Risk of progression to hypertension in a rural Chinese women population with prehypertension and normal blood pressure

Factors influencing the progression from prehypertension to hypertension among Chinese middle-aged and older adults: a 2-year longitudinal study

BACKGROUND

This study aimed to investigate the proportion of prehypertension cases progressing to hypertension among Chinese middle-aged and elderly populations over a 2-year period and related influencing factors.

METHODS

Data were obtained from the China Health and Retirement Longitudinal Study, and 2,845 individuals who were ≥ 45 years old and prehypertensive at baseline were followed from 2013-2015. Structured questionnaires were administered, and blood pressure (BP) and anthropometric measurements were performed by trained personnel. Multiple logistic regression analysis was done to investigate factors associated with prehypertension progressing to hypertension.

RESULTS

Over the 2-year follow-up, 28.5% experienced progression of prehypertension to hypertension; this occurred more frequently in men than women (29.7% vs. 27.1%). Among men, older age (55-64 years: adjusted odds ratio [aOR] = 1.414, 95% confidence interval [CI]:1.032-1.938; 65-74 years: aOR = 1.633, 95%CI: 1.132-2.355; ≥ 75 years: aOR = 2.974, 95%CI: 1.748-5.060), obesity (aOR = 1.634, 95%CI: 1.022-2.611), and number of chronic diseases (1: aOR = 1.366, 95%CI: 1.004-1.859; ≥ 2: aOR = 1.568, 95%CI: 1.134-2.169) were risk factors for progression to hypertension whereas being married/cohabiting (aOR = 0.642, 95% CI: 0.418-0.985) was a protective factor. Among women, risk factors included older age (55-64 years: aOR = 1.755, 95%CI: 1.256-2.450; 65-74 years: aOR = 2.430, 95%CI: 1.605-3.678; ≥ 75 years: aOR = 2.037, 95% CI: 1.038-3.995), married/cohabiting (aOR = 1.662, 95%CI: 1.052-2.626), obesity (aOR = 1.874, 95%CI: 1.229-2.857), and longer naps (≥ 30 and < 60 min: aOR = 1.682, 95%CI: 1.072-2.637; ≥ 60 min: aOR = 1.387, 95%CI: 1.019-1.889).

CONCLUSIONS

Chinese middle-aged and elderly individuals experienced a risk of prehypertension progressing to hypertension over a 2-year period, although the influencing factors differed by sex; this should be considered in interventions.

Evaluation of medication adherence and its relevant factors among hypertensive patients: A cross-sectional study in Shahrekord health-care system

BACKGROUND

Medication adherence means compliance with patient adherence to medication orders, including timely and correct consumption of medication prescribed by a physician. The present study aimed to determine the extent of adherence to hypertension drug medication in patients covered by comprehensive health service centers of Shahrekord, Iran.

MATERIALS AND METHODS

A cross-sectional study examined 401 hypertensive patients registered in the Integrated Health Record System (SIB). SIB is a Persian term related to Health Record System. To collect data, Morisky Medication Adherence Scale was used. The questionnaire was completed by the patients and analyzed using SPSS (SPSS Inc., Chicago, Illinois, USA, version 26), Chi-square test, independent t-test, and analysis of variance.

RESULTS

The results indicated that adherence to antihypertensive medication was low in 5.7% of patients, while 63.3% of patients had sufficient compliance. Forgetting to take medications (52.9%) was the most common reason for nonadherence to medication in hypertensive patients.

CONCLUSION

Given that forgetting to take medications was the main reason for nonadherence to medication in hypertensive patients, designing and implementing necessary trainings by comprehensive health centers to realize the importance of daily use of medication by hypertensive patients and their families are recommended.

Multiple self-care behaviors and associated factors in community-dwelling patients with hypertension in Myanmar

