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Article(id=1324077618819105066, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202510015, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1759593600000, receivedDateStr=2025-10-05, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614304498, onlineDateStr=2026-11-02, pubDate=1774368000000, pubDateStr=2026-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614304498, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614304498, creator=13701087609, updateTime=1793614304498, updator=13701087609, issue=Issue{id=1324077560820282023, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='1774368000000', pubDateStr='2026-03-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614290671, creator='13701087609', updateTime=1793614391469, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324077983656444429, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324077983660638734, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=997, endPage=1003, ext={EN=ArticleExt(id=1324077619230146859, articleId=1324077618819105066, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between anemia and hypertension in middle-aged and elderly women, China, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To examine the association between anemia and hypertension among middle-aged and older Chinese women.

Methods

Baseline data of 5 575 women aged ≥45 years from the 2015 China Health and Retirement Longitudinal Study (CHARLS) were collected, with anemia in 2018 as the outcome. Multivariable logistic regression was used to assess cross-sectional and longitudinal relationships between anemia and hypertension. Restricted Cubic Splines (RCS) were used to analyze the dose-response relationship between hemoglobin and the risk of hypertension in middle-aged and elderly women.

Results

Anemia was inversely associated with hypertension. In 2015, anemic women had a 25-35% lower prevalence of hypertension (Model 1: OR=0.65, 95% CI: 0.57-0.74; Model 4: OR=0.75, 95% CI: 0.63-0.88; both P<0.01). Over 2015—2018, baseline anemia reduced 3-year hypertension incidence by 42-50% (Model 1: OR=0.58, 95% CI: 0.43-0.79; Model 4: OR=0.50, 95% CI: 0.35-0.71; P<0.001). RCS showed a linear inverse relationship between hemoglobin level and hypertension risk. BMI influenced the strength of association, but no interaction was detected (all P > 0.05). Sensitivity analyses confirmed robustness.

Conclusion

Anemia is associated with lower prevalence and incidence of hypertension in middle-aged and older Chinese women.

, authors=Xue WANG, Cheng-lin ZHAO, authorsList=Xue WANG, Cheng-lin ZHAO, authorCompany=null, correspAuthors=Xue WANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324077624439472456, articleId=1324077618819105066, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=中国中老年女性贫血与高血压的关联研究, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

探讨中国中老年女性贫血与高血压的关联。

方法

收集中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）项目中2015年5 575名≥45 岁女性的基线数据，以2018年贫血为结局。采用多因素logistic回归模型分析贫血与高血压横断面及队列之间的关系，采用限制性立方样条（Restricted Cubic Splines, RCS）分析中老年女性人群血红蛋白与高血压发病风险的剂量-反应关系。

结果

贫血与高血压呈负相关，横断面分析（2015年）显示，贫血者的高血压患病风险降低 25%～35%（模型 1：OR=0.65，95% CI：0.57～0.74；模型 4：OR=0.75，95% CI：0.63～0.88；均 P<0.01）。前瞻性队列分析（2015—2018年）表明，基线贫血使 3 年后高血压发病风险下降 42%～50%（模型 1：OR=0.58，95% CI：0.43～0.79；模型 4：OR=0.50，95% CI：0.35～0.71；P<0.001）。RCS分析结果显示血红蛋白和高血压发病风险呈线性相关。亚组分析发现体重指数影响关联强度，各亚组之间未发现交互效应（交互检验均P>0.05）。敏感性分析结果稳健。

结论

中国中老年女性人群中贫血与高血压患病及新发风险呈负相关。

, authors=王雪, 赵城林, authorsList=王雪, 赵城林, authorCompany=null, correspAuthors=王雪, authorNote=

王雪（1996—），女，硕士，初级医师，研究方向：妇产科

, correspAuthorsNote=
王雪，E-mail:
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王雪（1996—），女，硕士，初级医师，研究方向：妇产科

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王雪（1996—），女，硕士，初级医师，研究方向：妇产科

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Journal of Medical Case Reports, 2023, 17(1): 44., articleTitle=Chronic anemia complicated by cardiac failure, pulmonary hypertension, and pericardial effusion: a case report, refAbstract=null), Reference(id=1324077640478491018, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, doi=null, pmid=null, pmcid=null, year=2025, volume=35, issue=7, pageStart=1344, pageEnd=1349, url=null, language=null, rfNumber=[22], rfOrder=23, authorNames=Stack KO, Shulman SB, Blume ED, journalName=Cardiology in the Young, refType=null, unstructuredReference=Stack KO, Shulman SB, Blume ED, et al. Real-world use of intravenous Iron sucrose in children with cardiac disease[J]. 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Research progress of the effect of shear stress on vascular endothelial cells function[J]. Advances in Clinical Medicine, 2023, 13(5): 7227-7231. (In Chinese), articleTitle=Research progress of the effect of shear stress on vascular endothelial cells function, refAbstract=null), Reference(id=1324077640818229646, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, doi=null, pmid=null, pmcid=null, year=2021, volume=11, issue=5, pageStart=708, pageEnd=null, url=null, language=null, rfNumber=[25], rfOrder=27, authorNames=Yang HJ, Koh E, Kang Y, journalName=Biomolecules, refType=null, unstructuredReference=Yang HJ, Koh E, Kang Y. Susceptibility of women to cardiovascular disease and the prevention potential of Mind-Body intervention by changes in neural circuits and cardiovascular physiology[J]. 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Am J Prev Cardiol, 2025, 23: 101057., articleTitle=Blood pressure reduction by gender and menopause status among hypertensive participants of a Mobile health cardiovascular risk self-management program, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1324077624733073737, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, xref=null, ext=[AuthorCompanyExt(id=1324077624741462346, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, companyId=1324077624733073737, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=The Prenatal Diagnosis Department, the Second People’s Hospital of Yibin, Yibin, Sichuan 644400, China), AuthorCompanyExt(id=1324077624749850955, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, companyId=1324077624733073737, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=宜宾市第二人民医院产前诊断科，四川 宜宾 644400)])], figs=[ArticleFig(id=1324077627870413150, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=EN, label=Fig.1, caption=Flowchart of study participant selection (CHARLS 2015-2018), figureFileSmall=Pe02ZwGwjDfmilKJt7nmqw==, figureFileBig=w+7mIBkgYLuMeX7Wiq+l4A==, tableContent=null), ArticleFig(id=1324077627945910623, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=CN, label=图1, caption=研究对象筛选流程图（CHARLS 2015—2018）, figureFileSmall=Pe02ZwGwjDfmilKJt7nmqw==, figureFileBig=w+7mIBkgYLuMeX7Wiq+l4A==, tableContent=null), ArticleFig(id=1324077628151431520, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=EN, label=Fig.2, caption=Dose-response relationship between hemoglobin and hypertension risk, figureFileSmall=ZGitC/mVS2IzyLhCEvjixw==, figureFileBig=w4AQ2M1ARJrrWabCAMApbg==, tableContent=null), ArticleFig(id=1324077631657869665, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=CN, label=图2, caption=血红蛋白与高血压风险的剂量-反应关系

