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Ожирение и артериальная гипертензия: роль критериев
Ожирение и артериальная гипертензия: роль критериев
Цыганкова Д.П., Кривошапова К.Е., Максимов С.А. и др. Ожирение и артериальная гипертензия: роль критериев. Системные гипертензии. 2019; 16 (1): 32–36.
DOI: 10.26442/2075082X.2019.180168
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Аннотация
Актуальность. Ожирение является основным независимым фактором риска артериальной гипертензии (АГ). Тесная ассоциация ожирения с артериальным давлением (АД) неоднократно была выявлена в различных этнических, возрастных и гендерных группах. Прямая связь между АГ и различными критериями ожирения изучалась во многих странах и этнических группах, но результаты исследований показывают, что до сих пор не определен критерий ожирения, наиболее точно прогнозирующий развитие АГ.
Цель: оценить связь различных критериев ожирения (индекс массы тела – ИМТ, окружность талии – ОТ, отношение ОТ/окружность бедер – ОБ, уровень висцерального жира – ВЖ, индекс висцерального ожирения – ИВО) с уровнем АД и распространенностью АГ у жителей Сибирского региона.
Материалы и методы. Были обследованы 1600 человек, постоянно проживающих на территории города Кемерово и Кемеровского района. Статистическая обработка данных проведена с применением прикладных программ Statistica 6.0. Наличие ожирения выявлялось по различным критериям: ИМТ, ОТ/ОБ, ОТ, уровню ВЖ, ИВО.
Результаты. Распространенность АГ составляла 66,2% среди мужчин и 66,5% среди женщин (р=0,886). В группе лиц с ожирением распространенность гипертонии варьировала у мужчин от 75,6% (по критериям ИМТ и ОТ/ОБ) до 85,9% (по уровню ВЖ), у женщин – от 76,0% (по критериям ОТ/ОБ) до 94,0% (по уровню ВЖ). При наличии ожирения по всем изучаемым критериям процент верно предсказанной АГ составлял 77,0%, при использовании только одного критерия – варьировал от 72,7% (уровень ВЖ) до 75,9% (ОТ), при использовании двух критериев – от 74,4% (ИМТ + уровень ВЖ) до 76,3% (ОТ/ОБ+ОТ).
Выводы. На уровень АД оказывали влияние большинство изучаемых критериев ожирения. Однако наибольшее повышение систолического АД регистрировалось при наличии ожирения по критериям ОТ, диастолического АД – по уровню ВЖ. Все изучаемые критерии ожирения (ИМТ, ОТ/ОБ, ОТ, уровень ВЖ, ИВО) продемонстрировали статистически значимое влияние на вероятность развития АГ, но в большей степени – ИМТ (ожирение по данному критерию ассоциировалось с вероятностью развития АГ в 2,15 раза).
Ключевые слова: артериальная гипертензия, ожирение, индекс массы тела, висцеральный жир.
Objective: to evaluate the relationship of different obesity criteria (BMI, WC, WC/HC, level of IV, IVO) to the level of blood pressure and the prevalence of hypertension among the inhabitants of the Siberian region
Materials and methods. It was surveyed 1600 people permanently living in the territory of the city of Kemerovo and the Kemerovo region. Statistical processing of data was carried out using the application programs Statistica 6.0. The presence of obesity by various criteria: body mass index (BMI), waist/hip ratio (WC/HC), waist circumference (WC), visceral fat (LV) level, visceral obesity index (IVO).
Results. The prevalence of hypertension was 66.2% among men and 66.5% among women (p=0.886). In the obese group, the prevalence of hypertension varied in men from 75.6% (according to the BMI and WC/HC criteria) to 85.9% (visceral fat level), in women from 76.0% (according to WC/HC) to 94.0% (according to the level of visceral fat). In the presence of obesity, according to all the criteria studied, the percentage of a correctly predicted AH was 77.0%, using only one criterion, ranged from 72.7% (LV level) to 75.9% (WC), using two criteria – from 74.4% (BMI+LV level) to 76.3% (WC/HC+WC).
