Sex differences in the awareness, treatment, and control of hypertension in China: a systematic review with meta-analyses

Blood Pressure Control and Maintenance in a Prospective Cohort of Younger Veterans: Roles of Sex, Race, Ethnicity, and Social Determinants of Health

Background

Proactive blood pressure (BP) management is particularly beneficial for younger Veterans, who have a greater prevalence and earlier onset of cardiovascular disease than non-Veterans. It is unknown what proportion of younger Veterans achieve and maintain BP control after hypertension onset and if BP control differs by demographics and social deprivation.

Methods

Electronic health records were merged from Veterans who enrolled in VA care 10/1/2001-9/30/2017 and met criteria for hypertension - first diagnosis or antihypertensive fill. BP control (140/90 mmHg), was estimated 1, 2, and 5 years post-hypertension documentation, and characterized by sex, race, and ethnicity. Adjusted logistic regressions assessed likelihood of BP control by these demographics and with the Social Deprivation Index (SDI).

Results

Overall, 17% patients met criteria for hypertension (n=198,367; 11% of women, median age 41). One year later, 59% of men and 65% of women achieved BP control. After adjustment, women had a 72% greater odds of BP control than men, with minimal change over 5 years. Black adults had a 22% lower odds of BP control than White adults. SDI did not significantly change these results.

Conclusions

In the largest study of hypertension in younger Veterans, 41% of men and 35% of women did not have BP control after 1 year, and BP control was consistently better for women through 5 years. Thus, the first year of hypertension management portends future, long-term BP control. As social deprivation did not affect BP control, the VA system may protect against disadvantages observed in the general U.S. population.

Management of Hypertension in the Asia-Pacific Region: A Structured Review

This article reviews available evidence regarding hypertension management in the Asia-Pacific region, focussing on five research questions that deal with specific aspects: blood pressure (BP) control, guideline recommendations, role of renin-angiotensin-aldosterone system (RAAS) inhibitors in clinical practice, pharmacological management and real-world adherence to guideline recommendations. A PubMed search identified 2537 articles, of which 94 were considered relevant. Compared with Europeans, Asians have higher systolic/diastolic/mean arterial BP, with a stronger association between BP and stroke. Calcium channel blockers are the most-commonly prescribed monotherapy in Asia, with significant variability between countries in the rates of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin-receptor blockers (ARBs) and single-pill combination (SPC) use. In clinical practice, ARBs are used more commonly than ACEis, despite the absence of recommendation from guidelines and clinical evidence supporting the use of one class of drug over the other. Ideally, antihypertensive treatment should be tailored to the individual patient, but currently there are limited data on the characteristics of hypertension in Asia-Pacific individuals. Large outcome studies assessing RAAS inhibitor efficacy and safety in multi-national Asian populations are lacking. Among treated patients, BP control rates were ~ 35 to 40%; BP control in Asia-Pacific is suboptimal, and disproportionately so compared with Western nations. Strategies to improve the management of hypertension include wider access/availability of affordable treatments, particularly SPCs (which improve adherence), effective public health screening programs targeting patients to drive health-seeking behaviours, an increase in physician/patient awareness and early implementation of lifestyle changes. A unified Asia-Pacific guideline on hypertension management with pragmatic recommendations, particularly in resource-limited settings, is essential.

A tryst of 'blood pressure control- sex- comorbidities': the odyssey of basic public health services in Yunnan in quest for truth

BACKGROUND

The Basic Public Health Service (BPHS), a recently announced free healthcare program, aims to combat the most prevalent Noncommunicable Disease-"Hypertension" (HTN)-and its risk factors on a nationwide scale. In China, there is a rife that HTN less impacts women during their lifetime. We, therefore, aimed to evaluate the sex disparity in hypertension patients with comorbidities among south-west Chinese and the contribution of BPHS to address that concern.

METHODS

We have opted for a multistage stratified random sampling method to enroll hypertensive patients of 35 years and older, divided them into BPHS and non-BPHS groups. We assessed the sex disparity in HTN patients with four major comorbidities- Dyslipidemia, Diabetes Mellitus (DM), Cardiovascular Disease (CVD), and Chronic Kidney Disease (CKD), and descriptive data were compiled. Odds ratios from logistic regression models estimated the effectiveness of BPHS in the management of HTN with comorbidities.

RESULTS

Among 1521 hypertensive patients,1011(66.5%) were managed in the BPHS group. The proportion of patients who had at least one comorbidity was 70.7% (95% confidence interval [CI]: 66.3-76.8%), patients aged 65 years and older were more likely to have coexisting comorbidities. Participants who received the BPHS showed significant blood pressure (BP) control with two comorbidities (odds ratio [OR] = 2.414, 95% CI: 1.276-4.570), three or more (OR = 5.500, 95%CI: 1.174-25.756). Patients with dyslipidemia and DM also benefited from BPHS in controlling BP (OR = 2.169, 95% CI: 1.430-3.289) and (OR = 2.785, 95%CI: 1.242-6.246), respectively. In certain high-income urban survey centers, there was sex differences in the HTN management provided by BPHS, with men having better BP control rates than women.

