Interaction effect of hypertension family history and dyslipidemia on the prevalence of hypertension
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摘要:
目的 探讨高血压家族史和血脂异常的交互作用对高血压患病风险的影响。 方法 2017—2018年开展南京市慢性病防控社会因素调查, 对61 098名≥18岁常住居民进行问卷调查、身体测量和实验室检测。采用复杂抽样的方法基于Logistic回归分析模型分析高血压家族史、血脂异常对高血压患病的影响。相乘和相加模型分析高血压家族史与血脂异常的交互作用。 结果 最终纳入60 283名调查对象。高血压患者15 686例, 标化患病率为29.8%。33.8%的居民有高血压家族史, 血脂异常标化率为29.8%。多因素Logistic回归分析模型调整混杂因素后, 有高血压家族史合并血脂异常人群患高血压的风险是无高血压家族史无血脂异常人群的4.881倍(95%CI : 4.381~5.438)。高血压家族史与血脂异常存在相乘交互作用(OR=1.107, 95% CI:1.015~1.208)。相加交互作用提示高血压家族史与血脂异常存在协同作用, 交互作用指数(synergyindex, S)、交互作用相对超额危险度比(relative excess risk of interaction, RERI)、交互作用归因比(attributable proportion of interaction, API)分别为1.603(95%CI: 1.447~1.775)、1.460(95% CI: 1.212~1.707)、29.9%(95% CI: 24.8~35.0)。 结论 高血压家族史与血脂异常存在协同作用, 两者同时存在时增加高血压患病风险。 Abstract:Objective To explore the effect of the interaction of family history of hypertension and dyslipidemia on the prevalence of hypertension. Methods Based on the Chronic Disease and Risk Factor Surveillance in Nanjing City from 2017 to 2018, a representative sample of 61 098 residents aged over 18 years were surveyed. All participants completed face-to-face questionnaires, anthropometric measurements and relevant laboratory examinations. A logistic regression model of complex sampling was utilized to analyze the influence of the family history of hypertension and dyslipidemia on the prevalence of hypertension. The multiplicative and additive models were applied to analyze the interaction effect of family history of hypertension and dyslipidemia. Results Finally, a total of 60 283 subjects were included in this study. Among them, there were 15 686 hypertensive patients with a standardized prevalence rate of 29.8%;33.8% of participants had a family history of hypertension, and the standardized rate of dyslipidemia was 29.8%. After adjusting for confounding factors by multivariate Logistic regression, participants with a family history of hypertension and dyslipidemia had a significantly higher risk of hypertension compared with those without a family history of hypertension and dyslipidemia (OR=4.881, 95% CI: 4.381-5.438). There was a multiplicative interaction between a family history of hypertension and dyslipidemia (OR=1.107, 95% CI: 1.015-1.208). The additive interaction model showed a synergistic effect between a family history of hypertension and dyslipidemia, the S, RERI, API% was 1.603(95%CI: 1.447-1.775), 1.460(95%CI: 1.212-1.707), and 29.9%(95%CI: 24.8-35.0), respectively. Conclusion Family history of hypertension and dyslipidemia has synergistic impact on risk of hypertension, and the simultaneous presence of both increases the risk of hypertension. -
Key words:
- Hypertension /
- Dyslipidemia /