Conclusions. The level of blood pressure was influenced by most of the obesity criteria studied, however, the greatest increase in SBP was recorded in the presence of obesity in terms of WC, DBP – in visceral fat. All obesity criteria studied (BMI, WC/HC, WC, IV level, IVO) showed a statistically significant effect on the likelihood of developing hypertension, but more so on BMI (obesity was associated with a 2.15-fold increase in AH)
Цель: оценить связь различных критериев ожирения (индекс массы тела – ИМТ, окружность талии – ОТ, отношение ОТ/окружность бедер – ОБ, уровень висцерального жира – ВЖ, индекс висцерального ожирения – ИВО) с уровнем АД и распространенностью АГ у жителей Сибирского региона.
Материалы и методы. Были обследованы 1600 человек, постоянно проживающих на территории города Кемерово и Кемеровского района. Статистическая обработка данных проведена с применением прикладных программ Statistica 6.0. Наличие ожирения выявлялось по различным критериям: ИМТ, ОТ/ОБ, ОТ, уровню ВЖ, ИВО.
Результаты. Распространенность АГ составляла 66,2% среди мужчин и 66,5% среди женщин (р=0,886). В группе лиц с ожирением распространенность гипертонии варьировала у мужчин от 75,6% (по критериям ИМТ и ОТ/ОБ) до 85,9% (по уровню ВЖ), у женщин – от 76,0% (по критериям ОТ/ОБ) до 94,0% (по уровню ВЖ). При наличии ожирения по всем изучаемым критериям процент верно предсказанной АГ составлял 77,0%, при использовании только одного критерия – варьировал от 72,7% (уровень ВЖ) до 75,9% (ОТ), при использовании двух критериев – от 74,4% (ИМТ + уровень ВЖ) до 76,3% (ОТ/ОБ+ОТ).
Выводы. На уровень АД оказывали влияние большинство изучаемых критериев ожирения. Однако наибольшее повышение систолического АД регистрировалось при наличии ожирения по критериям ОТ, диастолического АД – по уровню ВЖ. Все изучаемые критерии ожирения (ИМТ, ОТ/ОБ, ОТ, уровень ВЖ, ИВО) продемонстрировали статистически значимое влияние на вероятность развития АГ, но в большей степени – ИМТ (ожирение по данному критерию ассоциировалось с вероятностью развития АГ в 2,15 раза).
Ключевые слова: артериальная гипертензия, ожирение, индекс массы тела, висцеральный жир.
________________________________________________
Objective: to evaluate the relationship of different obesity criteria (BMI, WC, WC/HC, level of IV, IVO) to the level of blood pressure and the prevalence of hypertension among the inhabitants of the Siberian region
Materials and methods. It was surveyed 1600 people permanently living in the territory of the city of Kemerovo and the Kemerovo region. Statistical processing of data was carried out using the application programs Statistica 6.0. The presence of obesity by various criteria: body mass index (BMI), waist/hip ratio (WC/HC), waist circumference (WC), visceral fat (LV) level, visceral obesity index (IVO).
Results. The prevalence of hypertension was 66.2% among men and 66.5% among women (p=0.886). In the obese group, the prevalence of hypertension varied in men from 75.6% (according to the BMI and WC/HC criteria) to 85.9% (visceral fat level), in women from 76.0% (according to WC/HC) to 94.0% (according to the level of visceral fat). In the presence of obesity, according to all the criteria studied, the percentage of a correctly predicted AH was 77.0%, using only one criterion, ranged from 72.7% (LV level) to 75.9% (WC), using two criteria – from 74.4% (BMI+LV level) to 76.3% (WC/HC+WC).
