Association of lifestyle with blood pressure and hypertension risk in middle-aged and older adults
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摘要:
目的 探讨中老年人群生活方式及其变化与血压水平和高血压发生风险的关联。 方法 纳入东风-同济队列2008―2010年7 671名研究对象进行分析。分别采用线性回归和Logistic回归分析模型评估生活方式与血压水平和高血压发生风险的关联。 结果 校正混杂因素后，生活方式评分增加与血压水平和高血压风险的降低均有剂量反应关系。与基线生活方式评分0~1分组相比，＞4分组的SBP、DBP和平均动脉压分别降低4.03、2.25和2.84 mm Hg，新发高血压的OR值为0.68(95% CI: 0.52~0.88)。且每增加1分，高血压发生风险降低9%(OR=0.91, 95% CI: 0.87~0.95)。而从基线至2013年随访5年间生活方式评分维持在＞3的个体，其新发高血压风险的OR值为0.61(OR=0.61, 95% CI: 0.47~0.80)，但是从基线0~2分提高至随访＞3分并不能降低高血压风险(OR=0.87, 95% CI: 0.54~1.40)。 结论 中老年人群尽早并长期坚持健康生活方式对于高血压防控效益最大。 Abstract:Objective To explore the association between lifestyle and its changes with blood pressure levels and hypertension risk in middle-aged and older people. Methods A total of 7 671 participants were included the analyses in Dongfeng-Tongji Cohort from 2008 to 2010. Linear and Logistic regression models were used to estimate the relationship between lifestyle and blood pressure as well as hypertension, respectively. Results After adjusting for confounders, the result showed the dose-response associations between increased lifestyle scores and blood pressure as well as hypertension; compared with lifestyle scored 0-1 at baseline, the systolic blood pressure, diastolic blood pressure, and mean arterial pressure decreased 4.03, 2.25, and 2.84 mm Hg in > 4 scores groups, respectively; the OR of incident hypertension risk was 0.68 (95% CI: 0.52-0.88). Each increment in lifestyle score was associated with a 9% decreased risk of incident hypertension (OR=0.91, 95% CI: 0.87-0.95). During the 5-year period from baseline to follow-up in 2013, the maintenance of > 3 scores group was associated with hypertension (OR=0.61, 95% CI: 0.47-0.80), but increment from 0-2 scores at baseline to > 3 scores at follow-up did not reduce incident hypertension risk (OR=0.87, 95% CI: 0.54-1.40). Conclusion In the middle-aged and older population, early and long-term adherence to a healthy lifestyle has the greatest benefit for the prevention and control of hypertension. -
表 1 研究对象根据有无新发高血压的基线人口学特征[n(%)]
Table 1. Characteristics of study participants at baseline according to incident hypertension [n(%)]
变量 无高血压(n=3 941) 新发高血压(n=3 730) t/Z/χ2值 P值 年龄(x±s, 岁) 59.8±7.0 61.9±7.1 -13.028 < 0.001 女性 2 521(64.0) 2 186(58.6) 23.244 < 0.001 受教育程度 -5.078 < 0.001a 小学及以下 896(22.9) 1 040(28.1) 初中或高中 2 591(66.2) 2 304(62.3) 大学及以上 427(10.9) 354(9.6) 已婚/再婚 3 610(91.9) 3 410(91.6) 0.174 0.677 健康生活方式及评分 当前不吸烟 3 289(83.5) 3 060(82.0) 2.703 0.100 适度饮酒 3 489(88.5) 3 247(87.1) 3.921 0.048 适度锻炼 983(24.9) 922(24.7) 0.052 0.820 均衡膳食 1 800(45.7) 1 699(45.5) 0.012 0.913 正常体重 2 233(56.7) 1 661(44.5) 112.808 < 0.001 适宜睡眠时长(h) 2 226(56.5) 2 103(56.4) 0.008 0.928 0~1 139(3.5) 180(4.8) -5.954 < 0.001a 2 532(13.5) 609(16.3) 3 1 135(28.8) 1 147(30.8) 4 1 349(34.2) 1 172(31.4) ＞4 786(19.9) 622(16.7) 高血压家族史 615(16.0) 557(15.2) 0.907 0.341 2型糖尿病 333(9.3) 481(14.2) 40.746 < 0.001 高脂血症 1 609(41.0) 1 779(47.8) 36.572 < 0.001 注：a表示采用Wilcoxon检验比较两组差异。 
