Prevalence of prehypertension and hypertension in a Korean population: Korean National Health and Nutrition Survey 2001

Expert recommendations on the challenges of hypertension in Asia

A consensus meeting of leading Asian hypertension experts was held in January 2007 in Seoul, Korea, to discuss how to address the growing challenge of hypertension management in the region. This report summarises key recommendations from the group, including: raising public awareness about the impact of hypertension; improving physician education and training; increasing early detection, for example through routine blood pressure measurement; and development and adoption of pan-Asian treatment guidelines, which would greatly facilitate research into hypertension and its management. The group conclude that these challenges can only be met through a collaborative effort of government, healthcare professionals, food and healthcare industries, and patients and the public. Food and healthcare industries need to develop healthy foods and support healthy living programmes, while increasing research into antihypertensive medications in Asia. Government officials and policy makers need to be made aware of the value of investing in hypertension awareness, prevention and management programmes.

Prevalence of prehypertension and its relationship to risk factors for cardiovascular disease in Jamaica: analysis from a cross-sectional survey

BACKGROUND

Recent studies have documented an increased risk of cardiovascular disease (CVD) in persons with systolic blood pressures of 120-139 mmHg and/or diastolic blood pressures of 80-89 mmHg, classified as prehypertension in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. In this paper we estimate the prevalence of prehypertension in Jamaica and evaluate the relationship between prehypertension and other risk factors for CVD.

METHODS

The study used data from participants in the Jamaica Lifestyle Survey conducted from 2000-2001. A sample of 2012 persons, 15-74 years old, completed an interviewer administered questionnaire and had anthropometric and blood pressure measurements performed by trained observers using standardized procedures. Fasting glucose and total cholesterol were measured using a capillary blood sample. Analysis yielded crude, and sex-specific prevalence estimates for prehypertension and other CVD risk factors. Odds ratios for associations of prehypertension with CVD risk factors were obtained using logistic regression.

RESULTS

The prevalence of prehypertension among Jamaicans was 30% (95% confidence interval [CI] 27%-33%). Prehypertension was more common in males, 35% (CI 31%-39%), than females, 25% (CI 22%-28%). Almost 46% of participants were overweight; 19.7% were obese; 14.6% had hypercholesterolemia; 7.2% had diabetes mellitus and 17.8% smoked cigarettes. With the exception of cigarette smoking and low physical activity, all the CVD risk factors had significantly higher prevalence in the prehypertensive and hypertensive groups (p for trend < 0.001) compared to the normotensive group. Odds of obesity, overweight, high cholesterol and increased waist circumference were significantly higher among younger prehypertensive participants (15-44 years-old) when compared to normotensive young participants, but not among those 45-74 years-old. Among men, being prehypertensive increased the odds of having > or =3 CVD risk factors versus no risk factors almost three-fold (odds ratio [OR] 2.8 [CI 1.1-7.2]) while among women the odds of > or =3 CVD risk factors was increased two-fold (OR 2.0 [CI 1.3-3.8])

CONCLUSION

Prehypertension occurs in 30% of Jamaicans and is associated with increased prevalence of other CVD risk factors. Health-care providers should recognize the increased CVD risk of prehypertension and should seek to identify and treat modifiable risk factors in these persons.

Current status and characteristics of hypertension treatment by primary physicians in Korea: data from Korean epidemiology study on hypertension (KEY study)

BACKGROUND

This study was designed to investigate the characteristics, control rate, and factors affecting BP control in hypertensive patients treated by primary physicians in Korea.

METHODS

The study was a multicenter, nationwide, cross-sectional, population-based survey conducted to identify the current status of hypertension treatment in Korean patients. A direct mail survey was sent to a random sample of 800 primary-care clinics across the nation. A total of 529 physicians in 510 clinics agreed to participate in this study (63.8%). Among the recruited 13,452 patients, 13,184 were included in the analysis.

RESULTS

BP was controlled in 6,723 patients (51.0%). However, the control rate was lower in patients with diabetes (21.6%) or chronic kidney disease (CKD) (19.9%). Furthermore, the mean systolic and diastolic BP levels were higher in patients with diabetes and/or CKD. The mean BP level was higher in patients undergoing combination therapy than those undergoing single-drug therapy. Male gender, cardiovascular comorbidities, long duration of hypertension, and unhealthy lifestyle were associated with poor control of hypertension. In multivariate analysis, diabetes (odds ratio: 5.57; 95% confidence interval: 5.05-6.13) and CKD (odds ratio: 3.40; 95% confidence interval: 2.54-4.54) were the most significant independent factors related to poor BP control.

CONCLUSION

BP control is still largely unsatisfactory, especially in patients with diabetes and kidney disease, who could benefit the most from effective BP control. The reasons for poor BP control and high BP levels in those patients need to be investigated to improve BP control in Korea.