Conclusions. The level of blood pressure was influenced by most of the obesity criteria studied, however, the greatest increase in SBP was recorded in the presence of obesity in terms of WC, DBP – in visceral fat. All obesity criteria studied (BMI, WC/HC, WC, IV level, IVO) showed a statistically significant effect on the likelihood of developing hypertension, but more so on BMI (obesity was associated with a 2.15-fold increase in AH)
Полный текст
Список литературы
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13. Глобальное резюме по гипертонии: Всемирный день здоровья 2013 года. Geneva: Всемирная организация здравоохранения, 2013. / Global'noe reziume po gipertonii: Vsemirnyi den' zdorov'ia 2013 goda. Geneva: Vsemirnaia organizatsiia zdravookhraneniia, 2013. [in Russian]
14. Barbosa RA, Munaretti BD, Coqueiro Da SR, Borgatto FA. Anthropometric indexes of obesity and hypertension in elderly from Cuba and Barbados. J Nutr Health Aging 2011; 15: 17–21.
15. Lee ZB. A comparison of the predictive power of anthropometric indices for hypertensive and hypotension risk. PLOS One 2014; 9 (1): 1–11.
16. Tseng CH, Chong CK, Chan TT et al. Optimal anthropometric factor cutoffs for hyperglycemia, hypertension and dyslipidemia for the Taiwanese population. Atherosclerosis 2010; 210: 585–9.
17. Li M, McDermott RA. Using anthropometric indices to predict cardiometabolic risk factors in Australian indigenous populations. Diabetes Res Clin Pract 2010; 87: 401–6.
18. Kotian GB, Kedilaya PH. BMI is the best index to predict cardiovascular disease risk in young adult females. Int J Pharm Sci Rev Res 2013; 22 (1): 188–91.
19. Ononamadu CJ, Ihegboro GO, Ezekwesili CN et al. Comparative analysis of anthropometric indices of obesity as correlates and potential predictors of risk for hypertension and prehypertension in a population in Nigeria. Cardiovascular J Africa 2017; 28 (2): 92–9. DOI: 10.5830/CVJA-2016-061
2. Deng WW, Wang J, Liu MM et al. Body mass index compared with abdominal obesity indicators in relation to prehypertension and hypertension in adults: the CHPSNE study. Am J Hypertens 2013; 26 (1): 58–67. DOI: 10.1093/ajh/hps001
3. He L, Tang X, Song Y et al. Prevalence of cardiovascular disease and risk factors in a rural district of Beijing, China: a population-based survey of 58,308 residents. BMC Public Health 2012; 12: 34.
4. Savva SC, Tornaritis M, Savva ME et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord 2000; 24 (11): 1453–8. DOI: 10.1038/sj.ijo.0801401
5. Reckelhoff JF. Gender differences in the regulation of blood pressure. Hypertension 2001; 37 (5): 1199–208. DOI: 10.1161/01.HYP.37.5.1199
6. Feng R-N, Zhao C, Wang C et al. BMI is Strongly Associated with Hypertension, and Waist Circumference is Strongly Associated with Type 2 Diabetes and Dyslipidemia, in Northern Chinese Adults. J Epidemiol 2012; 22 (4): 317–23. DOI: 10.2188/jea.JE20110120
7. Woo JHS, Yu AL, Sham A. Is waist circumference a useful measure in predicting health outcomes in the elderly? Int J Obes Relat Metab Disord 2002; 26 (10): 1349–55. DOI: 10.1038/sj.ijo.0802080
8. Kotchen TA. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Commentary. Hypertension 2007; 49 (1): 19–20. DOI: 10.1161/01.HYP.0000250394.05703.06
9. Olinto MT, Nacul LC, Gigante DP et al. Waist circumference as a determinant of hypertension and diabetes in Brazilian women: a population-based study. Public Health Nutr 2004; 7 (5): 629–35. DOI: 10.1079/PHN2003582
10. Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med 2002; 162 (18): 2074–9. DOI: 10.1001/archinte.162.18.2074
11. Park SH, Kim S-G. Comparison of Hypertension Prediction Analysis Using Waist Measurement and Body Mass Index by Age Group. Osong Public Health Res Perspectives 2018; 9 (2): 45–9. DOI: 10.24171/j.phrp.2018.9.2.02
12. DeMarco VG, Annayya R. The pathophysiology of hypertension in patients with obesity. Endocrinol 2014; 10 (6): 364–76. DOI: 10.1038/nrendo.2014.44 PMCID: PMC4308954 NIHMSID: NIHMS656660 PMID: 24732974
13. Global'noe reziume po gipertonii: Vsemirnyi den' zdorov'ia 2013 goda. Geneva: Vsemirnaia organizatsiia zdravookhraneniia, 2013. [in Russian]
14. Barbosa RA, Munaretti BD, Coqueiro Da SR, Borgatto FA. Anthropometric indexes of obesity and hypertension in elderly from Cuba and Barbados. J Nutr Health Aging 2011; 15: 17–21.