CONCLUSIONS

Perhaps this is the first study in China to succinctly show the effectiveness and sex disparity regarding "management of hypertensive comorbidities". This supports that the BPHS program plays a pivotal role in controlling BP, therefore should recommend the national healthcare system to give women a foremost priority in BPHS, especially to those from low-socioeconomic and low-scientific literacy regions.

Mediating effect of subclinical inflammation on the process of morning hypertension leading to atrial fibrillation in community-based older adults

BACKGROUND

The impacts and mechanisms of morning hypertension (MHT) on the risk of new-onset atrial fibrillation (AF) in the elderly have not been clarified. We aimed to investigate an association between MHT and new-onset AF and explore a mediating effect of subclinical inflammation on this association.

METHODS

From 2008 to 2010, 1789 older adults aged ≥60 years were recruited in Shandong area, China. Morning blood pressure (BP) was assessed using 24-hour ambulatory BP monitoring. MHT was defined as BP ≥ 135/85 mm Hg during the period from wake time to 0900 a.m. Subclinical inflammation was assessed by hypersensitive C-reactive protein (hsCRP), tumor necrosis factor-alpha (TNF-α), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and galectin-3. New-onset AF was rated during the follow-up period.

RESULTS

Over an average 129.0 [standard deviation (SD): 21.58] months of follow-up, the hazard ratio of new-onset AF in MHT patients was 1.39 (95% confidence interval: 1.01 to 1.91) compared with non-MHT participants (Padjusted = 0.027). The risk of new-onset AF was 1.17-fold with one-SD increment of morning systolic BP. Subclinical inflammation was significantly associated with new-onset AF. The hazard ratios of new-onset AF were 2.29, 2.04, 2.08, 2.08, 2.03, and 3.25 for one-SD increment in hsCRP, TNF-α, SII, NLR, PLR, and galectin-3, respectively (Padjusted < 0.001). The analysis showed that hsCRP, TNF-α, SII, NLR, PLR, and galectin-3 separately mediated the process of MHT inducing new-onset AF (Padjusted < 0.05).

CONCLUSIONS

MHT is associated with an increased risk of new-onset AF. The subclinical inflammation might play a mediating role in this association.

Sex-based differences in risk of cardiovascular disease development and cardiovascular risk factors among individuals with hypertension: A cross-sectional study from primary care facilities

BACKGROUND

Over the last two decades, the understanding of cardiovascular disease (CVD) has expanded in Asian countries. Despite this progress, there have been limited investigations into sex-based differences in the development of CVD and cardiovascular risk factors (CVRFs).

AIM

We investigated whether males and females with hypertension had different risks of developing CVD and CVRFs.

METHODS

We used a stratified multi-stage sampling design involving 15 primary care centers in Thailand. We recruited 1,448 individuals aged 35-74 years old. The Framingham cardiovascular risk algorithm was used to determine the risk of CVD development.

RESULTS

Female patients were overall more likely to have lower CVD risk scores. However, they demonstrated higher scores in the moderate-risk (p < 0.001) and high-risk (p < 0.001) groups as compared with males. One in four females was at a high risk of developing CVD. Females had higher rates of all CVRFs against males across sub-risk groups, with the highest odds ratio observed in the high-risk group, which persisted after adjusting for covariations. Overall, female patients had higher rates of diabetes, hyperlipidemia, obesity, and abdominal obesity as compared with males. Females in the overall group had a lower prevalence of uncontrolled hypertension than males, in contrast to the high-risk group. Female patients also had a lower prevalence of cigarette smoking and alcohol consumption than males.

CONCLUSION

There is evidence of sex-based differences in the risk of CVD development in hypertensive individuals. The interaction of CVRFs with a high risk of developing CVD was noted in females.

Gender Difference of Blood Pressure Control Rate and Clinical Prognosis in Patients With Resistant Hypertension: Real-World Observation Study

BACKGROUND

There are several differences in the clinical course of hypertension due to the biological and social differences between men and women. Resistant hypertension is an advanced disease state, and significant gender difference could be expected, but much has not been revealed yet. The purpose of this study was to compare gender differences on the current status of blood pressure (BP) control and clinical prognosis in patients with resistant hypertension.

METHODS

This is a multicenter, retrospective cohort study using common data model databases of 3 tertiary hospitals in Korea. Total 4,926 patients with resistant hypertension were selected from January 2017 to December 2018. Occurrence of dialysis, heart failure (HF) hospitalization, myocardial infarction, stroke, dementia or all-cause mortality was followed up for 3 years.