Metabolic syndrome and target organ damage: role of blood pressure

A growing body of evidence indicates that the clustering of metabolic and hemodynamic abnormalities characterizing the metabolic syndrome is associated with a prevalence of subclinical damage in a variety of organs, such as left ventricular hypertrophy, thickening or atherosclerotic plaques of carotid arteries, microalbuminuria and deranged renal function. This is clinically relevant since these markers of target organ damage are associated with an increased risk of cardiovascular fatal and nonfatal events. The contribution of the metabolic syndrome to target organ damage in hypertensives is presumably responsible for a substantial increase in cardiovascular fatal and nonfatal events. Thus, target organ damage should be routinely searched for in hypertensives with metabolic syndrome in order to define initial therapeutic strategies and to monitor treatment-induced protection.

The accelerating epidemic of hypertension among rural Chinese women: results from Liaoning Province

BACKGROUND

The objective of the study was to assess prevalence, awareness, treatment, and control of hypertension and its risk factors in rural women in Liaoning Province in northeast China.

METHODS

We conducted a cross-sectional analysis of 23,178 women of minimum age 35 years, living in rural Liaoning province in northeast China. We measured their blood pressure (BP) and investigated associated factors. Hypertension was defined as an average systolic BP > or =140 mm Hg, and/or an average diastolic BP > or =90 mm Hg, and/or self-report of current treatment for hypertension with antihypertensive medication.

RESULTS

The overall prevalence of hypertension in this study was 38.6%. Among those with hypertension, 32.8% were aware that they had high BP, 27.4% were being treated with antihypertensive medications, and in 1.4% of the women the hypertension was controlled. Multivariate analysis revealed that higher age, Mongolian ethnicity, higher body mass index (BMI), higher waist circumference (WC), excessive salt intake, smoking, alcohol consumption, lipid disorder, diabetes, and family history of hypertension were associated with the prevalence of hypertension; a higher level of education (high school or beyond) and a higher income level were inversely related to hypertension prevalence.

CONCLUSIONS

Our results indicate that hypertension is highly prevalent in rural women in Liaoning province and it is associated with known risk factors. There are unacceptably low percentages of those with hypertension who are aware of their condition, are receiving treatment, and in whom hypertension is controlled. Our study suggests the urgent need for a public health program to improve the prevention, detection, and treatment of hypertension in rural Chinese women.

Prevalence, awareness, treatment, and risk factors associated with hypertension in the Iranian population: the national survey of risk factors for noncommunicable diseases of Iran

BACKGROUND

The prevalence of hypertension in the Middle East is not well defined. We examined the prevalence, awareness, treatment, and control of hypertension in Iran.

METHODS

The Survey of Risk Factors of Noncommunicable Diseases was conducted in 2005 and contains a representative sample of the Iranian adult population. Of 70,981 participants, the data of 68,250 adults aged 25-64 years who had two valid blood pressure (BP) readings were analyzed to estimate the total prevalence of hypertension (systolic BP >or= 140 mm Hg, diastolic BP >or= 90 mm Hg, or the concurrent use of antihypertensive agents) in the Iranian adult population.

RESULTS

Approximately 25% or 6.6 million Iranians aged 25-64 years had hypertension; additionally 46% or 12 million Iranians aged 25-64 years had prehypertension. Among hypertensive patients, 34% were aware of their elevated BP; 25% were taking antihypertensive medications; and of these treated subjects, only 24% had BP values <140/90 mm Hg. Hypertension and prehypertension were associated with age, male gender, obesity, central obesity, hypercholesterolemia, and diabetes.

CONCLUSIONS

The prevalence of hypertension and prehypertension is high, and the rates of awareness, treatment, and control are unacceptably low. These results underscore the urgent need to develop national strategies to improve prevention, detection, and treatment of hypertension in Iran.

Nationwide survey of prevalence and risk factors of prehypertension and hypertension in Iranian adults

OBJECTIVE

The aim of this study was to estimate the prevalence and risk factors of prehypertension (Pre-HTN) and hypertension (HTN) among the adult population of Iran.

METHODS

A nationwide cross-sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran. Blood pressure (BP) and associated risk factors of 35 048 men and 34 674 women aged 25-65 years (mean 44.1 years) were measured.

RESULTS

The prevalence of Pre-HTN was 59.6% in men and 44.5% in women; and 19.8% of men and 26.9% of women were hypertensive, according to Joint National Committee 7 criteria. Pre-HTN was more common among men whereas HTN was more common among women. Multivariate analysis revealed that age, overweight, obesity, abdominal obesity and high cholesterol were strongly associated with Pre-HTN in both genders. In women, low educational attainment, residence in an urban area and high blood glucose were also associated with Pre-HTN. Age, low educational attainment, overweight, obesity, abdominal obesity and high cholesterol and blood glucose were strongly associated with HTN in both genders.