注: 实线表示估计的校正比值比（OR），阴影区域代表95%置信区间（CI）。调整了年龄、婚姻、居住地、BMI、吸烟、饮酒、夜间睡眠时长、合并症、WBC、Hct、Scr、HDL、hs-CRP。该拟合曲线覆盖了 99% 的数据点范围。

, figureFileSmall=ZGitC/mVS2IzyLhCEvjixw==, figureFileBig=w4AQ2M1ARJrrWabCAMApbg==, tableContent=null), ArticleFig(id=1324077631855001954, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=EN, label=Fig.3, caption=E-value for the association between anemia and hypertension risk, figureFileSmall=rwPyiByU+rJR6I1fI//A0g==, figureFileBig=f+iyTa5AtUgKqvA2wQqUQw==, tableContent=null), ArticleFig(id=1324077631951470947, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=CN, label=图3, caption=贫血与高血压风险关联的 E 值评估

注: RR=相对危险度。A：2015 年横断面分析；B：2015—2018 年前瞻性队列分析。

, figureFileSmall=rwPyiByU+rJR6I1fI//A0g==, figureFileBig=f+iyTa5AtUgKqvA2wQqUQw==, tableContent=null), ArticleFig(id=1324077632186351972, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=EN, label=Table 1, caption=

Baseline characteristics of the survey population

, figureFileSmall=null, figureFileBig=null, tableContent=
项目总例数(n=5 575)非贫血组(n=4 294)贫血组(n=1 281)统计量值P值
年龄[岁，]59.3±9.259.2±9.059.5±10.10.8940.344
受教育程度[n(%)]12.0760.002
小学以下1 059(19.0)773(18.0)286(22.3)
初中161(2.9)124(2.9)37(2.9)
高中或以上4 355(78.1)3 397(79.1)958(74.8)
婚姻[n(%)]0.3270.567
已婚/同居5 258(94.3)4 054(94.4)1 204(94.0)
其他317(5.7)240(5.6)77(6.0)
居住地[n(%)]30.804<0.001
城市668(12.0)571(13.3)97(7.6)
农村4 136(74.2)3 142(73.2)994(77.6)
其他771(13.8)581(13.5)190(14.8)
BMI[kg/m2,n(%)]75.555<0.001
<253 235(58.0)2 358(54.9)877(68.5)
25～<301 932(34.7)1 590(37.0)342(26.7)
≥30408(7.3)346(8.1)62(4.8)
吸烟[n(%)]0.0520.819
无5 496(98.6)4 234(98.6)1 262(98.5)
有79(1.4)60(1.4)19(1.5)
饮酒[n(%)]1.0190.313
无4 762(85.4)3 679(85.7)1 083(84.5)
有813(14.6)615(14.3)198(15.5)
夜间睡眠时长[h,]6.3±2.06.3±2.06.2±2.114.7370.338
心脏病[n(%)]0.918<0.001
无4 891(87.7)3 726(86.8)1 165(90.9)
有684(12.3)568(13.2)116(9.1)
血脂异常[n(%)]15.957<0.001
无4 981(89.3)3 802(88.5)1 179(92.0)
有594(10.7)492(11.5)102(8.0)
糖尿病或血糖升高[n(%)]12.6630.504
无5 222(93.7)4 017(93.5)1 205(94.1)
有353(6.3)277(6.5)76(5.9)
抑郁症[n(%)]0.446<0.001
无3 094(55.5)2 443(56.9)651(50.8)
有2 481(44.5)1 851(43.1)630(49.2)
WBC[×1 000,]5.8±1.75.9±1.75.4±1.889.106<0.001
Hct[%,]39.3±5.040.7±4.334.6±4.02 057.666<0.001
MCV[fl,]90.1±7.690.9±6.187.4±10.8227.504<0.001
TG[mg/dl,]148.5±89.4152.5±90.6134.9±84.138.718<0.001
Scr[mg/dl,]0.7±0.20.7±0.20.7±0.332.982<0.001
HDL[mg/dl,]52.3±10.652.3±10.652.0±10.70.8550.355
LDL[mg/dl,]105.5±29.0107.5±29.398.8±26.590.586<0.001
TC[mg/dl,]189.9±36.2192.8±36.5180.1±33.4124.082<0.001
hs-CRP[mg/L, M(P25, P75)]1.4(0.7, 2.6)1.4(0.8, 2.6)1.1(0.6, 2.3)37.338<0.001
), ArticleFig(id=1324077632291209573, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=CN, label=表1, caption=

