Obesity-related hypertension?: weighing the evidence.
Obesity-related hypertension?: weighing the evidence.
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肥胖相关高血压？：权衡证据。
DOI：
10.1161/hypertensionaha.108.120915
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Kotchen,TheodoreA
中科院分区：
文献类型：
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作者：
Kotchen,TheodoreA
超重和肥胖是高血压的危险因素，肥胖人群中高血压的患病率大约是非肥胖人群的两倍。至少在过去的20年里，美国超重和肥胖的患病率一直在上升。这些增长发生在儿童、青少年和成年人，以及男女和所有种族/民族群体中。1,2 Cutler等人发表在本期《高血压》杂志上的文章，基于对相隔大约十年的两次全国健康和营养调查（NHANESs）数据的分析，报告称1988-1994年和1999-2004年期间，高血压的年龄标准化患病率从24.4%增加到28.9%。在所有种族/族裔群体中，女性的增长幅度大于男性。分析进一步表明，体重指数（BMI）的增加几乎是男性高血压患病率增加的全部原因，也是女性高血压患病率增加的一部分原因。此外，在两个NHANESs之间，非高血压个体和未经治疗的高血压受试者的平均收缩压升高。血压升高导致血压正常的受试者比例下降，高血压前期的受试者比例上升。鉴于大量证据支持肥胖和高血压之间的关系，BMI增加导致高血压患病率增加的假设是合理的。然而，超重或肥胖与高血压之间的关系是复杂的。高血压并不是肥胖的必然结果。此外，最近的证据表明，血压与血压正常者的各种肥胖指标相关，而与高血压个体无关。在Cutler等人的分析中，虽然高血压的患病率在所有BMI层中都有所增加，但只有在BMI为25kg /m2的个体中才观察到收缩压在整体血压分布中的上升。综上所述，这些观察结果表明，肥胖对血压的潜在影响在肥胖、高血压个体中减弱。由于NHANESs是横断面而非纵向的，因此不可能直接评估不同血压水平和不同肥胖水平下体重增加对血压的影响。与Cutler等人关于美国普通人群收缩压升高的报告3相反，世界卫生组织心血管疾病趋势和决定因素多国监测项目报告称，在20世纪80年代中期至90年代中期，包括美国在内的38个人群的血压下降。发生在肥胖率增加的情况下，不能用抗高血压药物的使用来解释。除了研究设计的差异外，这种明显的差异可能与以下事实有关：Cutler等人的分析描述的血压变化时间比跨国监测心血管疾病趋势和决定因素的报告更近。持续追踪以人群为基础的血压趋势，以及导致血压随时间变化的因素，将是相当有意义的。积极的一面是，自1960年以来，高血压意识和控制率一直在不断提高。在卡特勒等人报告的2次NHANESs之间，3高血压知晓率有所提高……
Overweight and obesity are established risk factors for hypertension, and hypertension is approximately twice as prevalent in the obese than in the nonobese. The prevalence of overweight and obesity has been increasing in the United States for at least the past 2 decades. These increases have occurred in children, adolescents, and adults, as well as in both genders and in all racial/ethic groups. 1, 2 Based on an analysis of data from 2 National Health and Nutrition Examination Surveys (NHANESs) approximately a decade apart, the article by Cutler et al3 in the current issue of Hypertension reports that the age-standardized prevalence of hypertension increased from 24.4% to 28.9% between 1988–1994 and 1999–2004. The increase was greater for women than men and occurred in all racial/ethnic groups. The analysis further suggests that an increase in body mass index (BMI) accounted for nearly all of the increased hypertension prevalence in men and for a portion of the increased prevalence in women. Furthermore, between the 2 NHANESs, mean systolic blood pressures increased in nonhypertensive individuals and in untreated hypertensive subjects. This upward shift of blood pressures resulted in a decreased percentage of subjects with normal blood pressure and an increased percentage with prehypertension. Given the extensive evidence supporting a relationship between obesity and hypertension, the hypothesis that an increased BMI contributes to the increased prevalence of hypertension is plausible. Nevertheless, the relationship between overweight or obesity and hypertension is complex. Hypertension is not an invariable consequence of obesity. In addition, recent evidence suggests that blood pressures are correlated with various measures of adiposity in normotensive but not in hypertensive individuals. 4 In the analysis of Cutler et al, 3 although the prevalence of hypertension increased in all of the BMI strata, the upward shift of systolic blood pressures across the overall blood pressure distribution was observed only in individuals with a BMI 25 kg/m2. Taken together, these observations suggest that a potential impact of adiposity on blood pressure is attenuated in obese, hypertensive individuals. Because the NHANESs are crosssectional rather than longitudinal, it is not possible to directly evaluate the impact of weight gain on blood pressure at different blood pressure levels and different levels of adiposity.In contrast to the report by Cutler et al3 of an upward shift of systolic blood pressure in the general US population, the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease project reported a decrease of blood pressure across 38 populations, including the United States, between the mid-1980s and the mid-1990s. 5 These reported decreases, based on crosssectional, population-based surveys, occurred despite increasing obesity rates and could not be accounted for by the use of antihypertensive drugs. In addition to differences of study design, this apparent discrepancy may be related to the fact that the analysis of Cutler et al3 describes blood pressure changes over a more recent time period than the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease report. Continued tracking of population-based blood pressure trends, and factors contributing to changes of blood pressure over time, would be of considerable interest. On a positive note, hypertension awareness and control rates have consistently improved over time since 1960. Between the 2 NHANESs in the report by Cutler et al, 3 there were increases in the rates of hypertension awareness …