摘要
目的 通过Meta分析总结高血压患者发生心血管疾病(Cardiovascular disease,CVD)相关危险因素,为推动CVD防治关口前移提供循证医学依据.方法 计算机检索Cochrane Library、PubMed、EMbase、Web of Science及CINAHL数据库中公开发表的有关高血压患者发生CVD相关危险因素的英文文献,检索时间截至2022年12月.2位研究者独立提取被纳入文献的相关数据,采用Revman 5.3软件进行Meta分析.结果 共纳入60篇文献、19种危险因素,共计2659691例患者.Meta分析结果显示,男性(OR=1.46,95％CI:1.23～1.74)、衰老(OR=0.36,95％CI:0.26～0.50)、糖尿病(OR=2.06,95％CI:1.53～2.78)、胆固醇偏高(OR=0.59,95％CI:0.40～0.88)、肾小球滤过率偏低(OR=2.61,95％CI:2.05～3.32)、贫血(OR=2.5,95％CI:1.80～3.42)、睡眠呼吸暂停(OR=2.2,95％CI:1.62～2.99)、低体能状态(OR=1.52,95％CI:1.00～2.31)、血压控制不佳(OR=0.55,95％CI:0.40～0.76)、高血压治疗经历(OR=1.4,95％CI:1.15～1.70)、抑郁(OR=1.81,95％CI:1.44～2.29)均是高血压人群发生CVD事件的危险因素,差异有统计学意义(P<0.05).亚组分析显示,男性高血压患者发生冠心病风险高于女性,年龄偏高组、尿蛋白偏高组患者发生非死亡性CVD事件风险较高,而糖尿病组患者发生CVD死亡的风险较高,差异均有统计学意义(P<0.05).结论 男性、衰老、糖尿病、胆固醇偏高、肾小球滤过率偏低、贫血、睡眠呼吸暂停、低体能状态、血压控制不佳、高血压治疗经历、抑郁均是高血压患者发生CVD事件的危险因素,提示对该类人群进行CVD一级预防的重点是优化合并症管理,同时控制原发病并提升机体运动能力.
Abstract
Objective To analyze and summarize risk factors related to cardiovascular diseases (CVD) in patients with hypertension through a Meta-analysis,and provide evidence-based medical grounds for advancing prevention and treatment of CVD.Methods The databases of Cochrane Library,PubMed,EMbase,Web of Science and CINAHL were retrieved for searching published English literature on risk factors related to CVD occurred in hypertensive patients up to Dec.2022.The relevant data in included literature was extracted by 2 researchers independently,and given a Meta-analysis by using Revman 5.3 software.Results A total of 60 articles and 19 risk factors involving 2659691 patients were included.The results of Meta-analysis showed that being male (OR=1.46,95％CI:1.23～1.74),aging (OR=0.36,95％CI:0.26～0.50),diabetes (OR=2.06,95％CI:1.53～2.78),higher cholesterol level (OR=0.59,95％CI:0.40～0.88),reduced glomerular filtration rate (GFR,OR=2.61,95％CI:2.05～3.32),anemia (OR=2.5,95％CI:1.80～3.42),obstructive sleep apnea syndrome (OSAS,OR=2.2,95％CI:1.62～2.99),low physical condition (OR=1.52,95％CI:1.00～2.31),poor blood pressure control (OR=0.55,95％CI:0.40～0.76),history of hypertension treatment (OR=1.4,95％CI:1.15～1.70),and depression (OR=1.81,95％CI:1.44～2.29) all were significant risk factors for CVD occurrence in hypertensive patients (P＜0.05).The results of subgroup analysis showed that male hypertensive patients had a higher risk of coronary heart disease (CHD) than female patients,patients with higher age and elevated urine protein (UP) had a higher risk of CVD death (P＜0.05).Conclusion Being male,aging,diabetes,higher cholesterol level,reduced GFR,anemia,OSAS,low physical condition,poor blood pressure control,history of hypertension treatment and depression all are risk factors for CVD occurrence in hypertensive patients.The conclusion suggests that the focus of primary prevention of CVD in the patients should be on optimizing the management of comorbidities,controlling primary disease and enhancing physical fitness.
维普
万方数据