调查人群的基线特征

, figureFileSmall=null, figureFileBig=null, tableContent=
项目总例数(n=5 575)非贫血组(n=4 294)贫血组(n=1 281)统计量值P值
年龄[岁，]59.3±9.259.2±9.059.5±10.10.8940.344
受教育程度[n(%)]12.0760.002
小学以下1 059(19.0)773(18.0)286(22.3)
初中161(2.9)124(2.9)37(2.9)
高中或以上4 355(78.1)3 397(79.1)958(74.8)
婚姻[n(%)]0.3270.567
已婚/同居5 258(94.3)4 054(94.4)1 204(94.0)
其他317(5.7)240(5.6)77(6.0)
居住地[n(%)]30.804<0.001
城市668(12.0)571(13.3)97(7.6)
农村4 136(74.2)3 142(73.2)994(77.6)
其他771(13.8)581(13.5)190(14.8)
BMI[kg/m2,n(%)]75.555<0.001
<253 235(58.0)2 358(54.9)877(68.5)
25～<301 932(34.7)1 590(37.0)342(26.7)
≥30408(7.3)346(8.1)62(4.8)
吸烟[n(%)]0.0520.819
无5 496(98.6)4 234(98.6)1 262(98.5)
有79(1.4)60(1.4)19(1.5)
饮酒[n(%)]1.0190.313
无4 762(85.4)3 679(85.7)1 083(84.5)
有813(14.6)615(14.3)198(15.5)
夜间睡眠时长[h,]6.3±2.06.3±2.06.2±2.114.7370.338
心脏病[n(%)]0.918<0.001
无4 891(87.7)3 726(86.8)1 165(90.9)
有684(12.3)568(13.2)116(9.1)
血脂异常[n(%)]15.957<0.001
无4 981(89.3)3 802(88.5)1 179(92.0)
有594(10.7)492(11.5)102(8.0)
糖尿病或血糖升高[n(%)]12.6630.504
无5 222(93.7)4 017(93.5)1 205(94.1)
有353(6.3)277(6.5)76(5.9)
抑郁症[n(%)]0.446<0.001
无3 094(55.5)2 443(56.9)651(50.8)
有2 481(44.5)1 851(43.1)630(49.2)
WBC[×1 000,]5.8±1.75.9±1.75.4±1.889.106<0.001
Hct[%,]39.3±5.040.7±4.334.6±4.02 057.666<0.001
MCV[fl,]90.1±7.690.9±6.187.4±10.8227.504<0.001
TG[mg/dl,]148.5±89.4152.5±90.6134.9±84.138.718<0.001
Scr[mg/dl,]0.7±0.20.7±0.20.7±0.332.982<0.001
HDL[mg/dl,]52.3±10.652.3±10.652.0±10.70.8550.355
LDL[mg/dl,]105.5±29.0107.5±29.398.8±26.590.586<0.001
TC[mg/dl,]189.9±36.2192.8±36.5180.1±33.4124.082<0.001
hs-CRP[mg/L, M(P25, P75)]1.4(0.7, 2.6)1.4(0.8, 2.6)1.1(0.6, 2.3)37.338<0.001
), ArticleFig(id=1324077632379289958, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=EN, label=Table 2, caption=

Univariate logistic regression analysis

, figureFileSmall=null, figureFileBig=null, tableContent=
项目OR(95%CI)P值
年龄1.07(1.06～1.07)<0.001
教育程度（ref=小学或以下）
中学0.59(0.41～0.84)0.003
高中或以上0.90(0.79～1.03)0.13
婚姻（ref=已婚/同居）
其他0.64(0.50～0.81)<0.001
居住地（ref=城市）
农村0.93(0.79～1.10)0.378
其他1.08(0.88～1.33)0.461
BMI（ref=<25）
25～<302.10(1.87～2.36)<0.001
≥303.90(3.14～4.85)<0.001
吸烟（ref=无）
有1.00(0.64～1.57)0.995
饮酒（ref=无）
有0.69(0.59～0.81)<0.001
夜间睡眠时长0.96(0.93～0.98)0.001
心脏病（ref=无）
有2.79(2.36～3.29)<0.001
血脂异常（ref=无）
有3.13(2.62～3.75)<0.001
糖尿病或血糖升高（ref=无）
有3.37(2.67～4.26)<0.001
抑郁症（ref=无）
有1.07(0.96～1.19)0.2
WBC1.13(1.10～1.17)<0.001
Hct1.03(1.02～1.04)<0.001
MCV1.00(0.99～1.01)0.768
TG1.00(1.00～1.00)<0.001
Scr1.81(1.40～2.36)<0.001
HDL0.99(0.98～0.99)<0.001
LDL1.00(1.00～1.01)<0.001
TC1.01(1.00～1.01)<0.001
hs-CRP1.05(1.03～1.07)<0.001
), ArticleFig(id=1324077632479953255, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=CN, label=表2, caption=