This study aimed to identify the prevalence of self-care behaviors and the associated factors among hypertensive patients in primary care in Myanmar. This cross-sectional study was conducted from April to May 2019 among 410 hypertensive patients in Myitkyina Township, Kachin State, Myanmar. Hypertensive patients aged 30–70 years old and being registered at the community health centers in Myitkyina Township were selected using multi-stage cluster random sampling. Self-care behaviors were measured by Hypertensive Self-Care Activity Level Effect (H-SCALE). Chi-square test and multiple logistic regression analysis were used to explore the associated factors. Prevalence of adherence to multiple self-care behaviors were low: avoidance of tobacco use at 50.2%, followed by physical activity at 24.9%, medication at 24.1%, weight management at 9.5%, and healthy diet at 2.7%, while abstinence from harmful alcohol drinking was high at 97.8%. Multiple logistic regression analysis indicated that younger patients, low family income, inadequate knowledge, and no comorbidity were associated with non-adherence to medication. Living in rural area and having poor self-efficacy were associated with non-adherence to weight management, while being younger, female and having poor self-efficacy were also associated with non-adherence to physical activity. Compared with Kachin, other ethnics were more likely to be non-adherent to avoidance of tobacco use. Although a majority of respondents were not harmful drinkers, adherence to medication, healthy diet, physical activity, weight management and avoidance of tobacco use were very low. Health practitioners should provide education programs for hypertensive patients to direct them towards practical techniques in managing their blood pressure.

Hypertension Prevalence and Determinants among Black South African Adults in Semi-Urban and Rural Areas

The burden of hypertension is reported to be on the rise in developing countries, such as South Africa, despite increased efforts to address it. Using a cross-sectional study design, we assessed and compared the prevalence of and risk factors associated with hypertension amongst adults aged ≥18 years in semi-urban and rural communities (1187 semi-urban and 1106 rural). Trained community health workers administered the INTERHEART Risk Score tool and performed blood pressure assessments using the MEDIC Pharmacists Choice Blood Pressure Monitor. Hypertension was defined to be a systolic blood pressure (BP) ≥ 140 mmHg and diastolic BP ≥ 90 mmHg. A multivariate logistic regression model was used to identify factors and determine their relationship with hypertension. The prevalence of hypertension amongst semi-urban and rural communities was 21% with no gender difference. In the semi-urban area, physical activity, family history, fruit intake, salty food, and eating meat were significantly associated with the odds of hypertension among women, whereas only the waist-to-hip ratio (WHR), diabetic status, and salty food were the predictors for rural women. Factors such as fried food and low fruit intake were significantly associated with the odds of hypertension among men in the semi-urban area, whereas only the WHR was significant among men in the rural area. Hypertension was found to be prevalent among semi-urban and rural adults in Limpopo Province, South Africa.

Factors Associated with Hypertension Among Men in Darkhan-Uul Province, Mongolia: A Cross-Sectional Study

In Mongolia, cardiovascular disease is the leading cause of death, and prevalence of hypertension is very high. The aim of this study was to investigate the association between hypertension and sociodemographic factors and health-related behaviors among men in Darkhan-Uul Province, Mongolia. This cross-sectional study was conducted between November 2015 and January 2016. Men whose wives were pregnant with ≤ 20 weeks gestation and had attended antenatal health checkups at public health facilities were recruited in this study. The data were collected as part of a survey of pregnant women and their partners. Data were collected using self-administered questionnaires, anthropometry, and spot urine samples. A total of 224 men participated in the survey, and data from 209 participants were included in the analysis. Multiple logistic regression analysis showed that men with higher BMI had higher odds of hypertension than those with lower BMI (adjusted odds ratio [AOR]: 1.14, 95% CI: 1.03-1.26). Those with urinary cotinine > 100 ng/ml (smokers) had a lower risk of hypertension (AOR: 0.24, 95% CI: 0.09-0.67) compared to participants with urinary cotinine/ml (nonsmokers). This is the first study to investigate the association between hypertension and sociodemographic factors and health-related behaviors among men in Mongolia. Based on the findings of this study, clinicians responsible for public health in Mongolia should provide health education regarding the importance of weight control in preventing hypertension.

Salt consumption and the risk of chronic diseases among Chinese adults in Ningbo city

Background

Chronic diseases have become one of essential public health concerns, leading causes of mortality in China. It is related to the changes in dietary pattern and dietary behavior. The objectives are to assess daily salt intake in Chinese people living in Ningbo and to examine its relationship with health outcomes.

Methods

Our study used data from health and nutrition survey in 2017. This study included 2811 adults aged 18–79 years (48% males) from urban and rural areas in Ningbo. A food frequency questionnaire together with demographic, physical and medical questionnaires was used to collect dietary intake, demographic, lifestyle and medical information. Ordinal logistic regression was used in the statistical analysis.

Results

The mean daily salt intake (13.0 g/day) of the participants was higher than the Chinese dietary reference intake (DRI, 6 g/d), which was related to higher risk of pre-hypertension and hypertension. Stratified by gender, education and lifestyle factors, daily salt intake was only significant in the blood pressure category (male: P = 0.048; less education: P = 0.003; urban: P = 0.006; no regular physical activity: P = 0.005, no regular smoking: P = 0.006). Ordinal logistic regression model shows that daily salt intake was significantly associated with higher odds of developing hypertension.

