 and DBP< 80 mm Hg), the adjusted hazard ratios(HRs) for developing new-onset IDH over the ensuing 10 years were 2.75 for normal BP, 3.29 for high-normal BP(both P< 0.0001), 1.31(P=0.40) for SDH, and 0.61(P=0.36) for ISH. The HRs of developing new-onset SDH were 3.32, 7.96, 7.10, and 23.12 for the normal BP, high-normal BP, ISH, and IDH groups, respectively(all P< 0.0001). The HRs of developing ISH were 3.26 for normal and 4.82 for high-normal BP(both P< 0.0001), 1.39(P=0.24) for IDH, and 1.69(P< 0.01) for SDH. Increased body mass index(BMI) during follow-up predicted new-onset IDH and SDH. Other predictors of IDH were younger age,male sex, and BMI at baseline. Predictors of ISH included older age, female sex, and increased BMI during follow-up. Conclusion-Given the propensity for increased baseline BMI and weight gain to predict new-onset IDH and the high probability of IDH to transition to SDH, it is likely that IDH is not a benign condition. ISH arises more commonly from normal and high-normal BP than from “burned-out”diastolic hypertension.

动脉粥样硬化多种族研究中代谢综合征和糖尿病作为主动脉瓣膜钙化预测因素的特点

Background -Calcific aortic valve disease is common in the elderly, is correlated with common cardiovascular risk factors, and is associated with increased cardiovascular event risk; however, whether metabolic syndrome is associated with an increased prevalence of aortic valve calcium(AVC) is not known. Methods and Results -The prevalence of AVC, as assessed by computed tomography, was compared in 6780 Multi-Ethnic Study of Atherosclerosis(MESA) participants with metabolic syndrome(n=1550; National Cholesterol Education Program’s Adult Treatment Panel III[ATP III] criteria), diabetes mellitus(n=1016), or neither condition(n=4024). The prevalence of AVC for those with neither condition, metabolic syndrome, or diabetes mellitus was, respectively, 8%, 12%, and 17%in women(P< 0.001) and 14%, 22%, and 24%in men(P< 0.001). Compared with those with neither condition, the adjusted relative risks for the presence of AVC were 1.45(95%CI 1.11 to 1.90) for metabolic syndrome and 2.12(95%CI 1.54 to 2.92) for diabetes mellitus in women and 1.70(95%CI 1.32 to 2.19) for metabolic syndrome and 1.73(95%CI 1.33 to 2.25) for diabetes mellitus in men. There was a graded, linear relationship between AVC prevalence and the number of metabolic syndrome components in both women and men(both P< 0.001). Similar results were obtained when the International Diabetes Federation metabolic syndrome definition was used. Conclusions -In the MESA cohort, the metabolic syndrome and diabetes mellitus are associated with increased risk of AVC, and AVC prevalence is increased with increasing number of metabolic syndrome components.

血压分类、高血压亚型与代谢综合征

背景:血压升高是代谢综合征(MetS)的表现之一,然而,各血压分类和高血压亚型与代谢综合征患病可能之间的关系尚未确定。方法:在1999—2002年国家健康和营养状况调查中选择了5968例年龄≥18岁、未经抗高血压治疗的受试者(加权为124700000)进行横断面研究,确定不同血压分类组的MetS(依据NCEP标准)患病可能性。根据JNC-VI血压分类,非高血压情况被分为理想血压、正常血压和高正常血压。