单因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目OR(95%CI)P值
年龄1.07(1.06～1.07)<0.001
教育程度（ref=小学或以下）
中学0.59(0.41～0.84)0.003
高中或以上0.90(0.79～1.03)0.13
婚姻（ref=已婚/同居）
其他0.64(0.50～0.81)<0.001
居住地（ref=城市）
农村0.93(0.79～1.10)0.378
其他1.08(0.88～1.33)0.461
BMI（ref=<25）
25～<302.10(1.87～2.36)<0.001
≥303.90(3.14～4.85)<0.001
吸烟（ref=无）
有1.00(0.64～1.57)0.995
饮酒（ref=无）
有0.69(0.59～0.81)<0.001
夜间睡眠时长0.96(0.93～0.98)0.001
心脏病（ref=无）
有2.79(2.36～3.29)<0.001
血脂异常（ref=无）
有3.13(2.62～3.75)<0.001
糖尿病或血糖升高（ref=无）
有3.37(2.67～4.26)<0.001
抑郁症（ref=无）
有1.07(0.96～1.19)0.2
WBC1.13(1.10～1.17)<0.001
Hct1.03(1.02～1.04)<0.001
MCV1.00(0.99～1.01)0.768
TG1.00(1.00～1.00)<0.001
Scr1.81(1.40～2.36)<0.001
HDL0.99(0.98～0.99)<0.001
LDL1.00(1.00～1.01)<0.001
TC1.01(1.00～1.01)<0.001
hs-CRP1.05(1.03～1.07)<0.001
), ArticleFig(id=1324077632584810856, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=EN, label=Table 3A, caption=

Cross-sectional association between anemia and hypertension (2015)

, figureFileSmall=null, figureFileBig=null, tableContent=
类别模型1模型2模型3模型4
OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值
非贫血1.001.001.001.00
贫血0.65(0.57～0.74)<0.0010.68(0.59～0.79)<0.0010.70(0.61～0.81)<0.0010.75(0.63～0.88)0.001
), ArticleFig(id=1324077632677085545, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=CN, label=表3A, caption=

贫血与高血压的横断面关联（2015 年）

, figureFileSmall=null, figureFileBig=null, tableContent=
类别模型1模型2模型3模型4
OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值
非贫血1.001.001.001.00
贫血0.65(0.57～0.74)<0.0010.68(0.59～0.79)<0.0010.70(0.61～0.81)<0.0010.75(0.63～0.88)0.001
), ArticleFig(id=1324077632756777322, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=EN, label=Table 3B, caption=

Prospective association between anemia and hypertension (2015-2018)

, figureFileSmall=null, figureFileBig=null, tableContent=
类别模型1模型2模型3模型4
OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值
非贫血1.001.001.001.00
贫血0.58(0.43～0.79)<0.0010.59(0.43～0.80)0.0010.59(0.43～0.80)0.0010.50(0.35～0.71)<0.001
), ArticleFig(id=1324077632924549483, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=CN, label=表3B, caption=

贫血与高血压的前瞻性关联（2015—2018）

, figureFileSmall=null, figureFileBig=null, tableContent=
类别模型1模型2模型3模型4
OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值
非贫血1.001.001.001.00
贫血0.58(0.43～0.79)<0.0010.59(0.43～0.80)0.0010.59(0.43～0.80)0.0010.50(0.35～0.71)<0.001
), ArticleFig(id=1324077633012629868, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=EN, label=Table 4, caption=

Subgroup analysis of anemia and hypertension

, figureFileSmall=null, figureFileBig=null, tableContent=
亚组总数贫血n(%)OR(95%CI)P for interaction
年龄（岁）0.232
<6046830(6.4)0.60(0.37～0.98)
≥6031826(8.2)0.41(0.24～0.68)
婚姻0.438
已婚/同居73854(7.3)0.52(0.36～0.75)
其他482(4.2)0.15(0.03～0.94)
居住地0.871
城市542(3.7)0.28(0.05～1.62)
农村62246(7.4)0.49(0.33～0.72)
其他1108(7.3)0.59(0.22～1.59)
BMI（kg/m2）0.296
<2558435(6.0)0.50(0.32～0.79)
25～<3017816(9.0)0.38(0.20～0.73)
≥30245(20.8)1.13(0.26～4.84)
心脏病0.773
无73452(7.1)0.48(0.33～0.69)
有524(7.7)0.60(0.16～2.31)
血脂异常0.715
无75052(6.9)0.49(0.34～0.71)
有364(11.1)0.41(0.09～1.78)
糖尿病或血糖升高0.960
无76153(7.0)0.50(0.35～0.72)
有253(12.0)0.34(0.04～2.91)
), ArticleFig(id=1324077633088127341, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=CN, label=表4, caption=

贫血与高血压的亚组分析

, figureFileSmall=null, figureFileBig=null, tableContent=
亚组总数贫血n(%)OR(95%CI)P for interaction
年龄（岁）0.232
<6046830(6.4)0.60(0.37～0.98)
≥6031826(8.2)0.41(0.24～0.68)
婚姻0.438
已婚/同居73854(7.3)0.52(0.36～0.75)
其他482(4.2)0.15(0.03～0.94)
居住地0.871
城市542(3.7)0.28(0.05～1.62)
农村62246(7.4)0.49(0.33～0.72)
其他1108(7.3)0.59(0.22～1.59)
BMI（kg/m2）0.296
<2558435(6.0)0.50(0.32～0.79)
25～<3017816(9.0)0.38(0.20～0.73)
≥30245(20.8)1.13(0.26～4.84)
心脏病0.773
无73452(7.1)0.48(0.33～0.69)
有524(7.7)0.60(0.16～2.31)
血脂异常0.715
无75052(6.9)0.49(0.34～0.71)
有364(11.1)0.41(0.09～1.78)
糖尿病或血糖升高0.960
无76153(7.0)0.50(0.35～0.72)
有253(12.0)0.34(0.04～2.91)
), ArticleFig(id=1324077633188790638, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=EN, label=Table 5A, caption=