Conclusion

The daily salt intake of the majority of citizens living in Ningbo exceeded Chinese DRI and may increase the risk of hypertension. Moreover, public health intervention of salt restriction is necessarily needed for the prevention and control the ongoing epidemic of chronic diseases.

Applying the theory of planned behavior to determine factors associated with physical activity by women with hypertension in rural areas of Iran

Background

Hypertension is the leading preventable cause of premature deaths worldwide. Physical activity reduces the levels of blood lipids and blood pressure in people suffering from hypertension.

Objectives

To apply the theory of planned behavior (TPB) to determine factors associated with physical activity by women with hypertension who were referred to health care centers in Kiashahr in 2016.

Methods

The present observational study was conducted in a cross-section of 215 women diagnosed with hypertension who had records in health care centers in Kiashahr and who were recruited through census from August to September 2016. The data collection tool was a custom-designed questionnaire based on the TPB, and the collected data were analyzed using descriptive and analytical statistical methods.

Results

The mean scores of knowledge, attitudes, subjective norms, perceived behavioral control, and intention to undertake physical activity were significantly (P < 0.01) higher among women who performed regular physical activity than in those without regular physical activity. Constructs including behavioral intention (P < 0.001, odds ratio (OR) 1.36, 95% confidence interval (CI) 1.15, 1.61) and attitude (P = 0.004, OR 1.27, 95% CI 1.08, 1.50) were significant predictors for undertaking physical activities.

Conclusions

Attitude and behavioral intention were predictors for undertaking physical activities. We recommended the design of interventional programs based on these 2 factors for women with hypertension living in rural areas of Iran.

Self-Care Behaviors and Related Factors in Hypertensive Patients

BACKGROUND

An assessment of an individual's hypertension self-care behavior may provide clinicians and practitioners with important information regarding how to better control hypertension.

OBJECTIVES

The objective of this study was to investigate the self-care behaviors of hypertensive patients.

PATIENTS AND METHODS

This cross-sectional study was conducted in 2014 in a sample of 1836 patients of both genders who had been diagnosed with hypertension in urban and rural health centers in the Kohgiluyeh Boyerahmad Province in southern Iran. They were randomly selected and were invited to participate in the study. Self-care activities were measured using the H-hypertension self-care activity level effects.

RESULTS

The mean age of the respondents was 63 (range: 30 - 92), and 36.1% reported adherence to the recommended levels of medication; 24.5% followed the physical activity level guidelines. Less than half (39.2%) met the criteria for practices related to weight management, and adherence to low-salt diet recommendations was also low (12.3%). Overall, 86.7% were nonsmokers, and 100% abstained from alcohol. The results of a logistic regression indicated that gender was significantly associated with adherence to physical activity (OR = 0.716) and non-smoking (OR = 1.503) recommendations; that is, women were more likely to take part in physical activity than men. There was also a significant association between age and adherence to both a low-salt diet (OR = 1.497) and medication (OR = 1.435).

CONCLUSIONS

Based on our findings, it is crucial to implement well-designed educational programs to improve hypertension self-care behaviors.

Salt intake, knowledge of salt intake, and blood pressure control in Chinese hypertensive patients

A cross-sectional study involving 2502 subjects was conducted to evaluate salt intake, knowledge of salt intake, and blood pressure control in hypertensive patients. The blood pressure control rate was 33.5% among the hypertensive patients. Of the patients, 69.9% had salt intake higher than 6 g/d. Overall 35.0% knew the recommended salt intake, and 94.9% knew that "excess salt intake can result in hypertension." Altogether, 85.8% of patients had received health education related to a low-salt diet at some time. Patients who consumed less than 6 g/d of salt had a higher control rate than those who consumed more than 6 g/d (48.7% vs. 27.0%; χ(2) = 111.0; P < .001). Patients with knowledge of the recommended salt intake had a higher control rate than those without (45.8% vs. 26.9%; χ(2) = 91.3; P < .001). Our findings suggest a high salt intake and low blood pressure control rate among Chinese hypertensive patients. Knowledge of recommended salt intake is inappropriate for patients with education of a low-salt diet.

Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings

The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on 'Hypertension and Cardiovascular risk in low resource settings', which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs.

