The Association Between Grip Strength And The Risk Of Hypertension With Ideal Cardiovascular Health Status

Objective: Cardiovascular diseases(CVDs)are the number 1 cause of death globally,representing 31% of all global deaths.The key to reducing the mortality rate is to intervene in the occurrence and development of diseases and prevent and cure diseases in various ways.Muscle strength has been proved to be closely related to health and disease.Based on the natural population cohort in northeast region of China,the distribution of grip strength was described in the 18 to 79 years old adult population,and the association between handgrip strength with blood pressure,the prevalence of hypertension and ideal cardiovascular health(ICH)status was analyzed by different genders and the degree of obesity.Understanding the distribution of muscle strength of adult and elders could help us to comprehend the muscle strength level and define sarcopenia in the Chinese population,guide the prevention and diagnosis of sarcopenia in clinical practice,establish the references and provide data support for evaluating the status of cardiovascular health,and preventing and curing hypertension.Methods: The measurement of grip strength was based on international standards.Two hands were measured three times separately.Describing the distribution of grip strength in adults was stratified according to gender and age.Generalized Additive Models for Location,Scale and Shape(GAMLSS)was adopted to describe the distribution of grip strength of adults and elder.Multiple linear regression was used to analyze the influencing factors for grip strength.Take the two standard deviations under the average grip strength of men and women less then 40 years old as the abnormal grip strength.After that the distribution of low handgrip strength was described.Pearson correlation analysis was used to study the related factors of grip strength.At the same time,multiple linear regression was used to analyze the correlation between grip strength and weight,waist and hip circumference,BMI,blood pressure and other factors.Binary Logistic regression analysis was used to explore the association between grip strength and the risk of hypertension.Intermediate analysis was used to explore the intermediary relationship between grip strength,BMI,and hypertension risk.The method of restrictive cubic spline was used to determine the linear relationship between grip strength and ideal cardiovascular score,and fit the curve.The independent variables were selected by LASSO(Least Absolute Shrinkage and Selection Operator)regression.And then multiple binary logistic regression was used to explore the relationship between grip strength and ICH status,and calculate the Odds Ratio(OR)with its 95% confidence interval(CI).Results: With the increase of age,the grip strength increased first and then decreased.Between the ages of 30 and 40,the grip strength of men and women reached the maximum 44.47 ± 8.79 and 27.15 ± 5.87,respectively.Grip strength is related to body weight,BMI,waist circumference,hip circumference,systolic blood pressure,and diastolic blood pressure in men and women.With the rise of BMI level,the grip strength was also increased.The results of multiple linear regression analysis indicated that age,gender,weight,waist-to-hip ratio,diastolic blood pressure,and educational level were related to grip strength.The lower limit of the normal grip strength was taken as two standard deviations under the average grip strength of men and women less than 40 years old.Therefore,grip strength less than 26.2 kg in men and 14.4 kg in women are considered abnormal.After stratification by age,with rise of age,the abnormal rate of grip strength was increasing gradually.Among people over 60 years old,the abnormal rate of grip strength in men and women were 31.1% and 21.1% respectively.After adjusting for factors such as age,waist-to-hip ratio,educational level,physical activity,smoking,and drinking,the relative grip strength of men and women was negatively correlated with systolic and diastolic blood pressure.The association between grip strength and hypertension were observed only in the male population with BMI ≥ 25,after adjusting for factors such as age,waist-to-hip ratio,education level,physical activity,smoking,drinking,etc.The OR value with its 95% CI were 0.31(0.11,0.91).That suggested that in the overweight or obese men,the higher the muscle strength was associated with the lower the prevalence of hypertension.No meaningful results were observed in the female population.In the association between grip strength and systolic blood pressure,diastolic blood pressure and the risk of hypertension,BMI has shown partial mediation.Conclusion: Muscle strength(handgrip strength)reaches a peak level before the age of 40,and then decreases with age,and the downward trend increases gradually in both men and women.Reference value was established for grip strength based on the population in the northeast China.The proportion of low muscle strength were increased significantly in the people over 60 years old.Which indicates that we should pay more attention for the people over 60 years.The reference value for handgrip strength provided a basis for clinical practice and epidemiology studies.In obese men,muscle strength may decrease the risk of hypertension.So that may support a new direction for the prevention of hypertension.Muscle strength was positively related with ICH score.Higher-level handgrip strength had a higher change to be an ICH health.Enhance muscle strength may help to improve cardiovascular health and reduce the risk of high blood pressure.