Cross-sectional association between anemia and hypertension (2015, multiple imputation validation)

, figureFileSmall=null, figureFileBig=null, tableContent=
类别模型1模型2模型3模型4
OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值
非贫血1.001.001.001.00
贫血0.67 (0.59～0.75)<0.0010.68 (0.59～0.77)<0.0010.69 (0.61～0.79)<0.0010.74 (0.63～0.86)<0.001
), ArticleFig(id=1324077633264288111, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=CN, label=表5A, caption=

贫血与高血压的横断面关联（2015 年，多重插补验证）

, figureFileSmall=null, figureFileBig=null, tableContent=
类别模型1模型2模型3模型4
OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值
非贫血1.001.001.001.00
贫血0.67 (0.59～0.75)<0.0010.68 (0.59～0.77)<0.0010.69 (0.61～0.79)<0.0010.74 (0.63～0.86)<0.001
), ArticleFig(id=1324077633323008368, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=EN, label=Table 5B, caption=

Prospective association between anemia and hypertension (2015—2018,multiple imputation validation)

, figureFileSmall=null, figureFileBig=null, tableContent=
类别模型1模型2模型3模型4
OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值
非贫血1.001.001.001.00
贫血0.56 (0.43～0.75)<0.0010.56 (0.42～0.75)<0.0010.56 (0.42～0.75)<0.0010.47 (0.34～0.66)<0.001
), ArticleFig(id=1324077633427865969, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077618819105066, language=CN, label=表5B, caption=

贫血与高血压的前瞻性关联（2015—2018，多重插补验证）

, figureFileSmall=null, figureFileBig=null, tableContent=
类别模型1模型2模型3模型4
OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值
非贫血1.001.001.001.00
贫血0.56 (0.43～0.75)<0.0010.56 (0.42～0.75)<0.0010.56 (0.42～0.75)<0.0010.47 (0.34～0.66)<0.001
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中国中老年女性贫血与高血压的关联研究
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王雪 , 赵城林
现代预防医学 | 流行病与统计方法 2026,53(6): 997-1003
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现代预防医学 |流行病与统计方法 2026 , 53 (6) : 997 -1003
中国中老年女性贫血与高血压的关联研究
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王雪 , 赵城林
作者信息
  • 宜宾市第二人民医院产前诊断科，四川 宜宾 644400
通讯作者:
王雪，E-mail:
作者简介:

王雪（1996—），女，硕士，初级医师，研究方向：妇产科

Association between anemia and hypertension in middle-aged and elderly women, China
Xue WANG , Cheng-lin ZHAO
Affiliations
  • The Prenatal Diagnosis Department, the Second People’s Hospital of Yibin, Yibin, Sichuan 644400, China
出版时间: 2026-03-25 doi: 10.20043/j.cnki.MPM.202510015
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摘要
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目的

探讨中国中老年女性贫血与高血压的关联。

方法

收集中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）项目中2015年5 575名≥45 岁女性的基线数据，以2018年贫血为结局。采用多因素logistic回归模型分析贫血与高血压横断面及队列之间的关系，采用限制性立方样条（Restricted Cubic Splines, RCS）分析中老年女性人群血红蛋白与高血压发病风险的剂量-反应关系。

结果

贫血与高血压呈负相关，横断面分析（2015年）显示，贫血者的高血压患病风险降低 25%～35%（模型 1：OR=0.65，95% CI：0.57～0.74；模型 4：OR=0.75，95% CI：0.63～0.88；均 P<0.01）。前瞻性队列分析（2015—2018年）表明，基线贫血使 3 年后高血压发病风险下降 42%～50%（模型 1：OR=0.58，95% CI：0.43～0.79；模型 4：OR=0.50，95% CI：0.35～0.71；P<0.001）。RCS分析结果显示血红蛋白和高血压发病风险呈线性相关。亚组分析发现体重指数影响关联强度，各亚组之间未发现交互效应（交互检验均P>0.05）。敏感性分析结果稳健。

结论

中国中老年女性人群中贫血与高血压患病及新发风险呈负相关。

贫血  /  高血压  /  女性  /  CHARLS数据库
Objective

To examine the association between anemia and hypertension among middle-aged and older Chinese women.

Methods

Baseline data of 5 575 women aged ≥45 years from the 2015 China Health and Retirement Longitudinal Study (CHARLS) were collected, with anemia in 2018 as the outcome. Multivariable logistic regression was used to assess cross-sectional and longitudinal relationships between anemia and hypertension. Restricted Cubic Splines (RCS) were used to analyze the dose-response relationship between hemoglobin and the risk of hypertension in middle-aged and elderly women.

Results

Anemia was inversely associated with hypertension. In 2015, anemic women had a 25-35% lower prevalence of hypertension (Model 1: OR=0.65, 95% CI: 0.57-0.74; Model 4: OR=0.75, 95% CI: 0.63-0.88; both P<0.01). Over 2015—2018, baseline anemia reduced 3-year hypertension incidence by 42-50% (Model 1: OR=0.58, 95% CI: 0.43-0.79; Model 4: OR=0.50, 95% CI: 0.35-0.71; P<0.001). RCS showed a linear inverse relationship between hemoglobin level and hypertension risk. BMI influenced the strength of association, but no interaction was detected (all P > 0.05). Sensitivity analyses confirmed robustness.

