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Abstract：
BACKGROUND: The aim of this study was to evaluate the association between obesity and risk of incident left ventricular hypertrophy (LVH) in community-dwelling populations with hypertension and investigate whether this association would be attenuated by a lower achieved systolic blood pressure (SBP).
RESULTS: We used the EMINCA (Echocardiographic Measurements in Normal Chinese Adults) criteria, which were derived from healthy Chinese populations to define LVH. A total of 2069 participants with hypertension and without LVH (obesity 20.4%) were included. The association between obesity and risk of incident LVH was evaluated using Cox proportional hazard models and stratified by achieved follow-up SBP levels (≥140, 130-139, and <130 mm Hg). These analyses were also assessed using the American Society of Echocardiography/European Association of Cardiovascular Imaging criteria, which were derived from European populations to define LVH. After a median follow-up of 2.90 years, the rates of incident LVH in the normal-weight, overweight, and obese groups were 13.5%, 20.3%, and 27.8%, respectively (P<0.001). In reference to normal weight, obesity was associated with increased risk of incident LVH (adjusted hazard ratio [aHR], 2.51 [95% CI, 1.91-3.29]), which was attenuated when achieved SBP was <130 mm Hg (aHR, 1.78 [95% CI, 0.99-3.19]). This association remained significant when achieved SBP was ≥140 mm Hg (aHR, 3.45 [95% CI, 2.13-5.58]) or at 130 to 139 mm Hg (aHR, 2.32 [95% CI, 1.23-4.36]). Differences in these findings were noted when LVH was defined by the American Society of Echocardiography/European Association of Cardiovascular Imaging criteria.
CONCLUSIONS: Obesity was associated with incident LVH and an SBP target <130 mm Hg might be needed to attenuate this risk in patients with hypertension and obesity.
RESULTS: We used the EMINCA (Echocardiographic Measurements in Normal Chinese Adults) criteria, which were derived from healthy Chinese populations to define LVH. A total of 2069 participants with hypertension and without LVH (obesity 20.4%) were included. The association between obesity and risk of incident LVH was evaluated using Cox proportional hazard models and stratified by achieved follow-up SBP levels (≥140, 130-139, and <130 mm Hg). These analyses were also assessed using the American Society of Echocardiography/European Association of Cardiovascular Imaging criteria, which were derived from European populations to define LVH. After a median follow-up of 2.90 years, the rates of incident LVH in the normal-weight, overweight, and obese groups were 13.5%, 20.3%, and 27.8%, respectively (P<0.001). In reference to normal weight, obesity was associated with increased risk of incident LVH (adjusted hazard ratio [aHR], 2.51 [95% CI, 1.91-3.29]), which was attenuated when achieved SBP was <130 mm Hg (aHR, 1.78 [95% CI, 0.99-3.19]). This association remained significant when achieved SBP was ≥140 mm Hg (aHR, 3.45 [95% CI, 2.13-5.58]) or at 130 to 139 mm Hg (aHR, 2.32 [95% CI, 1.23-4.36]). Differences in these findings were noted when LVH was defined by the American Society of Echocardiography/European Association of Cardiovascular Imaging criteria.
CONCLUSIONS: Obesity was associated with incident LVH and an SBP target <130 mm Hg might be needed to attenuate this risk in patients with hypertension and obesity.
摘要：
背景：本研究的目的是评估社区居住高血压人群中肥胖与左心室肥厚（LVH）风险之间的关系，并研究较低的收缩压（SBP）是否会减弱这种联系。
结果：我们使用了EMINCA（正常中国成年人的超声心动图测量）标准，它们来自健康的中国人群来定义LVH。共纳入2069名患有高血压和无LVH（肥胖20.4%）的参与者。使用Cox比例风险模型评估肥胖与发生LVH的风险之间的关系，并通过获得的随访SBP水平（≥140、130-139和<130mmHg）进行分层。这些分析也使用美国超声心动图学会/欧洲心血管成像协会标准进行评估。它们来自欧洲人群来定义LVH。经过2.90年的中位随访，正常体重的LVH发生率，超重,肥胖组是13.5%，20.3%,27.8%,分别(P<0.001)。关于正常体重，肥胖与LVH事件风险增加相关(调整后的风险比[aHR]，2.51[95%CI，1.91-3.29])，当达到的SBP<130mmHg(AHR，1.78[95%CI，0.99-3.19]）。当达到SBP≥140mmHg时，这种关联仍然显著(aHR，3.45[95%CI，2.13-5.58])或130至139mmHg(aHR，2.32[95%CI，1.23-4.36]）。当美国超声心动图学会/欧洲心血管成像协会标准定义LVH时，注意到这些发现的差异。
结论：肥胖与LVH相关，高血压和肥胖患者可能需要一个<130mmHg的SBP目标来降低这种风险。
结果：我们使用了EMINCA（正常中国成年人的超声心动图测量）标准，它们来自健康的中国人群来定义LVH。共纳入2069名患有高血压和无LVH（肥胖20.4%）的参与者。使用Cox比例风险模型评估肥胖与发生LVH的风险之间的关系，并通过获得的随访SBP水平（≥140、130-139和<130mmHg）进行分层。这些分析也使用美国超声心动图学会/欧洲心血管成像协会标准进行评估。它们来自欧洲人群来定义LVH。经过2.90年的中位随访，正常体重的LVH发生率，超重,肥胖组是13.5%，20.3%,27.8%,分别(P<0.001)。关于正常体重，肥胖与LVH事件风险增加相关(调整后的风险比[aHR]，2.51[95%CI，1.91-3.29])，当达到的SBP<130mmHg(AHR，1.78[95%CI，0.99-3.19]）。当达到SBP≥140mmHg时，这种关联仍然显著(aHR，3.45[95%CI，2.13-5.58])或130至139mmHg(aHR，2.32[95%CI，1.23-4.36]）。当美国超声心动图学会/欧洲心血管成像协会标准定义LVH时，注意到这些发现的差异。
结论：肥胖与LVH相关，高血压和肥胖患者可能需要一个<130mmHg的SBP目标来降低这种风险。