Predictive value for the rural Chinese population of the Framingham hypertension risk model: results from Liaoning Province

BACKGROUND

A prediction model from the US Framingham Heart Study (FHS) population has been established to estimate an individual's risk of developing hypertension. However, this model has not been widely tested in other cohorts. In this study, we examined the predictive capability of the FHS prediction model in a rural Chinese population.

METHODS

A total of 24,434 rural Chinese adults aged ≥35 years, without prevalent hypertension, diabetes mellitus, stroke, and coronary heart disease at baseline, were followed for the incidence of hypertension. Standard clinical examinations of blood pressure, weight and height, smoking status, and parental history of hypertension were observed biennially.

RESULTS

The mean age was 47.9 (SD = 10.2) years, and 49.5% of subjects were women. During a median 4.8 years of follow-up, we recorded a total of 8,675 incident hypertension cases. The cumulative 2-year and 4-year hypertension incidence rates were 7.7% and 25.6%, respectively. The C statistics for the 2-year and 4-year incidences of hypertension were 0.537 (95% confidence interval (CI) = 0.524-0.550) and 0.610 (95% CI = 0.602-0.618) for the FHS model, respectively. The Hosmer-Lemeshow χ(2) test results for 2-year and 4-year incidence of hypertension were 2,287.7 (P < 0.0001) and 8,227.1 (P < 0.0001), respectively. Sensitivity analysis indicates that the FHS prediction model still has a poor performance, although the predictive ability was better than for the overall population.

CONCLUSIONS

The FHS hypertension prediction model is not a valid tool with which to estimate the risk of incidence of hypertension among the rural Chinese population. A new hypertension risk equation for the rural Chinese population is needed.

Long-term prehypertension treatment with losartan effectively prevents brain damage and stroke in stroke-prone spontaneously hypertensive rats

Prehypertension has been associated with adverse cerebrovascular events and brain damage. The aims of this study were to investigate i) whether short- and long-term treatments with losartan or amlodipine for prehypertension were able to prevent blood pressure (BP)-linked brain damage, and ii) whether there is a difference in the effectiveness of treatment with losartan and amlodipine in protecting BP-linked brain damage. In the present study, prehypertensive treatment with losartan and amlodipine (6 and 16 weeks treatment with each drug) was performed on 4-week-old stroke-prone spontaneously hypertensive rats (SHRSP). The results showed that long-term (16 weeks) treatment with losartan is the most effective in lowering systolic blood pressure in the long term (up to 40 weeks follow-up). Additionally, compared with the amlodipine treatment groups, the short- and long-term losartan treatments protected SHRSP from stroke and improved their brains structurally and functionally more effectively, with the long-term treatment having more benefits. Mechanistically, the short- and long-term treatments with losartan reduced the activity of the local renin-angiotensin-aldosterone system (RAAS) in a time-dependent manner and more effectively than their respective counterpart amlodipine treatment group mainly by decreasing AT1R levels and increasing AT2R levels in the cerebral cortex. By contrast, the amlodipine treatment groups inhibited brain cell apoptosis more effectively as compared with the losartan treatment groups mainly through the suppression of local oxidative stress. Taken together, the results suggest that long-term losartan treatment for prehypertension effectively protects SHRSP from stroke-induced brain damage, and this protection is associated with reduced local RAAS activity than with brain cell apoptosis. Thus, the AT1R receptor blocker losartan is a good candidate drug that may be used in the clinic for long-term treatment on prehypertensive populations in order to prevent BP-linked brain damage.

Hypertension in developing countries

Data from different national and regional surveys show that hypertension is common in developing countries, particularly in urban areas, and that rates of awareness, treatment, and control are low. Several hypertension risk factors seem to be more common in developing countries than in developed regions. Findings from serial surveys show an increasing prevalence of hypertension in developing countries, possibly caused by urbanisation, ageing of population, changes to dietary habits, and social stress. High illiteracy rates, poor access to health facilities, bad dietary habits, poverty, and high costs of drugs contribute to poor blood pressure control. The health system in many developing countries is inadequate because of low funds, poor infrastructure, and inexperience. Priority is given to acute disorders, child and maternal health care, and control of communicable diseases. Governments, together with medical societies and non-governmental organisations, should support and promote preventive programmes aiming to increase public awareness, educate physicians, and reduce salt intake. Regulations for the food industry and the production and availability of generic drugs should be reinforced.