Conclusion

Anemia is associated with lower prevalence and incidence of hypertension in middle-aged and older Chinese women.

Anemia  /  Hypertension  /  Women  /  CHARLS database
王雪, 赵城林. 中国中老年女性贫血与高血压的关联研究. 现代预防医学, 2026 , 53 (6) : 997 -1003 . DOI: 10.20043/j.cnki.MPM.202510015
Xue WANG, Cheng-lin ZHAO. Association between anemia and hypertension in middle-aged and elderly women, China[J]. Modern Preventive Medicine, 2026 , 53 (6) : 997 -1003 . DOI: 10.20043/j.cnki.MPM.202510015
正文
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高血压是指以体循环动脉血压持续升高为特征的心血管综合征，是中国居民死亡重要原因[1]。一项全国性调查研究发现，在2012年至2015年期间，有大约 2.445亿≥18岁的中国人患有高血压，高血压的知晓率和控制率也低于发达国家[2]。“中国居民心血管病及其危险因素监测”项目于 2020至2022 年在多个省市及自治区监测也发现高血压患病率整体呈上升趋势[3]。长期血压升高，特别是难治性的高血压可直接导致卒中、冠心病、心衰和慢性肾病，治疗的高昂费用、伴随的残疾及早期死亡都给社会带来巨大的卫生经济负担[4]。
贫血是指人类外周血红细胞容量或血红蛋白浓度低于正常，常见表现包括虚弱、疲劳、注意力不集中以及工作和日常生活受限，其原因复杂[5]。尽管贫血与高血压为两个独立系统疾病，但越来越多国外的证据提示贫血与较低的高血压风险相关，例如尼泊尔的一项健康调查数据观察到在15～49岁女性中高血压与贫血呈负相关[6]；苏丹北部的一项基于社区的横断面研究也发现苏丹成年人中贫血与高血压负相关[7]；第五次韩国国家健康与营养检查调查（KNHANES V；2010—2012）发现贫血与高脉压呈正相关，但与高血压无关[8]。然而，以上这些结果能否推广至中国人群值得进一步探讨。本研究利用具有全国代表性的中国健康与养老追踪调查(China Health and Retirement Longitudinal Study, CHARLS)数据库，开展中老年女性人群贫血与高血压的关联研究，为制定针对中老年女性人群贫血筛查与高血压早期干预策略提供依据。
1　材料与方法
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1.1　研究对象
本研究采用CHARLS研究数据[9]。以 2015 年为基线数据，2018 年为随访数据。将贫血作为暴露因素，高血压作为结局指标。纳入标准为：女性、基线年龄≥45岁、具有完整基线血红蛋白（Hemoglobin,HGB）检测数据，以及有效的基线血压测量值、医师诊断高血压和高血压用药记录。基线已患高血压者被排除在高血压发病的纵向分析之外（见图1）。本研究符合赫尔辛基宣言，所有参与者在参与前签署书面知情同意书,由北京大学生物医学伦理审查委员会批准(IRB00001052-11015)。
1.2　暴露因素评估
采用世界卫生组织标准定义贫血：非妊娠女性HGB<12.0 g/dl[10]。
1.3　结局因素评估
高血压定义为满足以下任一标准：(1)平均收缩压≥140 mm Hg，(2)平均舒张压≥90 mm Hg，(3)自我报告医生诊断高血压或(4)当前使用降压药物[11]。血压测量采用欧姆龙HEM-7200血压计，放松并保持安静状态下测量三次，取三次读数平均值。
1.4　协变量评估
基于临床意义和既有文献预先确定的潜在混杂因素和效应修饰因素均在基线评估[12-13]。社会人口学因素：年龄（岁）、教育程度（小学或以下、初中、高中或以上）、婚姻状态（已婚/同居、其他）、居住地（城市、农村、其他）；人体测量因素与生活方式：体重指数（kg/m2）=体重（kg）/身高（m2），体重指数（Body mass index,BMI）分类：<25, 25～<30, ≥30、吸烟（无、有）、饮酒（无、有）、夜间睡眠时长（h）；健康状况与合并症：自我报告的医生确诊疾病史，包括心脏病（无、有）、血脂异常（无、有）、糖尿病或血糖升高（无、有）。抑郁症状（无、有）；血液指标：白细胞 (White Blood Cell, WBC, ×1 000)、红细胞压积 (Hematocrit, Hct, %) 、平均红细胞体积 (Mean Corpuscular Volume, MCV, fl)、甘油三酯 (Triglycerides, TG, mg/dl)、肌酐 (Creatinine, Scr, mg/dl)、高密度脂蛋白胆固醇 (High Density Lipoprotein Cholesterol, HDL, mg/dl)、低密度脂蛋白胆固醇 (Low Density Lipoprotein Cholesterol, LDL, mg/dl)、总胆固醇 (Total Cholesterol, TC, mg/dl)、血清高敏C反应蛋白 (High-sensitivity C-reactive protein, hs-CRP, mg/L)。
1.5　统计方法