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表 2 基线生活方式评分与血压值关联[β(95% CI)]
Table 2. The association between healthy lifestyle score at baseline and blood pressure [β(95% CI)]
变量 生活方式评分 每增加1分 P趋势 0~1 2 3 4 ＞4 分析样本/总人数a 241/319 894/1 141 1 841/2 282 2 099/2 521 1 230/1 408 SBP b 未校正 0 -2.04(-4.71~0.64) -2.94(-5.46~-0.41) -4.04(-6.55~-1.53) -4.17(-6.76~-1.57) -0.84(-1.25~-0.43) < 0.001 校正 0 -2.37(-5.06~0.31) -3.18(-5.75~-0.61) -4.01(-6.59~-1.43) -4.03(-6.73~-1.33) -0.70(-1.14~-0.27) 0.002 DBP b 0 未校正 0 -1.47(-3.08~0.15) -2.17(-3.70~-0.65) -2.81(-4.32~-1.30) -2.67(-4.24~-1.11) -0.50(-0.74~-0.25) < 0.001 校正 0 -1.14(-2.76~0.48) -1.74(-3.29~-0.19) -2.34(-3.90~-0.78) -2.25(-3.87~-0.62) -0.43(-0.70~-0.17) 0.001 PP b 0 未校正 0 -0.57(-2.78~1.64) -0.76(-2.85~1.32) -1.24(-3.31~0.83) -1.49(-3.64~0.65) -0.34(-0.68~-0.01) 0.049 校正 0 -1.23(-3.39~0.92) -1.44(-3.50~0.62) -1.67(-3.74~0.39) -1.78(-3.94~0.38) -0.27(-0.62~0.08) 0.128 MBP b 0 未校正 0 -1.66(-3.40~0.09) -2.43(-4.07~-0.78) -3.22(-4.85~-1.59) -3.17(-4.86~-1.48) -0.61(-0.88~-0.34) < 0.001 校正 0 -1.55(-3.32~0.22) -2.22(-3.91~-0.52) -2.90(-4.60~-1.20) -2.84(-4.61~-1.07) -0.52(-0.81~-0.24) < 0.001 注：a表示分析四种血压指标所用的样本量；b表示排除2018年随访服用降压药物人群；校正因素包括年龄(连续变量)、性别(男；女)、受教育程度(小学及以下；初中或高中；大学及以上)、婚姻状况(未婚/离异/丧偶；已婚/再婚)、高血压家族史(否；是)。
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表 3 生活方式评分与新发高血压的OR和95% CI
Table 3. OR and 95% CI for incident hypertension by healthy lifestyle score
生活方式评分 病例数/总人数 OR(95% CI)值 未校正 校正 0~1 180/319 1.00 1.00 2 609/1 141 0.88(0.68~1.13) 0.90(0.70~1.17) 3 1 147/2 282 0.78(0.62~0.99) 0.83(0.65~1.06) 4 1 172/2 521 0.67(0.53~0.85) 0.73(0.57~0.94) ＞4 622/1 408 0.61(0.48~0.78) 0.68(0.52~0.88) 每增加1分 0.89(0.85~0.92) 0.91(0.87~0.95) P趋势值 < 0.001 < 0.001
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表 4 五年期间生活方式评分变化与血压值及新发高血压的关联
Table 4. The association of lifestyle change during five-year period with blood pressure and incident hypertension
基线 第1次随访 分析样本/总人数a SBP b DBP b PP b MAP b 病例数/总人数 OR (95% CI)值 0~2 0~2 400/454 0.00 0.00 0.00 0.00 176/454 1.00 3 194/216 1.29(-1.61~4.20) -0.43(-2.25~1.38) 1.73(-0.64~4.09) 0.14(-1.80~2.08) 84/216 1.04(0.74~1.45) ＞3 85/95 0.05(-4.00~4.11) -0.47(-3.01~2.07) 0.52(-2.78~3.83) -0.30(-3.01~2.41) 33/95 0.87(0.54~1.40) 3 0~2 507/575 0.88(-1.37~3.13) -0.96(-2.37~0.45) 1.84(0.01~3.68) -0.35(-1.86~1.16) 226/575 1.07(0.82~1.39) 3 418/450 -1.63(-4.00~0.73) -1.17(-2.64~0.31) -0.47(-2.39~1.46) -1.32(-2.90~0.26) 146/450 0.79(0.60~1.05) ＞3 260/273 -1.78(-4.47~0.91) -1.30(-2.98~0.38) -0.47(-2.66~1.72) -1.46(-3.26~0.33) 83/273 0.74(0.53~1.02) ＞3 0~2 639/707 -1.25(-3.43~0.93) -1.47(-2.83~-0.11) 0.22(-1.56~1.99) -1.40(-2.85~0.06) 257/707 0.97(0.75~1.25) 3 830/885 -1.18(-3.30~0.93) -0.95(-2.28~0.37) -0.23(-1.95~1.49) -1.03(-2.44~0.38) 279/885 0.79(0.61~1.01) ＞3 704/749 -2.63(-4.81~-0.46) -2.23(-3.59~-0.87) -0.40(-2.18~1.37) -2.36(-3.82~-0.91) 195/749 0.61(0.47~0.80) 注：a表示分析四种血压指标所用的样本量；b表示排除2018年随访服用降压药物人群；校正因素包括年龄(连续变量)、性别(男；女)、受教育程度(小学及以下；初中或高中；大学及以上)、婚姻状况(未婚/离异/丧偶；已婚/再婚)、高血压家族史(否；是)。
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