CONCLUSION

Pre-HTN and HTN appear to be quiet common in Iran and were associated with obesity. More men than women present with Pre-HTN, whereas more women than men present with HTN. Prevention and treatment strategies are urgently needed to address the health burden of Pre-HTN and HTN and to prevent prehypertensive people from developing HTN and cardiovascular disease.

Prevalence and management of prehypertension and hypertension by geographic regions of Thailand: the Third National Health Examination Survey, 2004

OBJECTIVE

To determine the prevalence of prehypertension and hypertension, and management of hypertension, by geographic regions of Thailand.

METHODS

Using a stratified, multistage sampling design, data from a nationally representative sample of 39 290 individuals aged > or = 15 years were collected by interview, physical examination and blood sample.

RESULTS

The prevalence of hypertension and prehypertension weighted to the national 2004 population was 22.0% [95% confidence interval (CI) = 20.5-23.6] and 32.8% (95% CI = 31.5-34.1), respectively, with a higher prevalence in men compared to women. Hypertension was more common in urban compared to rural men, but similar between urban and rural women. Despite some variation, the prevalence of hypertension and prehypertension was relatively uniform across geographical regions. Of those identified as having hypertension in the survey, 69.8% (95% CI = 67.8-71.7) were unaware that they had hypertension. Although the majority of those who were aware (78.2%; 95% CI = 75.8-80.5) had taken blood pressure-lowering drugs in the last 2 weeks, of these only 36.6% (95% CI = 33.3-40.0) had blood pressure < 140/90 mmHg. Rural populations and those from the economically poorer Northeast region were more likely to be unaware that they had hypertension.

CONCLUSION

Compared to previous surveys, the prevalence of hypertension and prehypertension is rising rapidly, and is spread relatively evenly across regions of Thailand. Levels of awareness of hypertension were low across the country. A challenging task remains in improving screening, treatment and control of hypertension at the same time as promoting healthier lifestyles.

Current status and characteristics of hypertension control in community resident elderly Korean people: data from a Korean longitudinal study on health and aging (KLoSHa study)

Hypertension is a common disease that greatly impacts the health of the elderly. However, the status of blood pressure (BP) control in the elderly Korean population has not yet been investigated. Subjects aged 65 years or older living in Seongnam city, a suburb of Seoul, Korea, were included in this study. All subjects were evaluated by a physician, and medication was reviewed by a nurse. Seated BPs were measured by a trained nurse using standard methods. A total of 995 subjects were included in the current analysis (mean age: 76.3+/-8.7 years). The prevalence of hypertension was 68.7% in the study population, and this value increased with age, peaked in the 75-84 age group, and decreased thereafter. Only 66.1% of hypertensive patients had taken any antihypertensive medication, among which calcium channel blockers (64.2%) were most commonly used. Among the patients on antihypertensive medication, 46% were on combination drug therapy. BP was controlled in 38.5% of hypertensive patients, with systolic BP less controlled than diastolic BP, especially in the oldest-old population. The BP control rate was lower in high-risk patients of diabetes and renal disease. In conclusion, in community resident elderly populations, the BP control rate remains unsatisfactory, especially in high-risk patients. The benefit and optimal level of BP control in oldest-old population must be investigated because a lot of elderly hypertensive patients are currently being managed without definite evidence of related benefits.

Prevalence, awareness, treatment, and control of hypertension in rural adults from Liaoning Province, northeast China

Liaoning Province is located in northeast China, which has distinct weather conditions, geographic characteristics and lifestyles compared with other regions of the country; the lifestyle differences are especially pronounced in the rural parts of this region, where there is a dearth of financial and other resources. However, information on the prevalence, awareness, treatment, and control of hypertension in these impoverished areas is very scarce. We therefore performed multistage cluster random sampling of a group of 29,970 adult residents (>or=5 years of residency; >or=35 years of age) of the rural portions of Liaoning Province from 2005 to 2006. The sampling included a survey on blood pressure and associated risk factors. The overall prevalence of hypertension in the community was 36.2%, and 73.0% of hypertensives were unaware of their condition. Among the total group of hypertensives, only 19.8% were taking prescribed medication to lower their BP, and 0.9% had controlled hypertension. Of all subjects, 46.4% did not think that high blood pressure would endanger their lives. As to the reasons given by hypertensives who were aware of their hypertension for not taking antihypertensive medication, 47.4% reported that they lacked knowledge about the mortality of hypertension. The average salt intake in hypertensives was 16.6+/-9.9 g/day, and the percentages of smoking (44.3%), drinking (31.7%) and salt intake>6 g/day (86.8%) in hypertensives were high. Logistic regression analysis indicated that the relative risks (95% confidence interval [CI]) of overweight, obesity, smoking, drinking, increased salt intake and family history of hypertension for hypertension were 1.95 (range, 1.82-2.08), 2.92 (2.40-3.55), 1.19 (1.12-1.27), 1.16 (1.08-1.25), 1.26 (1.20-1.33) and 2.85 (2.66-3.05), respectively. A higher education level was found to be a protective factor. In conclusion, the prevalence of hypertension in adults living in the rural parts of Liaoning Province was high, and the rates of awareness, treatment, and control were unacceptably low, which may have been due to unique geographical characteristics, unwholesome lifestyles, greater sodium intake, lower education levels, and genetic risk factors.