对于正态分布的连续变量，用均值±标准差（）描述，组间比较采用单因素方差分析；对于偏态分布的连续变量，则用中位数及四分位数M（P25，P75）描述，组间比较采用Kruskal-Wallis H检验。分类变量以绝对值（%）表示，组间差异比较采用χ2检验。多因素logistic回归模型估计基线贫血与高血压患病的比值比（Odds Ratio, OR）及其置信区间（Confidence Interval, CI）。变量纳入遵循“临床需要+单因素P<0.05且效应变化>10%”原则；共线性判定采用GVIF^(1/2Df)≥2为界，TG、LDL、TC因达阈值被排除。最终建立4个模型：模型1未调整；模型2纳入人口学+生活方式（年龄、婚姻、居住地、BMI、吸烟、饮酒、夜间睡眠时长）；模型3进一步纳入合并症（心脏病、血脂异常、糖尿病或血糖升高）；模型4再纳入血液指标（WBC、Hct、Scr、HDL、hs-CRP）。血红蛋白浓度与高血压风险之间潜在的非线性剂量-反应关系采用限制性立方样条（Restricted Cubic Splines, RCS）。亚组分析按年龄(<60岁，≥60岁)、婚姻、居住地、BMI、吸烟、饮酒及合并症分层。缺失值<10%直接删除；敏感性分析采用MICE多重插补并计算E值评估未测量混杂[14]。
所有统计分析均使用R统计软件(http://www.Rproject.org; The R Foundation, Vienna, Austria)和风锐统计软件 (version 2.1.1; Beijing FreeClinical Medical Technology Co., Ltd, Beijing, China)。检验水准α=0.05。
2　结果
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2.1　调查对象基线特征
本研究共纳入5 575例受试者，平均年龄59.3岁。与非贫血组(n=4 294)相比，贫血组(n=1 281)受教育程度(74.8% vs 79.1%，P=0.002)、城市居住比例(7.6% vs 13.3%，P<0.001)、体重指数 (4.8% vs 8.1%，P<0.001)，心脏病比例(9.1% vs 13.2%)和血脂异常比例(8.0% vs 11.5%)、WBC、Hct、MCV、TG、Scr、LDL、TC及hs-CRP水平更低(均P<0.001)，而抑郁症状检出率高(49.2% vs 43.1%，P<0.001)。见表1。
2.2　贫血与高血压的单因素logistic回归分析（横断面）
单因素logistic回归分析显示，年龄、婚姻、BMI、饮酒、夜间睡眠时长、心脏病、血脂异常、糖尿病或血糖升高、WBC、Hct、TG、Scr、HDL、LDL、TC及hs-CRP均与高血压显著相关（P值均<0.05）。其余变量无统计学意义。见表2。
2.3　贫血与高血压的多因素logistic回归分析
2.3.1　横断面分析（2015年）
仅使用 2015 年基线数据，比较贫血与非贫血者高血压患病差异。与非贫血者相比，贫血者的高血压患病风险降低 25%～35%（模型 1：OR=0.65，95% CI：0.57～0.74；模型 4：OR=0.75，95% CI：0.63～0.88；均 P<0.01）。见表3A。
2.3.2　前瞻性队列分析（2015—2018年）
排除2015 年已患高血压个体并随访 3 年，基线贫血使新发高血压发病风险下降 42%～50%（模型 1：OR=0.58，95% CI：0.43～0.79；模型 4：OR=0.50，95% CI：0.35～0.71；均P<0.001），效应强于横断面且方向一致，提示中老年女性贫血与高血压呈稳定负向关联。
2.4　血红蛋白与高血压发病风险的剂量-反应关系
采用限制性立方样条模型评估中老年女性基线血红蛋白浓度和 3 年后高血压发病风险之间的剂量-反应关系。结果显示，血红蛋白浓度与高血压风险之间存在整体统计学关联（P for overall=0.023）。然而，非线性检验未达到统计学显著性（P for non-linearity=0.183），提示两者之间呈线性递增趋势（见图2）。
2.5　亚组分析及交互作用检验
将年龄(<60岁，≥60岁)、婚姻、居住地、BMI及合并症进行亚组分析,交互检验均P>0.05。各亚组方向一致：年龄<60岁（OR=0.60，95% CI：0.37～0.98）与≥60岁（OR=0.41，95% CI：0.24～0.68）、已婚/同居（OR=0.52，95% CI：0.36～0.75）与其他婚姻状态（OR=0.15，95% CI：0.03～0.94）均呈负相关；农村、BMI<25 kg/m2及25～<30kg/m2、无合并症女性关联有统计学意义，其余亚组OR的95% CI包含1。见表4。
2.6　敏感性分析
为检验缺失协变量及潜在未测量混杂的影响，首先采用多重插补（5 套数据集）并校正社会人口学特征、生活方式、合并疾病及血液指标后，贫血与高血压的负向关联保持稳定：横断面（2015 年）多因素 logistic 回归显示高血压患病风险降低 26%～33%（表5A）；前瞻性队列（2015—2018 年）显示基线贫血使 3 年后高血压发病风险下降 44%～53%（表5B）。其次，通过计算表5A及表5B模型4的效应值估计的E值：横断面分析 E=2.00，前瞻性队列分析 E=3.41，即需存在与“贫血”及“高血压”均至少 2～3 倍风险相关的混杂因素才能完全解释本研究结果（图3）。
3　讨论
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本研究基于中国健康与养老追踪调查（CHARLS）数据库，通过横断面分析及前瞻性队列设计，系统探讨了中国≥45岁中老年女性人群中贫血与高血压的关联。多因素logistic回归分析结果显示，横断面分析中贫血女性高血压患病的风险降低（OR=0.75，95% CI：0.63～0.88）。前瞻性队列分析进一步证实，基线贫血状态降低高血压的新发风险（OR=0.50，95% CI：0.35～0.71）。这一发现为理解贫血与高血压的复杂关系提供了新的中国人群证据。
