HIV/AIDS患者静息心率和血脂异常与正常高值血压/高血压的关联

  目的  探索HIV/AIDS患者中的静息心率(resting heart rate, RHR)过快和血脂异常与正常高值血压/高血压的关联及其交互作用。  方法  采用横断面研究的方法，基于浙江省台州市2017―2019年“HIV与衰老相关疾病前瞻性队列研究”基线数据，纳入分析30岁以上的HIV/AIDS患者。采用Logistic回归分析模型分析HIV/AIDS患者患正常高值血压/高血压的影响因素，用相乘模型探索RHR过快和血脂异常的交互作用。RHR过快定义为RHR>90次/min；血脂异常定义为TC、TG、LDL-C升高或HDL-C降低。  结果  共1 645例HIV/AIDS患者纳入分析，其中正常高值血压和高血压的患病率分别为42.8%和28.1%。15.8%(260/1 645)的研究对象的RHR过快，59.2%(974/1 645)存在血脂异常。多分类Logistic回归分析模型结果显示，调整年龄、性别、BMI、腰臀比和TC之后，TG升高和RHR过快是正常高值血压(aOR=1.56, 95% CI:1.14~2.13, P=0.005；aOR=1.60, 95% CI:1.06~2.43, P=0.026)和高血压(aOR=1.94, 95% CI:1.37~2.75, P < 0.001；aOR=1.95, 95% CI:1.20~3.18, P=0.007)的独立影响因素。同时，TG升高和RHR过快对正常高值血压(P=0.017)和高血压(P=0.032)均存在负向相乘交互作用。TC、LDL-C及HDL-C异常与RHR过快对正常高值血压和高血压均未观察到交互作用。  结论  RHR过快和TG升高是HIV/AIDS患者正常高值血压和高血压的独立危险因素。此外，RHR过快和TG升高之间存在负向的相乘交互作用，提示RHR过快可能降低TG引起致高血压发生的阈值，其机制需要进一步研究去阐明。

Associations of resting heart rate and dyslipidemia with prehypertension and hypertension among HIV/AIDS patients

  Objective  To assess the associations of elevated resting heart rate (RHR) and dyslipidemia and their interactions with prehypertension and hypertension among HIV/AIDS patients.  Methods  A cross-sectional assessment was conducted among 1 645 HIV/AIDS patients over 30 years old from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART) between 2017 to 2019. Multinomial Logistic regression model was used to assess the factors associated with prehypertension and hypertension. Multiplicative model was used to explore the interaction between elevated RHR and dyslipidemia. Elevated RHR was defined as > 90 beats/min; dyslipidemia was defined as elevated total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) or decreased high-density lipoprotein cholesterol (HDL-C) levels.  Results  Among 1 645 HIV/AIDS patients, prevalence of prehypertension and hypertension were 42.8% and 28.1%, respectively. 15.8% (260/1 645) of the subjects had elevated RHR, and 59.2% (974/1 645) had dyslipidemia. After adjusting for age, sex, body mass index, waist to hip ratio and TC, elevated TG and elevated RHR were independently associated with prehypertension (aOR=1.56, 95% CI: 1.14-2.13, P=0.005; aOR=1.60, 95% CI: 1.06-2.43, P=0.026) and hypertension (aOR=1.94, 95% CI: 1.37-2.75, P < 0.001; aOR=1.95, 95% CI: 1.20-3.18, P=0.007), and there was a negative multiplicative interaction between elevated TG and elevated RHR with prehypertension (P=0.017) and hypertension (P=0.032). No interaction was observed between abnormal TC, LDL-C, HDL-C and elevated RHR on prehypertension and hypertension.  Conclusion  Elevated RHR and elevated TC are independently associated with prehypertension and hypertension in HIV/AIDS patients. The negative interactions between elevated RHR and elevated TC on prehypertension and hypertension suggest that faster RHR is likely to reduce the threshold for TG levels to cause hypertension. Further studies are needed to reveal the underlying mechanism between RHR, TG and hypertension.