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目的 :探讨上海社区中老年人群血压的正常范围与早期血管病变间的相关性。方法 :采取整群抽样的方法,对上海市宝山区淞南镇1 657名40岁及以上血压正常(收缩压<140 mm Hg、舒张压<90 mm Hg且未服用降压药物)的居民进行问卷调查和体格检查,并检测其血糖、血脂、肾功能、尿白蛋白及测量肱-踝脉搏波传导速度(brachialankle pulse wave velocity,Ba-PWV)。按血压将研究人群分为理想血压组(收缩压<120 mm Hg且舒张压<80 mm Hg)、单纯舒张压偏高组(收缩压<120 mm Hg且舒张压80~89 mm Hg)、单纯收缩压偏高组(收缩压120~139 mm Hg且舒张压<80 mm Hg)、收缩压和舒张压均偏高组(收缩压120~139 mm Hg且舒张压80~89 mm Hg),分析4组间各项指标的差异。结果:理想血压组、单纯舒张压偏高组、单纯收缩压偏高组、收缩压和舒张压均偏高组的Ba-PWV升高患病率分别为10.2%、16.3%、35.9%、36.8%;尿白蛋白增加的患病率分别为25.0%、23.3%、30.2%、35.5%。单纯收缩压偏高组、收缩压和舒张压均偏高组的上述Ba-PWV升高、尿白蛋白增加的患病率均较理想血压组显著升高(P均<0.001)。多元Logistic回归分析表明,以理想血压组作为参照,单纯收缩压偏高组、收缩压和舒张压均偏高组Ba-PWV升高的风险显著增加,比值比(odds ratios,OR)[95%可信区间(confidence interval,CI)]分别为3.47(2.41~5.03)和5.70(3.79~8.68);而收缩压和舒张压均偏高组尿白蛋白增加的风险亦显著增加[OR(95%CI)为1.71(1.23~2.38)]。结论:上海社区中老年人群血压水平在正常范围内升高与早期血管病变风险增加显著相关。
Objective: To explore the correlation between the normal range of blood pressure and the early vascular disease in the middle-aged and elderly population in Shanghai community. Methods: A total of 1 657 residents 40 years of age and over with normal blood pressure (systolic blood pressure <140 mm Hg, diastolic blood pressure <90 mm Hg and no antihypertensive drugs) in Songnan Town, Baoshan District, Shanghai were surveyed by cluster sampling method Investigation and physical examination were performed. Blood glucose, blood lipid, renal function, urinary albumin and brachialankle pulse wave velocity (Ba-PWV) were measured. The study population was divided into ideal blood pressure group (systolic blood pressure <120 mm Hg and diastolic blood pressure <80 mm Hg), high diastolic blood pressure group (systolic blood pressure <120 mm Hg and diastolic blood pressure 80-89 mm Hg) Patients with high SBP (systolic BP 120 ~ 139 mm Hg and diastolic BP <80 mm Hg) had higher systolic and diastolic BP (systolic BP 120 ~ 139 mm Hg and diastolic BP 80 ~ 89 mm Hg) Differences between the four groups of indicators. Results: The prevalences of elevated Ba-PWV in ideal blood pressure group, high pure diastolic pressure group, high pure systolic pressure group and elevated systolic pressure and diastolic pressure were 10.2%, 16.3%, 35.9% and 36.8 %; The prevalence of urinary albumin increased 25.0%, 23.3%, 30.2%, 35.5% respectively. The higher Ba-PWV and the higher prevalence of urinary albumin in the patients with higher systolic BP, higher systolic and diastolic BP were significantly higher than those in the ideal BPH (all P <0.001). Multivariate logistic regression analysis showed that the risk of Ba-PWV increased significantly in systolic blood pressure group and high diastolic blood pressure group with ideal systolic blood pressure group as the reference, the odds ratios (OR) [95% Confidence interval (CI)] were 3.47 (2.41 ~ 5.03) and 5.70 (3.79 ~ 8.68), respectively; while the patients with high systolic and diastolic blood pressure also had a significantly increased risk of urinary albumin [OR (95% CI) was 1.71 (1.23 to 2.38)]. Conclusion: The increase of blood pressure in middle-aged and elderly people in Shanghai community within the normal range is significantly associated with the increased risk of early vascular disease.