亚组分析及交互作用检验发现BMI影响贫血与高血压的关联方向与强度。BMI<25 kg/m2及25～<30 kg/m2者，贫血者高血压风险低于非贫血者（OR=0.38～0.50）；而BMI≥30 kg/m2者，贫血与高血压呈正相关（OR=1.13，95% CI 0.26～4.84），虽因例数少未达统计学显著水平，交互检验P=0.296，但效应逆转。结合既往文献报告肥胖状态下慢性炎症、胰岛素抵抗及铁代谢紊乱可能削弱贫血对低灌注的“保护”信号从而升高血压[15]。提示BMI是潜在效应修饰因子。未来需扩大肥胖人群样本，验证BMI对贫血与高血压关联的影响。
贫血-高血压关系机制尚未统一。现有研究呈“升压-降压”双向假说。其一是血红蛋白携氧能力下降，组织缺氧刺激肾素-血管紧张素-醛固酮系统（RAAS）并增强交感神经输出，潜在驱动血压升高[16-18]；其二是血红蛋白浓度降低削弱对NO的清除，导致血管舒张因子NO生物利用度相对增加[19-20]，同时高动力循环状态使心输出量代偿性增加、外周阻力下降，总体效应趋于降压[21]。此外，贫血常与营养不良、慢性消耗性疾病、恶性肿瘤或心力衰竭并存，这些合并状态及其治疗策略（如更严格的血压控制、药物副作用）亦可导致血压偏低[22]。新近研究进一步拓宽了贫血-降压的潜在通路，短链脂肪酸减少可能抑制铁吸收并加重贫血，进而通过NO血管舒张通路协同降压[23]。同时，红细胞比容下降引起的血液黏度降低，可能减弱血管内皮剪切力，促使血管舒张因子释放增加，从而进一步降低血压[24]。
由于中老年女性经历绝经过渡期及绝经期，雌激素水平骤降影响血管功能（如内皮功能障碍风险升高），其贫血与高血压关联可能显著区别于男性或年轻女性[25-26]。然而，针对该人群的前瞻性研究稀缺。本研究采用CHARLS数据库，因其全国代表性、大样本量、丰富的中老年健康信息及前瞻性设计，对聚焦中国中老年女性这一关键人群提供了独特平台。但同样存在以下局限性：其一，研究所依托的 CHARLS 数据库未收录贫血的详细分型信息及血清铁、铁蛋白等关键铁代谢指标，致使无法深入剖析不同病因贫血与高血压关联的潜在异质性，也难以进一步阐释不同类型贫血影响血压的特异性作用机制；其二，尽管研究已纳入人口学特征、生活方式、基础疾病等多类已知混杂因素，并采用 E 值评估法量化了未测量混杂因素对研究结果的干扰程度，但受限于队列研究的观察性本质，仍无法完全排除遗传背景、未被捕捉的环境暴露等残余混杂因素对关联结果的潜在影响；其三，研究对象仅覆盖中国≥45岁中老年女性，缺乏男性及其他种族人群数据，结果向外推及至全球不同人群仍受限；其四，高血压相关数据依赖研究对象的自我报告，存在一定的回忆偏差，可能导致高血压患病情况的误判，进而对贫血与高血压的关联分析结果产生干扰；其五，本研究虽采用前瞻性队列设计，在一定程度上降低了反向因果关联的干扰，但所得结果仍仅能证实贫血与高血压之间存在统计学关联，尚不足以确立二者明确的因果关系。未来研究需进一步整合贫血分型、铁代谢指标等精细化数据，采用客观的高血压诊断标准以减少回忆偏差，并结合孟德尔随机化等因果推断方法，为明确二者的关联模式及内在作用机制提供更可靠的证据支持。
在这项全国代表性样本中发现，中老年女性贫血者高血压风险下降 25%～50%，且 BMI<30 kg/m2时该关联效应稳定，BMI≥30 kg/m2时效应消失。这一结果或可为中老年女性高血压的精准防控提供实践参考，其公共卫生价值主要体现在三方面：其一，考虑到贫血与高血压的密切关联，将血红蛋白检测纳入≥45岁女性常规高血压筛查项目，实现一次采血完成双重评估，可能有助于避免单一关注血压而遗漏贫血状态，为综合干预提供更全面的依据；其二，基于贫血与高血压的负相关证据，对于贫血且血压处于 130～139/80～89 mm Hg的轻中度升高人群，适度放缓降压强度、优先纠正贫血，或许能减少低血压及跌倒事件的发生风险，这一策略有待更大样本量的干预性研究进一步验证；其三，针对BMI≥30 kg/m2的肥胖女性，鉴于其贫血与高血压的负向关联消失，在补铁或纠正贫血的同时强化减重干预，可能有助于避免盲目补铁带来的高血压风险掩盖问题，提升干预措施的精准性。此外，该负相关为探索贫血与高血压的共同调控通路提供了可检验假设，未来需结合贫血分型、铁代谢指标等精细化数据，进一步夯实精准防控的证据基础。
综上，本研究基于具有全国代表性的CHARLS数据，通过横断面与前瞻性队列研究相结合，在中国中老年女性人群中系统揭示贫血与高血压患病及新发风险呈负相关。提示在未来评估中老年女性高血压风险时，需将贫血状态作为一个独特的考量因素。

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2026年第53卷第6期
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doi: 10.20043/j.cnki.MPM.202510015
  • 接收时间：2025-10-05
  • 首发时间：2026-11-02
  • 出版时间：2026-03-25
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    宜宾市第二人民医院产前诊断科，四川 宜宾 644400

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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