RESULTS

Male patients with resistant hypertension were younger but had a higher cardiovascular risk than female patients. Prevalence of left ventricular hypertrophy and proteinuria was higher in men than in women. On-treatment diastolic BP was lower in women than in men and target BP achievement rate was higher in women than in men. During 3 years, the incidence of dialysis and myocardial infarction was higher in men, and the incidence of stroke and dementia was higher in women. After adjustment, male sex was an independent risk factor for HF hospitalization, myocardial infarction, and all-cause death.

CONCLUSION

In resistant hypertension, men were younger than women, but end-organ damage was more common and the risk of cardiovascular event was higher. More intensive cardiovascular prevention strategies may be required in male patients with resistant hypertension.

Identification of sex characteristics of obesity and hypertension in the adult population of the Vladimir region

Aim. To identify sex characteristics of the prevalence of obesity and hypertension (HTN) in the adult population of the Vladimir region.

Material and methods. The study included 1350 people, men and women aged 30-69 years from 5 cities of the Vladimir region (Vladimir, Kovrov, Murom, Yuriev-Polsky and Vyazniki). The response rate was at least 80%. In total, 1174 people completed the study, including 424 men (36,1%) and 750 women (63,9%). The survey was conducted according to a standard questionnaire, including socio-demographic parameters and behavioral risk factors. In all patients, anthropometric parameters, blood pressure, heart rate and resting electrocardiography were assessed.

Results. The average body mass index among women was significantly highercompared to men (29,9±6,2 kg/m2 vs 28,3±4,7 kg/m2, p<0,001), while waist circumference among men exceeded similar parameters among women (95,5±11,7 cm vs 91,9±15,3 cm, p<0,001). Sex differences in anthropometric indicators have a number of features in different cities. Every third man is obese, while among women this figure was significantly higher (33,7% vs 42,1%, p<0,001). Every second man and 2/3 of women had abdominal obesity (53,1% and 71,6%, p<0,001). The prevalence of HTN among men and women was comparable (41,5% and 39,9%, respectively). Electrocardiographic signs of left ventricular (LV) hypertrophy are detected in every third respondent, while its prevalence between men and women did not differ statistically (30,5% and 35,5%, respectively).

Conclusion. In the surveyed population of men and women of the Vladimir region, the prevalence of obesity and HTN were comparable. The prevalence of obesity and abdominal obesity has sex differences due to the greater severity among women. Hypertension is also highly likely to be associated with LV hypertrophy. Obviously, in order to correct obesity and HTN, lifestyle changes at the population level must be combined with the use of antihypertensive therapy to achieve target blood pressure levels and regress LV hypertrophy.

Ethnicity Disparities in the Prevalence, Awareness, Treatment, and Control Rates of Hypertension in China

Objectives

Previous studies reported that there were disparities in hypertension management among different ethnic groups, and this study aimed to systematically determine the prevalence, awareness, treatment, and control rates of hypertension in multiple Chinese ethnic groups.

Methods

We searched Embase, PubMed, and Web of Science for articles up to 25 October, 2022. The pooled prevalence, awareness, treatment, and control rates of hypertension were estimated with 95% confidence intervals (CI). The heterogeneity of estimates among studies was assessed by the Cochran Q test and I ² statistic. Meta-regression analyses were conducted to identify the factors influencing the heterogeneity of the pooled prevalence, awareness, treatment, and control rate of hypertension.

Results

In total, 45 publications including 193,788 cases and 587,826 subjects were eligible for the analyses. The lowest prevalence was found in the Han group (27.0%), and the highest prevalence was in the Mongolian population (39.8%). The awareness rates ranged from 24.4% to 58.0% in the four ethnic groups. Both the highest treatment and control rates were found in the Mongolian population (50.6% and 16.0%, respectively), whereas the Yi group had the lowest control rate (8.0%). In addition, the study year, the mean age of subjects, mean body mass index of subjects, tobacco use (%), alcohol use (%), residence (urban%), and education (primary school%) had varied effects on heterogeneity.

Conclusions

These findings highlight the disparities in prevalence, awareness, treatment, and control rates of hypertension in a different ethnic population of China, which could provide suggestions for making targeted prevention measures.

Stroke in Women: A Review Focused on Epidemiology, Risk Factors, and Outcomes

Stroke is a particularly important issue for women. Women account for over half of all persons who experienced a stroke. The lifetime risk of stroke is higher in women than in men. In addition, women have worse stroke outcomes than men. Several risk factors have a higher association with stroke in women than in men, and women-specific risk factors that men do not have should be considered. This focused review highlights recent findings in stroke epidemiology, risk factors, and outcomes in women.

Prevalence and the age of onset patterns of stroke in Jiangsu Province, China

OBJECTIVES

Little was known regarding the current age of onset patterns of stroke. This study aimed to examine the prevalence of stroke and explore the age of onset patterns of stroke in Jiangsu Province, China.

MATERIALS AND METHODS

Participants were recruited from April 2012 to April 2013 in Jiangsu Province, China. Survival analysis models were used to evaluate the hazards of stroke by a single year of age. Kaplan-Meier analysis and the log-rank test were used to explore the disparities of the age of onset patterns of stroke.

