高血压人群中体质指数与全死因死亡风险的队列研究

摘要

Objective To investigate the relationship between body mass index (BMI) and all-cause mortality in hypertensive population.Methods All participants were selected from a prospective cohort study based on a rural population from Henan province,China.Cox proportional hazards regression models were used to estimate the associations of different levels of BMI stratification with all-cause mortality.Restricted cubic spline models were used to detect the doseresponse relation.Results Among the 5 461 hypertensive patients,a total of 31 048.38 person-years follow-up was conducted.The median of follow-up time was 6 years,and 589 deaths occurred during the follow-up period.Compared to normal weight group (18.5 kg/m2＜BMI＜24.0 kg/m2) the multivariate-adjusted hazard ratios for all-cause mortality associated with BMI levels (＜ 18.5 kg/m2,24-28 kg/m2,and ≥28 kg/m2) were 0.83 (95％CI:0.37-1.87),0.81 (95％CI:0.67-0.97),and 0.72 (95％CI:0.56-0.91),respectively.The dose-response analysis showed a nonlinear,reverse "S" shaped relationship (non-linearity P＜0.001).Conclusion Overweight or obese might have a protective effect on all-cause mortality in hypertensive population,which supports the "obesity paradox" phenomenon.%目的 探讨高血压队列人群中BMI和全死因死亡风险的关系.方法 研究对象为河南省某农村地区高血压队列人群,应用Cox风险比例回归模型计算基线时不同BMI水平人群随访期间的全死因死亡比例HR值及其95％CI,并采用限制性立方样条模型拟合BMI与全死因死亡风险的剂量-反应关系.结果 5 461名高血压队列人群累积随访31 048.38人年,平均随访6年,随访期间死亡589人.控制潜在的混杂因素后,以基线正常体重组(18.5 kg/m2＜BMI＜24.0 kg/m2)为参照,低体重组(BMI＜ 18.5 kg/m2)、超重组(24.0 kg/m2＜BMI＜28.0 kg/m2)和肥胖组(BMI≥28 kg/m2)人群发生死亡的HR值(95％CI)分别为0.83 (0.37 ～ 1.87)、0.81 (0.67～ 0.97)和0.72(0.56～0.91).限制性立方样条模型分析结果显示,在高血压队列人群中,基线BMI和全死因死亡风险关联强度呈现倒“S”形非线性剂量反应关系(非线性检验P＜0.001).结论 超重和肥胖可能是高血压人群死亡风险的保护因素,与“肥胖悖论”一致.