甘油三酯葡萄糖-体重指数与夜间高血压患者夜间血压水平的相关性

The correlation between triglyceride glucose-body mass index and nocturnal blood pressure levels in patients with nocturnal hypertension

摘要

目的 探讨甘油三酯葡萄糖-体重指数（TyG-BMI）与夜间高血压（NH）人群夜间动态血压参数的相关性。方法 采用横断面研究设计。纳入 2020 年 1 月—2023 年 3 月期间就诊于泰达国际心血管病医院高血压科及 2023 年 9 月—2025 年 4 月天津康汇医院高血压科门诊的 NH 患者共 1 301 例作为研究对象，收集患者资料并计算其 TyG-BMI，将患者按 TyG-BMI 四分位数分组，应用广义线性模型分析不同 TyG-BMI 分组与夜间动态血压参数的关联，按照年龄、性别、吸烟情况、饮酒情况以及入组时间划分亚组进行分层分析。绘制限制性立方样条图（RCS 曲线）分析 TyG-BMI 与 NH 患者发生靶器官损害的关系。结果 总人群平均年龄为（47.75±13.55）岁，TyG-BMI 均值为 243.17±42.31。TyG-BMI 四分位组间夜间平均收缩压、夜间平均舒张压、夜间平均心率差异有统计学意义（均P＜0.05）。广义线性模型结果显示，在校正混杂因素后，与第 1 四分位组比较，TyG-BMI 最高四分位组的夜间平均收缩压、夜间平均舒张压、夜间平均心率分别高 5.14 mmHg（95%CI：2.65～7.62, P＜0.001）、3.99 mmHg（95%CI：2.18～5.80, P＜0.001）、2.46 次/min（95%CI：1.06～3.85, P＜0.001）。排除年龄≥ 60 岁人群（n=1 014）以及糖尿病人群（n=1 109）后分别进行敏感性分析，结果与主要分析结果相似。亚组分析结果表明，TyG-BMI 不同分组与年龄、性别、吸烟及饮酒之间存在交互作用（均 P＜0.05）。在年龄＜45 岁及女性人群中，TyG-BMI 较高分位组的夜间平均收缩压升高更为显著，分别为 7.11（95%CI：3.78～10.43）mmHg、8.93（95%CI：4.29～13.56）mmHg。限制性立方样图显示，TyG-BMI（P_总体=0.017, P_非线性=0.011）与 NH 人群靶器官损害风险之间存在非线性相关。结论 在 NH 患者中，TyG-BMI 与夜间动态血压水平呈正相关。与 TyG-BMI 第 1 四分位组相比，年龄＜45 岁人群 TyG-BMI 最高四分位组的夜间平均收缩压增幅高于年龄≥ 45 岁人群，女性人群 TyG-BMI 最高四分位组夜间平均收缩压增幅高于男性人群。

Abstract

Objective To explore the correlation between triglyceride glucose-body mass index (TyG-BMI) and nocturnal ambulatory blood pressure parameters in nocturnal hypertension (NH) population. Methods A cross-sectional study design was adopted. A total of 1 301 patients with NH attending the Hypertension Department of TEDA IntermationalCardiovascular Disease Hospital between January 2020 and March 2023 and the Hypertension Department of TianjinKanghui Hospital between September 2023 and April 2025 were selected as the study subjects, and the patients' data werecollected and the TyG-BMI was calculated, and patients were grouped into quartiles according to TyG-BMI.A generalisedlinear model was applied to analyse the association between TyG-BMI groups and nocturnal ambulatory blood pressureparamefers. Stratified analyses were conducted according to age,gender，smoking status， alcohol consumption and enrollment period. A restricted cubic curve (RCS curve) was drawn to analyse the correlation between TyG-BMI and theoccurrence of target organ damage in patients with NH. Results The mean age of the total population was (47.75±13.55) years old, and the mean TyG-BMI was 243.17±42.31.The differences of the mean noctunal systolic blood pressture.mean nocturnal diastolic blood pressure, and mean nocturnal heart rate among the 4 groups were statistically significant(P＜0.05).The results of the generalised linear model showed that, after correcting for confounders, compared with the firstquartile group, the nocturnal systolic blood pressure, nocturnal diastolic blood pressure, and nocturnal heart rate were higherin the highest quartile group of the TyG-BMI by 5.14 mmHg(95%CI: 2.65 to 7.62,P＜0.001),3.99 mmHg (95%CI:2.18 to5.80,P＜0.001), and 2.46 beats/min (95%CI:1.06 to 3.85,P＜0.001). Sensitivity analyses were conducted after excludingindividuals aged ≥ 60 years (=1 014) and those with diabetes (n=1 109), yielding results consistent with the primaryanalysis. The results of subgroup analyses showed that there was an interaction between different subgroups of TyG-BMIand age, gender,smoking and alcohol consumption (all P＜0.05). In the＜45-year-old and female populations, the noctumalsystolic blood pressure was more significantly elevated in the higher tertile groups of TyG-BMI, which were 7.11 mmHg(95%CI: 3.78 to 10.43) and 8.93 mmHg (95%CI:4.29 to 13.56), respectively.Restricted cubic plots showed a nonlinearcorrelation between TyG-BMI (P_overall=0.017，P_nonlinear=0.011) and risk of target organ injuy in the NH population. Conclusion In NH patients,TyG-BMI showed a positive correlation with nocturnal ambulatory blood pressure levels. Compared with the first quartile, the increase in mean nocturnal systolic blood pressure was greater in the highest TyG-BMIquartile among those aged ＜45 years than in those aged ≥ 45 years. Furthermore, the increase in nocturnal systolic bloodpressure was higher in the highest TyG-BMI quartile groups among female patients than in male patients.

关键词

夜间高血压 / 甘油三酯葡萄糖-体重指数 / 动态血压 / 靶器官损害

Key words

nocturnal hypertension / triglyceride glucose-body mass index / ambulatory blood pressure / target organdamage

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基金资助

中华医学会心血管病学分会临床研究专项基金(CSCF2023A02)