RESULTS

This population-based study was conducted among 39,887 participants aged ≥ 18 years in Jiangsu Province, China. Of the 740 (1.9%) events of stroke, 13.2% suffered from hemorrhagic stroke (HS) and 86.8% suffered from ischemic stroke (IS). The prevalence of HS and IS were 0.3% and 1.7%, respectively. The estimated mean age of onset of stroke was 71.98 (95% CI: 71.97-71.99) years by the survival model. Up to age of 45 years, the estimated hazards of stroke onset were at a relatively low level. From the age of 45 years, the increases in hazards accelerated and peaked at age 75 years. Urban, smoking, and drinking males had a higher risk of stroke than their counterparts (P < 0.05). However, no such difference was found among females.

CONCLUSIONS

The findings emphasize the importance of implementing stroke prevention interventions in Jiangsu Province, China, especially for urban, smoking, and drinking males. It is of great significance to strengthen comprehensive management of health-related behaviors, including smoking cessation and moderate consumption of alcohol to have sustained beneficial effects on stroke risk. Chenlu He and Qian Chen contributed equally to this work.

Accumulated unhealthy behaviours and insomnia in Japanese dwellers with and without cardiovascular risk factors: a cross-sectional study

OBJECTIVES

To date, the association between accumulated unhealthy behaviours and insomnia in individuals stratified according to the presence or absence of major cardiovascular risk factors is unclear. This study aimed to examine the effect of accumulated unhealthy behaviours on insomnia in Japanese dwellers.

DESIGN

Cross-sectional study.

SETTING

Baseline data between April 2012 and March 2015.

PARTICIPANTS

Our study used cross-sectional data among Japanese aged 35-74 years in a rural community (N=9565), the attendees of annual municipal or work site health check-up programmes.

MAIN OUTCOME MEASURES

Insomnia was assessed by Athens Insomnia Scale, which was set at 6 points and greater; other scales were given. Participants were categorised into three groups by their number of unhealthy behaviours (no exercise habit, smoking, alcohol drinking, skipping breakfast and obesity): 0-1, 2-3, 4 or more. The association between accumulated unhealthy behaviours and insomnia was estimated by logistic regression analysis. Further analysis was done after stratification of cardiovascular risk factors assessed by anthropometrics and clinical biochemistry measurements.

RESULTS

The overall prevalence of insomnia was 13.3% for men and 19.3% for women. Men with unhealthy behaviour factors were more likely to have insomnia after adjusting for potential confounders, compared with the least unhealthy group (trend p=0.013). Women with four or more unhealthy behaviour factors were more likely to have insomnia, compared with the lowest groups (OR 1.175, 95% CI 1.077 to 1.282). Insomnia has an association with the unhealthy behaviours among men without cardiovascular risk factors (lowest groups: OR 1.133, 95% CI 1.037 to 1.238, trend p=0.026). Women without hypertension were more likely to have suspected insomnia, compared with the lowest group (OR 1.215, 95% CI 1.101 to 1.341).

CONCLUSION

The results showed accumulated unhealthy behaviours were associated with increased risk of insomnia in Japanese dwellers. For healthy population without cardiovascular risk factors, unhealthy behaviours should be considered as background conditions for insomnia.

The Burden of Resistant Hypertension Across the World

PURPOSE OF REVIEW

Resistant hypertension (R-HTN) is related to worse cardiovascular, renal outcomes, and death compared to non R-HTN. We aimed to review the burden of R-HTN across the world, focusing on its prevalence, associated factors and outcomes, and the impact of treatment.

RECENT FINDINGS

R-HTN prevalence among hypertensive individuals varies around 10-20%, depending on the population and definition applied. R-HTN consistently relates to older age, chronic kidney disease, obesity, and obstructive sleep apnea - which are increasing in prevalence with global population aging. As such, R-HTN prevalence is also expected to rise. Infrequent use of ambulatory blood pressure monitoring to identify at higher risk individuals and poor adherence to treatment are still barriers in the approach of R-HTN. Available evidence suggests that 10-20% of patients with hypertension have R-HTN. However, the prevalence of true R-HTN using contemporaneous standardized definitions is still unknown. Novel strategies to address clinicians, patients and health system barriers to treatment inertia and adherence are fundamental to reduce the burden of R-HTN.

Sex differences in the antihypertensive treatment and risk of uncontrolled hypertension in 5308 hypertensive patients in the United Arab Emirates

BACKGROUND

Sex differences in the antihypertensive medications used to control blood pressure and risk factor control in hypertensive patients is poorly understood.

METHODS

We conducted a retrospective review of the patients newly diagnosed with hypertension registered for treatment in 52 outpatient settings across Abu Dhabi province between 1 January and 31 December 2017. We explored sex differences in risk factors and treatment management over 6 months of the follow-up period of each patient. Multiple logistic regression models were used to identify factors associated with poor BP control.