- Family history of hypertension /
- Interaction
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表 1 研究对象的基线资料[n(%)]
Table 1. Baseline data of study participants [n(%)]
基本特征 总人群 高血压患病数 高血压患病率(%) χ2 P值 性别 227.503 <0.001 男性 29 848(49.4) 8 579(54.3) 32.8 女性 30 435(50.6) 7 107(45.7) 26.9 年龄(岁) 13 772.929 a <0.001 <35 23 162(28.7) 1 206(5.0) 5.2 35~<45 8 853(18.5) 1 286(8.8) 14.3 45~55 10 805(19.5) 3 408(20.4) 31.2 >55 17 463(33.3) 9 786(65.8) 58.9 地区 23.420 <0.001 主城区 38 814(65.1) 9 850(63.9) 29.3 非主城区 21 469(34.9) 5 836(36.1) 30.8 文化程度 5 358.827 <0.001 小学及以下 5 458(11.1) 2 709(20.0) 53.5 初中/高中 27 020(47.0) 9 486(58.9) 37.4 大专及以上 27 805(41.9) 3 491(21.1) 15.0 职业 7 288.193 <0.001 蓝领人员 13 334(21.8) 3 272(19.5) 26.7 服务人员 7 192(11.3) 1 113(6.5) 17.2 白领人员 19 406(30.2) 2 991(17.7) 17.4 学生 3 835(5.6) 138(0.6) 3.3 未就业/离退休 16 516(31.1) 8 172(55.7) 53.5 婚姻状况 3 164.152 <0.001 未婚 10 556(14.1) 593(3.0) 6.3 已婚/同居 47 536(81.0) 14 028(88.0) 32.4 其他 2 191(4.9) 1 065(9.0) 55.1 现在吸烟 457.147 <0.001 是 11 430(19.2) 3 877(23.7) 36.8 否 48 853(80.8) 11 809(76.3) 28.2 饮酒 125.813 <0.001 是 17 652(29.0) 5 143(31.3) 32.2 否 42 631(71.0) 10 543(68.7) 28.9 BMI分类 4 523.556 <0.001 低/正常体重 34 406(55.4) 5 614(36.3) 19.6 超重 20 112(34.6) 7 107(45.1) 38.8 肥胖 5 765(10.0) 2 965(18.6) 55.4 糖尿病 4 612.557 <0.001 是 5 663(10.9) 3 608(24.4) 66.8 否 54 620(89.1) 12 078(75.6) 25.3 高血压家族史 1 993.599 <0.001 是 20 011(33.8) 7 472(45.7) 40.3 否 40 272(66.2) 8 214(54.3) 24.5 血脂异常 3 134.436 <0.001 是 17 093(29.8) 7 166(45.6) 45.6 否 43 190(70.2) 8 520(54.4) 23.1 注：a代表该处是趋势性χ2检验。 
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表 2 高血压家族史和血脂异常相乘交互作用
Table 2. The multiplicative interaction between the family history of hypertension and dyslipidemia
变量 β值 sx Wald值 P值 OR(95% CI)值 血脂异常 0.466 0.049 89.100 < 0.001 1.594(1.436~1.769) 高血压家族史 1.080 0.034 980.190 < 0.001 2.944(2.737~3.166) 血脂异常且高血压家族史 0.102 0.041 6.116 0.013 1.107(1.015~1.208) 注：调整性别、年龄、地区、教育、婚姻、职业、现在吸烟、饮酒、BMI、糖尿病。
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表 3 高血压家族史与血脂异常对高血压患病的叉生分析
Table 3. The interaction of the family history of hypertension and dyslipidemia on the prevalence of hypertension
高血压家族史 血脂异常 高血压患病数 高血压患病率(%) 单因素分析OR(95% CI)值 多因素分析ORa(95% CI)值 否 否 3 073 14.8 1.000 1.000 否 是 2 177 31.5 2.656(2.443~2.887) 1.508(1.354~1.679) 是 否 3 774 31.5 2.955(2.776~3.247) 2.914(2.708~3.135) 是 是 3 698 56.1 7.376(6.741~8.071) 4.881(4.381~5.438) 注：a调整性别、年龄、地区、教育、婚姻、职业、现在吸烟、饮酒、BMI、糖尿病。
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表 4 高血压家族史与血脂异常相加交互作用
Table 4. Additive interaction between the family history of hypertension and dyslipidemia
指标 估计值 (95% CI)值 RERI 1.460 1.212~1.707 API(%) 29.900 24.800~35.000 S 1.603 1.447~1.775 注：调整性别、年龄、地区、教育、婚姻、职业、现在吸烟、饮酒、BMI、糖尿病。
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