CAJ | 학술논문

目的分析老年男性高血压患者的体质指数(BMI)对心血管事件的影响,探讨老年男性高血压患者中的肥胖矛盾现象.方法本研究为回顾性队列研究.从2004年1月至2014年1月,纳入老年男性高血压患者839例,根据BMI指数分为3组:正常组(18.5 kg/m2≤BMI＜ 24.0 kg/m2)274例,超重组(24.O kg/m2≤BMI＜ 28.0 kg/m2) 430例,肥胖组(BMI≥28.0 kg/m2) 135例.统计所有患者10年间的心血管事件情况,分析不同BMI水平的全因死亡及心血管事件的差异,采用Cox比例风险回归模型分析全因死亡及心血管事件(心脑血管死亡、新发或再发心肌梗死、卒中和脑梗死)的危险因素.结果纳入的839例男性高血压的平均年龄为(75.4±4.8)岁,基线收缩压(133.7±14.6)mmHg(1 mmHg =0.133 kPa),舒张压(74.3±9.3)mmHg.839例患者均获得完整随访,3组间的基线收缩压及舒张压差异无统计学意义.839例患者中共发生全因死亡178例,心脑血管死亡54例,新发/再发心肌梗死51例,新发/再发脑梗死105例.其中,超重组的全因死亡发生率为16.74％(72/430),低于正常组的27.01％(74/274)(P＜0.05).Kaplan-Meier曲线显示体质量正常组的全因死亡及心血管死亡率均高于其余两组(P均＜ 0.05).根据Cox比例风险回归模型,BMI≥24.0 kg/m2患者的全因死亡及心脑血管死亡的风险分别为BMI＜ 24.0 kg/m2的86.7％(RR=0.867,95％ CI:0.792～0.949)和17.9％(RR=0.179,95％CI:0.05 ～0.645).结论在老年男性高血压患者中,体质量超常的患者显示出更好的心血管预后,存在肥胖矛盾现象.
목적 분석노년남성고혈압환자적체질지수(BMI)대심혈관사건적영향,탐토노년남성고혈압환자중적비반모순현상.방법 본연구위회고성대렬연구.종2004년1월지2014년1월,납입노년남성고혈압환자839례,근거BMI지수분위3조:정상조(18.5 kg/m2≤BMI＜ 24.0 kg/m2)274례,초중조(24.O kg/m2≤BMI＜ 28.0 kg/m2) 430례,비반조(BMI≥28.0 kg/m2) 135례.통계소유환자10년간적심혈관사건정황,분석불동BMI수평적전인사망급심혈관사건적차이,채용Cox비례풍험회귀모형분석전인사망급심혈관사건(심뇌혈관사망、신발혹재발심기경사、졸중화뇌경사)적위험인소.결과 납입적839례남성고혈압적평균년령위(75.4±4.8)세,기선수축압(133.7±14.6)mmHg(1 mmHg =0.133 kPa),서장압(74.3±9.3)mmHg.839례환자균획득완정수방,3조간적기선수축압급서장압차이무통계학의의.839례환자중공발생전인사망178례,심뇌혈관사망54례,신발/재발심기경사51례,신발/재발뇌경사105례.기중,초중조적전인사망발생솔위16.74％(72/430),저우정상조적27.01％(74/274)(P＜0.05).Kaplan-Meier곡선현시체질량정상조적전인사망급심혈관사망솔균고우기여량조(P균＜ 0.05).근거Cox비례풍험회귀모형,BMI≥24.0 kg/m2환자적전인사망급심뇌혈관사망적풍험분별위BMI＜ 24.0 kg/m2적86.7％(RR=0.867,95％ CI:0.792～0.949)화17.9％(RR=0.179,95％CI:0.05 ～0.645).결론 재노년남성고혈압환자중,체질량초상적환자현시출경호적심혈관예후,존재비반모순현상.
Objective To observe the long-term relationship between body mass index (BMI) and cardiovascular events in male elderly hypertensive patients.Methods A total of 839 male elderly (＞ 65 years old) hypertensive patients were included in this prospective study.Baseline data were obtained on January 2004 and participants were followed up yearly till January 2014.Patients were divided into 3 groups according to their BMI:normal weight group (18.5 kg/m2 ≤BMI ＜24.0 kg/m2),overweight group (24.0 kg/m2 ≤ BMI ＜ 28.0 kg/m2),obese group (BMI ≥ 28.0 kg/m2).All-cause death and cardiovascular events were compared.Results The average age of all 839 hypertension men was (75.4 ± 4.8) years at baseline.Baseline systolic blood pressure was (133.7 ± 14.6) mmHg(1 mmHg =0.133 kPa),diastolic blood pressure was (74.3 ± 9.3) mmHg.Baseline systolic and diastolic blood pressure was similar among the three groups.All 839 patients completed follow-up.There were 178 all-cause deaths,54 cardiovascular deaths,51 new/recurrent myocardial infarctions and 105 new/recurrent strokes during follow up.Incidence of all-cause mortality in overweight group (16.74％,72/430) was significantly lower than in normal weight group (27.01％ (74/274),P ＜ 0.05).Kaplan-Meier curves showed the all-cause mortality and cardiovascular mortality were higher in normal weight group than in the other two groups.According to the Cox proportional hazards regression model,the risk of all-cause mortality (RR =0.867,95％ CI:0.792-0.949) and cardiovascular death (RR =0.179,95 ％ CI:0.05-0.645) in patients with a BMI ≥ 24.0 kg/m2 were lower than in the group with BMI ＜ 24.0 kg/m2.Conclusion Obesity paradox phenomenon is observed in elderly male hypertensive patients in that higher BMI is associated with lower mortality risks in elderly male hypertensive patients during the 10 years follow-up.