15. Lee ZB. A comparison of the predictive power of anthropometric indices for hypertensive and hypotension risk. PLOS One 2014; 9 (1): 1–11.
16. Tseng CH, Chong CK, Chan TT et al. Optimal anthropometric factor cutoffs for hyperglycemia, hypertension and dyslipidemia for the Taiwanese population. Atherosclerosis 2010; 210: 585–9.
17. Li M, McDermott RA. Using anthropometric indices to predict cardiometabolic risk factors in Australian indigenous populations. Diabetes Res Clin Pract 2010; 87: 401–6.
18. Kotian GB, Kedilaya PH. BMI is the best index to predict cardiovascular disease risk in young adult females. Int J Pharm Sci Rev Res 2013; 22 (1): 188–91.
19. Ononamadu CJ, Ihegboro GO, Ezekwesili CN et al. Comparative analysis of anthropometric indices of obesity as correlates and potential predictors of risk for hypertension and prehypertension in a population in Nigeria. Cardiovascular J Africa 2017; 28 (2): 92–9. DOI: 10.5830/CVJA-2016-061
2. Deng WW, Wang J, Liu MM et al. Body mass index compared with abdominal obesity indicators in relation to prehypertension and hypertension in adults: the CHPSNE study. Am J Hypertens 2013; 26 (1): 58–67. DOI: 10.1093/ajh/hps001
3. He L, Tang X, Song Y et al. Prevalence of cardiovascular disease and risk factors in a rural district of Beijing, China: a population-based survey of 58,308 residents. BMC Public Health 2012; 12: 34.
4. Savva SC, Tornaritis M, Savva ME et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord 2000; 24 (11): 1453–8. DOI: 10.1038/sj.ijo.0801401
5. Reckelhoff JF. Gender differences in the regulation of blood pressure. Hypertension 2001; 37 (5): 1199–208. DOI: 10.1161/01.HYP.37.5.1199
6. Feng R-N, Zhao C, Wang C et al. BMI is Strongly Associated with Hypertension, and Waist Circumference is Strongly Associated with Type 2 Diabetes and Dyslipidemia, in Northern Chinese Adults. J Epidemiol 2012; 22 (4): 317–23. DOI: 10.2188/jea.JE20110120
7. Woo JHS, Yu AL, Sham A. Is waist circumference a useful measure in predicting health outcomes in the elderly? Int J Obes Relat Metab Disord 2002; 26 (10): 1349–55. DOI: 10.1038/sj.ijo.0802080
8. Kotchen TA. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Commentary. Hypertension 2007; 49 (1): 19–20. DOI: 10.1161/01.HYP.0000250394.05703.06
9. Olinto MT, Nacul LC, Gigante DP et al. Waist circumference as a determinant of hypertension and diabetes in Brazilian women: a population-based study. Public Health Nutr 2004; 7 (5): 629–35. DOI: 10.1079/PHN2003582
10. Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med 2002; 162 (18): 2074–9. DOI: 10.1001/archinte.162.18.2074
11. Park SH, Kim S-G. Comparison of Hypertension Prediction Analysis Using Waist Measurement and Body Mass Index by Age Group. Osong Public Health Res Perspectives 2018; 9 (2): 45–9. DOI: 10.24171/j.phrp.2018.9.2.02
12. DeMarco VG, Annayya R. The pathophysiology of hypertension in patients with obesity. Endocrinol 2014; 10 (6): 364–76. DOI: 10.1038/nrendo.2014.44 PMCID: PMC4308954 NIHMSID: NIHMS656660 PMID: 24732974
13. Глобальное резюме по гипертонии: Всемирный день здоровья 2013 года. Geneva: Всемирная организация здравоохранения, 2013. / Global'noe reziume po gipertonii: Vsemirnyi den' zdorov'ia 2013 goda. Geneva: Vsemirnaia organizatsiia zdravookhraneniia, 2013. [in Russian]
14. Barbosa RA, Munaretti BD, Coqueiro Da SR, Borgatto FA. Anthropometric indexes of obesity and hypertension in elderly from Cuba and Barbados. J Nutr Health Aging 2011; 15: 17–21.
15. Lee ZB. A comparison of the predictive power of anthropometric indices for hypertensive and hypotension risk. PLOS One 2014; 9 (1): 1–11.
16. Tseng CH, Chong CK, Chan TT et al. Optimal anthropometric factor cutoffs for hyperglycemia, hypertension and dyslipidemia for the Taiwanese population. Atherosclerosis 2010; 210: 585–9.
17. Li M, McDermott RA. Using anthropometric indices to predict cardiometabolic risk factors in Australian indigenous populations. Diabetes Res Clin Pract 2010; 87: 401–6.
18. Kotian GB, Kedilaya PH. BMI is the best index to predict cardiovascular disease risk in young adult females. Int J Pharm Sci Rev Res 2013; 22 (1): 188–91.
19. Ononamadu CJ, Ihegboro GO, Ezekwesili CN et al. Comparative analysis of anthropometric indices of obesity as correlates and potential predictors of risk for hypertension and prehypertension in a population in Nigeria. Cardiovascular J Africa 2017; 28 (2): 92–9. DOI: 10.5830/CVJA-2016-061
________________________________________________
2. Deng WW, Wang J, Liu MM et al. Body mass index compared with abdominal obesity indicators in relation to prehypertension and hypertension in adults: the CHPSNE study. Am J Hypertens 2013; 26 (1): 58–67. DOI: 10.1093/ajh/hps001
3. He L, Tang X, Song Y et al. Prevalence of cardiovascular disease and risk factors in a rural district of Beijing, China: a population-based survey of 58,308 residents. BMC Public Health 2012; 12: 34.