RESULTS

A total of 5308 patients (2559 men and 2849 women) were identified. We observed an increase in SBP and DBP levels in men (1.72/1.13 mmHg) and only SBP in women (0.87/-0.021 mmHg) with increased incidence of comorbidities overtime. The overall BP control was suboptimal (65%) (<140/90 mmHg) with no significant difference between women (65.3%) and men (64.2%). In men with dyslipidemia, use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker with diuretics and in women, only calcium channel blockers showed higher for BP control. Factors significantly associated with poor BP control in men are being overweight and obese, and dyslipidemia in men. After the age of 50, women in contrast to men, with dyslipidemia and heart rate >80 beats per minute are less likely to maintain hypertension control.

CONCLUSION

Sex-specific analysis indicated that BP control among United Arab Emirates men and women was suboptimal (65%). Interventions aiming to achieve better control of BP in hypertensive patients with metabolic syndrome should be emphasized.

Measuring Knowledge, Attitudes, and Barriers to Medication Adherence in Potential Bariatric Surgery Patients

BACKGROUND

Bariatric surgery is an effective treatment for the obesity epidemic, but the poor attendance and adherence rates of post-surgery recommendations threaten treatment effectiveness and health outcomes. Preoperatively, we investigated the unique contributions of clinical (e.g., medical and psychiatric comorbidities), sociodemographic (e.g., sex, age, and educational level), and psychopathological variables (e.g., binge eating severity, the general level of psychopathological distress, and alexithymia traits) on differing dimensions of adherence in a group of patients seeking bariatric surgery.

METHODS

The final sample consisted of 501 patients (346 women). All participants underwent a full psychiatric interview. Self-report questionnaires were used to assess psychopathology, binge eating severity, alexithymia, and three aspects of adherence: knowledge, attitude, and barriers to medical recommendations.

RESULTS

Attitude to adherence was associated with alexithymia (β = -2.228; p < 0.001) and binge eating disorder (β = 0.103; p = 0.047). The knowledge subscale was related to medical comorbidity (β = 0.113; p = 0.012) and alexithymia (β = -2.256; p < 0.001); with age (β = 0.161; p = 0.002) and psychiatric comorbidity (β =0.107; p = 0.021) manifesting in the barrier subscale.

CONCLUSION

We demonstrated that alexithymia and psychiatric and eating disorders impaired adherence reducing attitude and knowledge of treatment and increasing the barriers. Both patient and doctor can benefit from measuring adherence prior to surgery, with a qualitative approach shedding light on the status of adherence prior to the postsurgical phase when the damage regarding adherence is, already, done. Graphical Abstract.

Association of age and blood pressure among 3.3 million adults: insights from China PEACE million persons project

OBJECTIVE

To assess the association between blood pressure (BP) with age and its heterogeneity across various sociodemographic subgroups in China.

METHODS

In this cross-sectional study, we analysed the data from nearly 3.3 million individuals aged 35-75 years from all 31 provinces in mainland China collected from September 2014 through August 2019. On the basis of possible combinations of eight characteristics and antihypertensive status, subgroups of at least 10 000 individuals were created and the age--blood pressure relationship was determined for each group.

RESULTS

The study included 3 291 058 participants (59.6% women), with a mean age of 55.8 ± 9.8 years. The prevalence of hypertension was 47.6%, of which 30.0% were taking antihypertensive medications. The mean SBP was 135.9 ± 20.2 mmHg. SBP increased at a mean unadjusted rate of 0.639 ± 0.001 mmHg/year. For 95% of the 25 145 subgroups, the SBP increased by 0.28--0.85 mmHg/year. The most common characteristics in the subgroups with the steepest association were female sex, rural area, low education, low-income family, Tibet region, and farmer occupation. The increase in SBP ranged from 0.13 to 0.41 mmHg/year for 95% of the treated subgroups and from 0.33 to 0.82 mmHg/year for 95% of the untreated subgroups.

CONCLUSION

Blood pressure is positively associated with age in this study, with almost three-fold variation across subgroups, indicating subgroup differences in biology, behaviour, or exposures. Antihypertension strongly blunts the association of age and blood pressure and diminishes the variation.

Gender differences and determinants of prevalence, awareness, treatment and control of hypertension among adults in China and Sweden

Background

Failure to promote early detection and better management of hypertension will contribute to the increasing burden of cardiovascular diseases. This study aims to assess the gender differences in the prevalence, awareness, treatment and control of hypertension, together with its associated factors, in China and Sweden.

Methods

We used data from two cross-sectional studies: the Västerbotten Intervention Program in northern Sweden (n = 25,511) and the Shanghai survey in eastern China (n = 25,356). We employed multivariable logistic regression to examine the socio-demographics, lifestyle behaviours, and biological factors associated with the prevalence, awareness, treatment and control of hypertension.

