静息心率与高血压发病风险的关系及性别、年龄对其的修饰效应

目的探讨我国农村地区成年人群静息心率与高血压发病风险的关系及性别、年龄对其的修饰效应。方法该研究为队列研究。于2007年7月至2008年8月在河南省新安县选取2个镇为研究现场,以自然村为单位采用整群随机抽样的方法抽取调查村庄,进行基线调查。根据标准入选常住居民20194人。于2013年7月至2014年10月对入选者进行随访,最终完成随访者17265人。排除基线高血压患者、基线静息心率资料缺失者、随访期间死亡者、随访时高血压诊断资料缺失者以及诊断为妊娠高血压者,最终共10212人纳入该研究。基线和随访调查均包含问卷调查(人口统计学资料、行为危险因素、疾病史及用药史等)、人体测量(身高、体重、静息心率及血压测量)、空腹血糖以及脂质谱检测。按照静息心率的四分位数值将研究对象分为4组,即Q1组、Q2组、Q3组和Q4组。既往无高血压病史,随访期间收缩压≥140 mmHg(1 mmHg=0.133 kPa)和/或舒张压≥90 mmHg,或正在服用降压药物定义为新发高血压。以基线静息心率为自变量,以随访与基线的血压差值为因变量,采用多重线性回归分析静息心率与血压差值的关系。采用多因素logistic回归模型分析静息心率与高血压发病风险的关联强度即比值比(OR)及其95%可信区间(CI)]。然后采用公式计算高血压发病风险,即计算其相对危险度(RR)。该研究还针对性别(男性和女性)和年龄(<60岁和≥60岁)进行了亚组分析。结果研究平均随访6.0年,新发高血压病例累计2059例,其中男性839例。多因素logistic回归分析结果显示,在总人群中校正了潜在混杂因素后,静息心率每增加5次/min,高血压发病风险的RR值为1.04(95%CI 1.01~1.08,P<0.05)。校正潜在混杂因素后,在女性人群中静息心率每增加5次/min,收缩压差值增加0.18 mmHg(95%CI 0.01~0.36 mmHg,P=0.046),同时高血压发病风险增加(RR=1.07,95%CI 1.03~1.11,P<0.05)。在女性人群中,Q3组(静息心率76~82次/min)和Q4组(静息心率>82次/min)高血压发病风险均高于Q1组(静息心率<70次/min),RR值分别为1.39(95%CI 1.18~1.63,P<0.05)和1.22(95%CI 1.02~1.45,P<0.05)。在男性人群中,无论<60岁组还是≥60岁组,静息心率加快均不增加高血压发病风险(P均>0.05)。而<60岁组的女性静息心率加快则高血压发病风险增加(RR=1.05,95%CI 1.01~1.10,P<0.05),≥60岁组的女性静息心率加快高血压的发病风险则更高(RR=1.14,95%CI 1.04~1.25,P<0.05)。结论对于我国农村地区成年人群而言,静息心率与高血压发病风险具有一定的关联,且具有性别差异。静息心率较快的女性人群高血压发病风险更高,且以老年女性为甚。

The sex- and age-specific association between resting heart rate and hypertension in rural adult residents of Henan province

Objective To investigate the sex-and age-specific association between resting heart rate and hypertension in rural adult residents of Henan province.Methods At baseline,a total of 20194 participants were randomly selected from Xin′an County of Henan province between July 2007 and August 2008.After excluding participants with hypertension or without resting heart rate data at baseline,and participants died or without hypertension outcome or diagnosed as gestational hypertension during follow-up between July 2013 and October 2014,10212 participants were finally included in this study.Multiple linear regression model was used to examine the association between resting heart rate and change of blood pressure.Logistic regression model was used to estimate the association between resting heart rate and risk of hypertension.Results There were 2059 new hypertensive cases(839 male)during the 6 years follow-up.After controlling for potential confounders,per 5 beats/minutes increases in resting heart rate was associated with 0.18 mmHg(1 mmHg=0.133 kPa)(95%CI 0.01-0.36 mmHg,P=0.046)absolute increase in systolic blood pressure and 7%higher risk of developing hypertension in women(95%CI 1.03-1.11,P<0.05).Compared with resting heart rate<70 beats/minutes,the adjusted RRs for 76-82 and>82 beats/minutes groups were 1.39(95%CI 1.18-1.63,P<0.05)and 1.22(95%CI 1.02-1.45,P<0.05),respectively.For both age groups,increased resting heart rate was positively associated with risk of hypertension in women(RR=1.05(95%CI 1.01-1.10),P<0.05(the women those<60 years);RR=1.14(95%CI 1.04-1.25),P<0.05(the women those≥60 years).However,no significant association was found between resting heart rate and hypertension in male residents.Conclusions Increased resting heart rate is associated with high risk of hypertension in women who live in rural area,especially in elder women of this cohort.