Body mass index and the prevalence of prehypertension and hypertension in a Chinese rural population

BACKGROUND

To evaluate the status of overweight and obesity in a Chinese rural adult population and describe relationships between body mass index (BMI) and blood pressure according to JNC-7.

METHODS

The study was conducted in 2004-2006, used a multistage cluster sampling method to select a representative sample. A total of 45,925 adults, age 35 years or older, were examined. Height, weight and blood pressure were obtained by trained doctors. Overweight and obesity were defined according to the World Health Organization classification and Chinese definition.

RESULTS

The prevalence of overweight and obesity were 16.3% and 1.3% in males, and 24.4% and 2.7% in females (p for gender differences <0.05) according to the World Health Organization classification; The prevalence of overweight and obesity were 29.5% and 5.3% according to the Chinese definition.The prevalence of elevated blood pressure (prehypertension and hypertension) and mean levels of systolic and diastolic blood pressure increased as BMI increased. Multivariate logistic regression revealed that overweight and obesity were risk factors for prehypertension and hypertension whether in males or females.

CONCLUSIONS

Overweight and obesity has become very prevalent in the Chinese rural adult population. It is a great health problem. Our study quantifies the strong associations of BMI and elevated blood pressure. It is time to pay more attention to overweight and obese in the county of China.

Prehypertension

Prehypertension--blood pressure between 120-139/80-89 mmHg--is a major public health concern. The condition is very prevalent (especially in obese young people), is often associated with other cardiovascular risk factors and independently increases the risk of hypertension and subsequent cardiovascular events. In the general population, prehypertension can be lowered, but not often reliably, by lifestyle modifications. Drug therapy for prehypertension is not yet recommended, except for individuals with diabetes, chronic kidney disease, and perhaps known coronary artery disease, because of short-term cost considerations and unproven long-term benefits. Ongoing research will probably identify which individuals with blood pressures in the prehypertensive range, but with no serious comorbidities, would benefit from treatment. In this Review, we attempt to summarize the recently published data concerning the epidemiology, attendant risks and potential treatment options for this important and growing public-health problem.

Prehypertension in the Ashanti region of Ghana, West Africa: an opportunity for early prevention of clinical hypertension

OBJECTIVE

To assess prehypertension among Ghanaian adults in the Ashanti region of Ghana, West Africa.

DESIGN

Cross-sectional study.

PARTICIPANTS

There were 1431 participants aged 18 years or more. Prehypertension was defined as blood pressure of 120-139/80-89 mmHg.

MAIN OUTCOME MEASURES

Prehypertension.

RESULTS

Overall, 31% of the study population were normotensive, 40% were prehypertensive and 29% were hypertensive. Prehypertension was more common in non-hypertensive males than non-hypertensive females (66% vs 49%, P<0.001). Prehypertension was also more common in those aged 35 years compared with those aged <35 years (P<0.001), and in overweight and obese people compared with people of normal weight (P=0.03). In a multivariate logistic regression model, male sex [odds ratio (OR) 2.36; 95% confidence interval (CI) 1.77-3.15; P<0.001], age 35-49 years (OR 1.56; 95% CI 1.12-2.18; P<0.01) and 50 years (OR 2.13; 95% CI 1.33-3.42; P=0.002)], overweight (OR 1.61; 95% CI 1.09-2.36; P=0.02) and obesity (OR 2.71; 95% CI 1.40-5.24; P=0.003) were independently associated with higher odds of prehypertension, whilst current smoking (OR 0.36; 95% CI 0.16-0.81; P=0.01) was associated with lower odds of prehypertension.

CONCLUSION

Prehypertension is very common among non-hypertensive subjects in the Ashanti region of Ghana. As a large proportion of people with prehypertension will progress to clinical hypertension, targeting these people early with lifestyle modifications such as weight reduction may provide important long-term benefits.