4. Savva SC, Tornaritis M, Savva ME et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord 2000; 24 (11): 1453–8. DOI: 10.1038/sj.ijo.0801401
5. Reckelhoff JF. Gender differences in the regulation of blood pressure. Hypertension 2001; 37 (5): 1199–208. DOI: 10.1161/01.HYP.37.5.1199
6. Feng R-N, Zhao C, Wang C et al. BMI is Strongly Associated with Hypertension, and Waist Circumference is Strongly Associated with Type 2 Diabetes and Dyslipidemia, in Northern Chinese Adults. J Epidemiol 2012; 22 (4): 317–23. DOI: 10.2188/jea.JE20110120
7. Woo JHS, Yu AL, Sham A. Is waist circumference a useful measure in predicting health outcomes in the elderly? Int J Obes Relat Metab Disord 2002; 26 (10): 1349–55. DOI: 10.1038/sj.ijo.0802080
8. Kotchen TA. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Commentary. Hypertension 2007; 49 (1): 19–20. DOI: 10.1161/01.HYP.0000250394.05703.06
9. Olinto MT, Nacul LC, Gigante DP et al. Waist circumference as a determinant of hypertension and diabetes in Brazilian women: a population-based study. Public Health Nutr 2004; 7 (5): 629–35. DOI: 10.1079/PHN2003582
10. Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med 2002; 162 (18): 2074–9. DOI: 10.1001/archinte.162.18.2074
11. Park SH, Kim S-G. Comparison of Hypertension Prediction Analysis Using Waist Measurement and Body Mass Index by Age Group. Osong Public Health Res Perspectives 2018; 9 (2): 45–9. DOI: 10.24171/j.phrp.2018.9.2.02
12. DeMarco VG, Annayya R. The pathophysiology of hypertension in patients with obesity. Endocrinol 2014; 10 (6): 364–76. DOI: 10.1038/nrendo.2014.44 PMCID: PMC4308954 NIHMSID: NIHMS656660 PMID: 24732974
13. Global'noe reziume po gipertonii: Vsemirnyi den' zdorov'ia 2013 goda. Geneva: Vsemirnaia organizatsiia zdravookhraneniia, 2013. [in Russian]
14. Barbosa RA, Munaretti BD, Coqueiro Da SR, Borgatto FA. Anthropometric indexes of obesity and hypertension in elderly from Cuba and Barbados. J Nutr Health Aging 2011; 15: 17–21.
15. Lee ZB. A comparison of the predictive power of anthropometric indices for hypertensive and hypotension risk. PLOS One 2014; 9 (1): 1–11.
16. Tseng CH, Chong CK, Chan TT et al. Optimal anthropometric factor cutoffs for hyperglycemia, hypertension and dyslipidemia for the Taiwanese population. Atherosclerosis 2010; 210: 585–9.
17. Li M, McDermott RA. Using anthropometric indices to predict cardiometabolic risk factors in Australian indigenous populations. Diabetes Res Clin Pract 2010; 87: 401–6.
18. Kotian GB, Kedilaya PH. BMI is the best index to predict cardiovascular disease risk in young adult females. Int J Pharm Sci Rev Res 2013; 22 (1): 188–91.
19. Ononamadu CJ, Ihegboro GO, Ezekwesili CN et al. Comparative analysis of anthropometric indices of obesity as correlates and potential predictors of risk for hypertension and prehypertension in a population in Nigeria. Cardiovascular J Africa 2017; 28 (2): 92–9. DOI: 10.5830/CVJA-2016-061
Авторы
Д.П.Цыганкова1, К.Е.Кривошапова1, С.А.Максимов1, Е.В.Индукаева1, Э.Б.Шаповалова1, Г.В.Артамонова1, О.Л.Барбараш1,2
1ФГБНУ «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний». 650002, Россия, Кемерово, Сосновый бульвар, д. 6;
2ФГБОУ ВО «Кемеровский государственный медицинский университет» Минздрава России. 650029, Россия, Кемерово, ул. Ворошилова 22а
1Research Institute for Complex Issues of Cardiovascular Diseases. 650002, Russian Federation, Kemerovo, Sosnovyi bul'var, d. 6;
2Kemerovo State Medical University of Ministry of Health of the Russian Federation. 650029,
Russian Federation, Kemerovo, ul. Voroshilova 22a
1ФГБНУ «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний». 650002, Россия, Кемерово, Сосновый бульвар, д. 6;
2ФГБОУ ВО «Кемеровский государственный медицинский университет» Минздрава России. 650029, Россия, Кемерово, ул. Ворошилова 22а
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1Research Institute for Complex Issues of Cardiovascular Diseases. 650002, Russian Federation, Kemerovo, Sosnovyi bul'var, d. 6;
2Kemerovo State Medical University of Ministry of Health of the Russian Federation. 650029,
Russian Federation, Kemerovo, ul. Voroshilova 22a
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