Results

Men had a higher prevalence of hypertension (43% in Sweden, 39% in China) than their female counterparts (29 and 36%, respectively). In Sweden, men were less aware of, less treated for, and had less control over their hypertension than women. Chinese men were more aware of, had similar levels of treatment for, and had less control over their hypertension compared to women. Awareness and control of hypertension was lower in China compared to Sweden. Only 33 and 38% of hypertensive Chinese men and women who were treated reached the treatment goals, compared with a respective 48 and 59% in Sweden. Old age, impaired glucose tolerance or diabetes, a family history of hypertension or cardiovascular diseases, low physical activity and overweight or obesity were found to increase the odds of hypertension and its diagnosis.

Conclusions

This study shows the age and gender differences in the prevalence, awareness, treatment and control of hypertension among adults in China and Sweden. Multisectoral intervention should be developed to address the increasing burden of sedentary lifestyle, overweight and obesity and diabetes, all of which are linked to the prevention and control of hypertension. Development and implementation of the gender- and context-specific intervention for the prevention and control of hypertension facilitates understanding with regard to the implementation barriers and facilitators.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09862-4.

Association of hemoglobin glycation index and its interaction with obesity/family history of hypertension on hypertension risk: a community-based cross-sectional survey

Background

Hemoglobin glycation index (HGI) is considered to be a convenient measurable indicator to assess the inter-individual variation of HbA1c. In the present study, we tested the relationship between HGI and risk of hypertension, and further explored the possible interacting influences of HGI with other such factors on hypertension risk among Chinese individuals.

Methods

The eligible subjects were chosen from a community-based cross-sectional survey in China. We collected relevant data and clinical indicators for each participant. HGI was calculated as “measured HbA1c-predicted HbA1c” and divided into four categories according to quartile. The following indicators were used to assess interactive effects: (1) relative excess risk due to interaction (RERI); (2) attributable proportion due to interaction (AP); and (3) synergy index (SI). Statistical analysis was performed using R software.

Results

Specifically, 1777 eligible participants were selected in this cross-sectional survey. There were 433 subjects who were identified to have hypertension (24.4%). A significant increase in the prevalence of hypertension from Q1 to Q4 of HGI was observed (p < 0.001). Multivariable logistic model demonstrated that subjects at the highest HGI group had a substantially increased risk of being hypertensive than subjects in the first quartile of HGI, as indicated by the OR value of 1.87 (95% CI 1.26–2.78). Moreover, a significant interaction between family history of hypertension and HGI on hypertension risk was detected (RERI: 1.36, 95% CI 0.11–2.63; AP: 0.43, 95% CI 0.17–0.69; and SI:2.68, 95% CI 1.10–6.48). The interactive effect between HGI and abdominal obesity was also found to be significant, as estimated by the value of RERI (1.04, 95% CI 0.24–1.85), AP (0.33, 95% CI 0.11–0.56) and SI (1.96, 95% CI 1.01–3.79). However, in the analysis of the interaction between HGI and general obesity, only the AP value (0.28, 95% CI 0.01–0.54) was observed to be significant.

Conclusion

High HGI was independently associated with the risk of hypertension. Moreover, HGI significantly shared interactions with obesity and family history of hypertension that influenced the risk of hypertension.

Sex differences in the association between major risk factors and the risk of stroke in the UK Biobank cohort study

Objective

To determine whether there are sex differences in the association between risk factors and incident stroke, including stroke subtypes.

Methods

A total of 471,971 (56% women) UK Biobank participants without a history of cardiovascular disease were included. During 9 years of follow-up, 4,662 (44% women) cases of stroke were recorded. Cox models yielded adjusted hazard ratios (HRs) and women-to-men ratios of HRs (RHRs) for stroke associated with 7 risk factors.

Results

The incidence rate per 10,000 person-years was 8.66 (8.29–9.04) in women and 13.96 (13.44–14.50) in men for any stroke, 6.06 (5.75–6.38) in women and 11.35 (10.88; 11.84) in men for ischemic stroke, and 1.56 (1.41–1.73) in women and 2.23 (2.02–2.45) in men for hemorrhagic stroke. The association between increases in blood pressure, body anthropometry, and lipids, diabetes, and atrial fibrillation and any stroke was similar between men and women. Hypertension, smoking, and a low socioeconomic status were associated with a greater HR of any stroke in women than men; the RHRs were 1.36 (1.26–1.47), 1.18 (1.02–1.36), and 1.17 (1.03–1.33), respectively. Diabetes was associated with a higher HR of ischemic stroke in women than men (RHR 1.25 [1.00–1.56]). Atrial fibrillation was associated with a higher HR of hemorrhagic stroke in women than men (RHR 2.80 [1.07–7.36]).

Conclusion

Several risk factors are more strongly associated with the risk of any stroke or stroke subtypes in women compared with men. Despite this, the incidence of stroke remains higher among men than women.