High prevalence of prehypertension and hypertension in a working population in Hungary

BACKGROUND

Hungary has one of the highest mortality rates due to strokes among the European Union countries. As elevated blood pressure (BP) is the principal risk factor for strokes, we assessed BP levels, as well as awareness and treatment status of hypertension and prehypertension in a working population sample in Hungary.

METHODS

Worksite employees in Budapest and Szeged were screened for their BP using an automated BP measuring instrument (BpTRU). BpTRU readings of heart rate (HR) were also recorded. Respondents were classified as normotensives (NT), prehypertensives (PHTN) and hypertensives (HTN) according to their BP levels, as defined by the JNC 7 guidelines. Body height and body weight were measured and body mass index (BMI) was calculated. Self-reported information regarding smoking was collected.

RESULTS

In total, 2,012 respondents were recruited (1,000 white collar; 1,012 blue-collar workers), with a mean (±s.d.) age of 34.8 (±9.9) years. Of all respondents, 22.6% were identified as HTN and 39.8% as PHTN. Among HTN, 40% were unaware of their condition and only 18.5% were adequately treated. PHTN were similar in age as NT, but showed significantly higher HR.

CONCLUSIONS

A high proportion of relatively young and apparently healthy Hungarian employees were diagnosed with prehypertension and hypertension. Only a small proportion of HTN had their BP controlled. BMI and HR were significantly higher among individuals with prehypertension compared to NT. Whether the high rates of hypertension, prehypertension, and low levels of control explain the high stroke mortality and unfavorable cardiovascular disease (CVD) profile of Hungary needs further study.

A predictive model for risk of prehypertension and hypertension and expected benefit after population-based life-style modification (KCIS No. 24)

BACKGROUND

Few reports have identified and quantified significant risk factors responsible for multistate natural course of progression to hypertension and also regression of prehypertension to normal, which provides baseline risks to estimate the size of expected benefit derived from population-based life-style modification.

METHODS

Data used for estimating clinical parameters governing temporal natural course of hypertension are derived from 42,027 participants attending screening annually between 1999 and 2002. Information on transition history between normal, prehypertension, stage 1 and stage 2 hypertension between screens was therefore collected to compute multistep composite risk scores without intervention program. The expected benefits of risk reduction in prehypertension and hypertension under different intervention programs by modifying the related risk factors from abnormal to normal ranges were estimated.

RESULTS

The majority of risk factors play a more remarkable role in prehypertension and stage 1 hypertension but less in stage 2 hypertension. The greater the number of risk factors included in the intervention programs becomes, the lower the mean risk score is expected to achieve. The 5-year predicted cumulative risk for stage 2 hypertension decreased from 23.6% in the absence of intervention program to 14% with the provision of "six-component intervention" in men. The results were similar for women.

CONCLUSIONS

Multiple risk factors responsible for multistep transitions between prehypertension and hypertension were identified by using population-based screening data to derive multistep composite risk scores, which are useful for the expected benefit of reducing risk of hypertension by providing population-based life-style modification.

Combined effect of obstructive sleep apnea and age on daytime blood pressure

Epidemiologic studies have shown obstructive sleep apnea (OSA) is an independent risk factor for systemic hypertension. The prevalence of systemic hypertension also increases gradually with age. The purpose of this study was to assess the combined effect of OSA and age on daytime blood pressure. Patients who received nocturnal polysomnography in Tainan Municipal Hospital were invited between October 2008 and February 2010. Daytime blood pressure was measured. Participants were classified into three groups: nonapnea (n = 14, 18%) with RDI <5 episodes/h; mild to moderate OSA (n = 34, 43%) with RDI ≧ 5 and <30; and severe OSA (n = 31, 39%) with RDI ≧ 30. Seventy-nine patients (79/101, 78.2%) (63 males) completed the study. The mean of age, severity of OSA (RDI) and systolic blood pressure (SBP) was 40.3 ± 15.4 years, 28.1 ± 26.0/h and 132.6 ± 19.7 mmHg, respectively. RDI and age were significant risk factors for SBP (P < 0.05). SBP became severe when patients were older in the group of mild to moderate OSA (p = 0.0067) and diastolic blood pressure (DBP) became severe when patients were older in the group of nonapnea and mild to moderate OSA (P = 0.0042 and 0.0168, respectively). But the daytime blood pressure and age were not correlated significantly for the severe OSA subjects. This study revealed that age and RDI were risk factors in development of daytime hypertension. For patients with mild to moderate OSA, SBP was significantly worse when getting older and for patients with nonapnea and mild to moderate OSA, DBP was significantly worse with increasing age.