【摘要】 目的：探究中高强度身体活动（moderate-to-vigorous physical activity, MVPA）对高血压患者全因及心血管疾病（cardiovascular disease, CVD）死亡风险的影响。方法：纳入来自美国国家健康与营养调查（national health and nutrition examination survey, NHANES）数据库的9 512名高血压患者，事件终点为全因死亡和CVD死亡。基于全球体力活动问卷（global physical activity questionnaire, GPAQ）评估患者身体活动（physical activity, PA），根据活动领域、强度、频率、持续时间计算每周总MVPA分钟数，并按四分位数划分为PA1（总MVPA<180 min）、PA2(180 min≤总MVPA<480 min)、PA3(480 min≤总MVPA<1 260 min)、PA4（总MVPA≥1 260 min）组。通过Kaplan-Meier(K-M)生存分析与Cox比例风险回归探索高血压患者MVPA与全因及CVD死亡率的相关性。随后采用限制性立方样条（restricted cubic spline, RCS）评估MVPA与死亡风险间的非线性关联，并经阈值效应分析和两段式Cox回归模型计算MVPA对死亡风险的作用拐点。通过亚组分析判断MVPA与其他混杂因素的交互作用。结果：在77.2个月的平均随访期内，发生1 131例全因死亡和353例CVD死亡。K-M生存分析显示，PA4组的全因死亡率及CVD死亡率最低。而多变量Cox回归分析表明，与PA1组相比，PA4组与较低的全因死亡率相关，PA3组与较低的CVD死亡率相关。此外，高血压患者MVPA水平与全因及CVD死亡风险均呈L型关联，表现为死亡风险先随MVPA的增加而显著下降，随后逐渐平稳。其中，全因死亡率在MVPA为620 min/周时趋于稳定，CVD死亡率在625 min/周时趋于稳定。当MVPA一定时，75～225 min/d的持续时间、0%<VPA/总MVPA≤50%的强度占比与更低的全因死亡率相关。结论：高血压患者全因死亡风险及CVD死亡风险与MVPA的剂量反应关联呈L型，MVPA临界值分别为620 min/周、625 min/周。每周总MVPA相同时，适度的持续时间与中高等强度组合的运动模式带来的健康益处更大。更多还原

【Abstract】 Objective: To explore the effect of moderate-to-vigorous physical activity(MVPA) on the risk of all-cause and cardiovascular disease(CVD) mortality in hypertensive patients. Methods: Nine thousand five hundred and twelve hypertensive patients were enrolled from the national health and nutrition examination survey(NHANES) database with endpoints of allcause and CVD mortality. Global physical activity questionnaire(GPAQ) was used to evaluate physical activity(PA). Total MVPA per week was calculated according to field, intensity, frequency, and duration and divided into PA1(total MVPA<180 min), PA2(180 min≤total MVPA<480 min), PA3(480 min≤total MVPA<1 260 min), and PA4(total MVPA≥1 260 min) groups by quartile. Kaplan-Meier(K-M) survival analysis and Cox proportional hazard regression were used to investigate the association among MVPA and risk of all-cause and CVD mortality in hypertensive patients. The nonlinear correlation between MVPA and mortality was analyzed by restricted cubic spline(RCS), and the cutoff point of MVPA on mortality was calculated through threshold effect analysis and a two-stage Cox proportional risk model. Subgroup analysis was performed to determine the interaction between MVPA and other confounding factors. Results: During an average follow-up period of 77.2 months, 1 131 all-cause and 353 CVD deaths occurred. K-M survival analysis showed the lowest all-cause and CVD mortality in the PA4 group. Multivariate Cox regression analysis showed that the PA4 group was associated with lower all-cause mortality and the PA3 group with lower CVD mortality compared to the PA1 group. Besides, An L-shaped association was observed between MVPA and mortality, where the mortality decreased significantly with the increase in MVPA initially, but then gradually stabilized. The all-cause mortality remained stable at 620 min/week, and the CVD mortality remained stable at 625 min/week. The duration of 75-225 min/day and the proportion of 0%<VPA/total MVPA ≤50% has a greater reduction in all-cause mortality when MVPA was constant. Conclusions: The dose-response among MVPA and the risk of all-cause and CVD mortality in hypertensive patients is L-shaped, with thresholds of 620 min/week and 625 min/week, respectively. A moderate duration and a combination of moderate and vigorous intensity lead to greater health benefits when MVPA was constant.更多还原