Transcutaneous electrical acupoint stimulation for stage 1 hypertension: protocol for a randomized controlled pilot trial

Background

Hypertension is a major pathogenic factor of cardiovascular diseases. Insufficient blood pressure control rate and sub-optimal medication adherence remain challenges for effective management of hypertension. Transcutaneous electrical acupoint stimulation (TEAS) has been used to treat various diseases, including hypertension, but the scientific evidence for its benefit remains insufficient. Therefore, we will perform a randomized, controlled clinical trial in patients with stage 1 hypertension to evaluate the effect of TEAS.

Methods/design

The study will be a two-arm parallel, randomized controlled trial. Sixty patients with stage 1 hypertension will be randomly assigned to the TEAS group and the control group in a 1:1 ratio. The participants in the TEAS group will receive non-invasive acupoint electrical stimulation for 30 min at four acupoints in the upper and lower extremities at home, 4 times weekly for 12 weeks for a total of 48 sessions. Participants in the control group will not receive any form of acupoint stimulation. All participants in both groups will receive lifestyle education on how to control high blood pressure, including diet, weight control, and exercise. The primary outcome measure will be the change of the mean systolic blood pressure from baseline to 12 weeks. Secondary outcomes include the change of mean diastolic blood pressure, quality of life, body mass index, and physical activity level.

Discussion

This pilot, randomized, controlled trial will explore the feasibility of TEAS. It will also provide potential clinical evidence for the efficacy and safety of TEAS in the treatment of patients with stage 1 hypertension. The results of this study will be published in peer-reviewed journals. Furthermore, this pilot trial as the precursor of a large scale randomized controlled trial will inform the sample size of the subsequent trial.

Trial registration

Chinese clinical trial registry, ChiCTR1900025042, Registered on 8 August 2019 (http://www.chictr.org.cn/showproj.aspx?proj=41496).

Elevated glycosylated hemoglobin levels and their interactive effects on hypertension risk in nondiabetic Chinese population: a cross-sectional survey

BACKGROUND

Abnormal glucose metabolism has been suggested to be involved in the development of hypertension. This study investigated the effect of the association and potential interaction of glycosylated hemoglobin (HbA1c) and other factors on the risk of hypertension among Chinese nondiabetic adults.

METHODS

As a cross-sectional survey, the current work deployed a questionnaire survey, anthropometric tests, and biochemical measures for each of the eligible participants. The HbA1c levels were quantified and grouped by quartiles. Correlations between HbA1c and hypertension, isolated systolic hypertension (ISH), and isolated diastolic hypertension (IDH) risk were investigated by logistic analyses. For evaluating the interactive effects, the parameters of relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were calculated, respectively.

RESULTS

In the current study, 1462 nondiabetic subjects were enrolled. In total, the prevalence rates of hypertension, ISH and IDH were 22.4, 9.6 and 4.5%, respectively. When HbA1c levels were grouped by quartile, it was revealed that the prevalence rates of hypertension and ISH were substantially elevated across groups (Pfor trend < 0.001). In the multivariable logistic regression analyses, in comparison with the first quartile of HbA1c, the normalized OR for hypertension risk was 1.90 (95% CI: 1.28-2.80) for the highest quartile. Also, the risk of ISH was significantly increased with HbA1c level in the highest quartile relative to in the bottom quartile (OR: 2.23,95% CI:1.47-3.71). However, no significant relationship between the HbA1c level and IDH risk was observed (OR: 1.78, 95% CI: 0.82-3.84). Eventually, it was demonstrated from the interactive effect analysis that HbA1c significantly interacted with abdominal obesity (RERI: 1.48, 95% CI: 0.38-2.58; AP: 0.37, 95% CI: 0.14-0.60 and SI: 1.96, 95% CI: 1.06-3.62) and family history of hypertension (AP: 0.37, 95% CI: 0.05-0.70) in influencing the risk of hypertension in nondiabetic participants.

CONCLUSION

Higher HbA1c levels significantly enhanced the risk of hypertension and ISH, but not IDH among Chinese nondiabetic adults. Moreover, the risk of hypertension was also aggravated by the upregulated HbA1c in a synergistic manner alongside abdominal obesity and family history of hypertension.

Stroke in Women

PURPOSE OF REVIEW

This article reviews sex differences in stroke risk and presentation, with a particular emphasis on the unique risk factors women experience throughout the lifespan.

RECENT FINDINGS

Although prior studies suggested women have worse outcomes after stroke, it is now clear that age, prestroke functional status, and comorbidities explain many of the differences between men and women in stroke severity, functional outcomes, and mortality. Several meta-analyses and large cohort studies have evaluated the risk factors for women related to reproductive factors and found that fewer years between menarche and menopause, pregnancy complications (preeclampsia/eclampsia, preterm delivery, and stillbirth), oophorectomy, hormone replacement therapy use, and younger age at menopause all increase the risk of stroke. Although the nonreproductive risks of stroke overlap between men and women, those with greater impact on women include age, hypertension, atrial fibrillation, socioeconomic status, and depression.

SUMMARY

Significant sex differences are observed in risk factors of stroke and stroke outcome. Including this information in the clinical assessment of the individual patient may support development of more effective prevention plans.

Self-reported diet management, dietary quality, and blood pressure control in Korean adults with hypertension

OBJECTIVES

Hypertension control is a major public health concern. Daily preventive practices of the affected individual are essential for controlling blood pressure (BP). We investigated the association of diet management practice, dietary quality, and BP control among Korean adults with known hypertension.

METHODS

We included 4107 participants aged 40-79 years who reported physician-diagnosed hypertension in the Korea National Health and Nutrition Examination Survey 2013-2016. Dietary management practice was defined by self-report, and dietary intakes were assessed by a 24-h dietary recall. Dietary quality and adherence were evaluated based on the Korean Healthy Eating Index (KHEI) using food and nutrient intakes assessed by a 24-h dietary recall. BP control was defined as systolic/diastolic BP < 140/90 mmHg.

RESULTS

While the prevalence of dietary management was higher in women than men, BP control rate was not different by sex. Dietary management practice had no significant association with BP control in both men and women. Only in men, dietary quality was positively associated with BP control (OR: 1.10 per KHEI 10 score increase, 95% CI: 1.00-1.20, p-value = 0.04). Men who had a highly adherent diet seemed to have a higher possibility of BP control, but there was no statistical significance (OR: 1.54, 95% CI: 0.84-2.81, p-value = 0.16).

CONCLUSIONS

A high-quality diet was positively associated with BP control in Korean men aware of their hypertension. Our findings highlight the beneficial impact of dietary management as a means for achieving blood pressure control.

Prevalence, Awareness, Treatment and Control of Hypertension in Russian Federation (Data of Observational ESSERF-2 Study)

Participants of the study ESSE-RF-2 and co-authors: Moscow: Konstantinov V. V., Pokrovskaya M.S., Efimova I.A., Sivakova O.V.; Krasnodar: Alekseenko S.N., Gubarev S.V.; Оmsk: Livzan M.A., Grishechkina I.A., Rozhkova M.Yu.; Republic of Karelia: Vezikova N.N., Skopec I. S.; Ryazan: Filippov E.V., Dobrynina N.V., Nikulina N.N., Pereverzeva K.G., Moseychuk K.A.

Aim. Evaluate the prevalence, awareness, treatment, and control of hypertension among people aged 25-64 examined in 4 regions of the Russian Federation.

 Material and methods. Study materials were the representative selections of non-organized male (n=3000) and female (n=3714) inhabitants of aged 25-64 from 4 regions of the Russian Federation (Krasnodar region, Omsk region, Ryazan region, the Republic of Karelia), response rate>80%. Systematic stratified multilevel random election was formed with locality criteria (Kisch method). All the participants were interviewed using the standard questionnaire. The universal epidemiological methods and evaluation criteria were used. The study was approved by the local ethics Committee of National research center for preventive medicine. Participants signed informed consent. Hypertension was defined as an average systolic blood pressure (SBP)≥140 mmHg and/or average diastolic blood pressure (DBP)≥90 mmHg and/or antihypertensive therapy (AHT). The efficacy of treatment was the achievement of the target BP. Control group – patients with BP<140/90 mmHg.

 

Results. Mean SBP and DBP were 128.7±0,3 mmHg and 82.8±0.1 mmHg, respectively, higher BP was detected among male (p<0,001). The prevalence of hypertension was 44.2% that was higher among males than females (49.1% vs 39.9%, р˂0.0005), the highest hypertension frequency was in the Ryazan region. The awareness of hypertension was higher among females than in males 76.8% vs 69.4%. There were more persons with hypertension grade 1 among those, who were not aware of the hypertension. Medications were taken by 65.5% of females and 41.8% of males.

Angiotensin-converting enzyme inhibitors were received by 49.9% of patients, angiotensin II receptor antagonists by 30.9%, beta blockers – 29.5%, diuretics – 22.7%, calcium antagonists – 15.7%, centrally acting drugs – 3.3%, others – 0.2%. The lack of AHT intake was negatively associated with age, ischemic heart disease, urban life and hypo-HDL especially among males. Heart rate >80 per min in females increased by 1.7 times the probability of absence of AHT. The prevalence of effectively treated was 49.7% of the participants with hypertension. The associations between ineffective treatment and abdominal obesity, ischemic heart disease (males), age, rural type of settlement, obesity (females) were found. Only 24.9% of patients had control of the hypertension.

Conclusion. The prevalence of hypertension in Russian Federation remains high. An important task of the medical community is to identify the disease at an earlier stage of its development, before the appearance of complications. This approach can reduce the period from the onset of high blood pressure to a visit to the doctor.