Changes in average blood pressure and incidence of high blood pressure 1983-1984 to 1987-1988 in four population cohorts in the People's Republic of China. The PRC-USA Cardiovascular and Cardiopulmonary Epidemiology Research Group

Incident hypertension in urban slums of central India: a prospective cohort study

Background

Numerous studies have highlighted the burden of hypertension by estimating its prevalence. However, information regarding quantum and characteristics of persons whose blood pressure converts to hypertension range from their previous state of prehypertension or normal blood pressure is crucial for any public health programme. We aimed to estimate incidence rate of hypertension and to identify risk factors for the same, so that it is useful for programme implementation.

Methods

We established a cohort of adults residing in urban slums of Bhopal, who were registered in a baseline cardiovascular risk assessment survey, which was performed between November 2017 and March 2018. Blood pressure assessment was done at least three times at baseline for diagnosis of hypertension, which was defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg on two occasions. Participants who did not have a diagnosis of hypertension were followed up during April–June 2019.

Results

Of the 5673 participants assessed at baseline, 4185 did not have hypertension of which 3199 (76.4%) were followed up after a median on 1.25 years (IQR 1.08–1.60) and a total of 170 (5.31%) individuals were detected with incident hypertension. Overall incidence rate of hypertension was 4.1 (95% CI 3.54 to 4.75) per 100 person-years of follow-up. On multivariate analysis, age (relative risk/RR 1.98; 95% CI 1.19 to 3.3, for age >60 years), being in first and second wealth tertile (T-1 RR 1.85; 95% CI 1.17 to 2.91) and being illiterate (RR 1.94; 95% CI 1.31 to 2.86) were significant predictors of incident hypertension. Individuals who had prehypertension at baseline also had a significantly increased risk of developing hypertension (RR 2.72; 95% CI 1.83 to 4.03).

Conclusions

We found that incidence of hypertension in urban slums of central India is higher with increasing age and in men. Illiteracy, lower Wealth Index and prehypertension are other determinants. We also demonstrate feasibility of establishing a cohort within the public health delivery system, driven by efforts of community health workers.

Prevalence, treatment patterns and control rates of metabolic syndrome in a Chinese diabetic population: China Cardiometabolic Registries 3B study

AIMS/INTRODUCTION

To investigate the prevalence and risk factors of metabolic syndrome (MetS) in Chinese type 2 diabetes mellitus patients, and assess the effect of MetS on the treatment patterns and blood glucose, blood pressure and blood lipids goal achievements.

MATERIALS AND METHODS

Data from 25,454 type 2 diabetes mellitus patients including demographic data, anthropometric measurements, treatment patterns, and blood glucose and lipid profiles were retrospectively analyzed.

RESULTS

Using modified Adult Treatment Panel III MetS criteria, the prevalence of MetS was 57.4% in type 2 diabetes mellitus patients. Multivariable logistic regression analysis showed that type 2 diabetes mellitus patients, who also fulfilled the criteria for MetS, tended to be women, living in the northeast, with a diabetes duration ≥5 years and leading a sedentary lifestyle. Most MetS (53.4%) and non-MetS (57%) diabetes patients received oral hypoglycemic drugs. Insulin or insulin combination therapies were more applied in MetS (37.5%) than in non-MetS (33.1%) diabetes patients, and the percentages of MetS diabetes patients receiving antihypertensive and lipid-modulating drugs were 52.9% and 28.2% vs 38.3% and 19.3% of the non-MetS diabetes patients. Just 37.5%, 15.6% and 32.9% of the MetS diabetes patients vs 54.6%, 45.6% and 40.4% of the non-MetS diabetes patients achieved the individual target goals for control of blood glucose (glycosylated hemoglobin <7%), blood pressure (systolic blood pressure <130 mmHg, diastolic blood pressure <80 mmHg) and blood lipids (total cholesterol <4.5 mmol/L), whereas just 2.1% achieved all three target goals.

CONCLUSIONS

MetS with a high prevalence in Chinese type 2 diabetes mellitus patients is associated with poor blood glucose, blood pressure and blood lipids control rate.

Body mass index and waist circumference combined predicts obesity-related hypertension better than either alone in a rural Chinese population

Limited information is available on the association of obesity defined by both body mass index (BMI) and waist circumference (WC) with incident hypertension in rural China. A total of 9,174 participants ≥18 years old from rural areas in middle of China, free of hypertension, diabetes, myocardial infarction and stroke, were selected in this cohort study. Questionnaire interview and anthropometric and laboratory measurements were performed at baseline (2007–2008) and follow-up (2013–2014). During the 6 years of follow-up, hypertension developed in 733/3,620 men and 1,051/5,554 women. After controlling for age, education level, smoking, drinking, physical activity, and family history of hypertension, the relative risk of hypertension was lower for participants with high BMI but normal WC than those with both BMI and WC obesity for men 18–39 and 40–59 years old. Women 18–39 years old with normal BMI but high WC showed a 1.96-fold risk of hypertension, and being female with age 40–59 years and high BMI but normal WC was independently associated with hypertension incidence as compared with both normal BMI and WC. BMI is more associated with hypertension as compared with WC in both genders. High WC tends to add additional risk of hypertension in young women.

Ethnic differences in the incidence of hypertension among rural Chinese adults: results from Liaoning Province

BACKGROUND

This study was conducted to examine the differences in the incidence of hypertension and associated risk factors between Mongolian and Han populations in northeast China.

METHODS

A population-based sample of 4753 Mongolian subjects and 20,247 Han subjects aged ≥ 35 years and free from hypertension at baseline were followed from 2004-2006 to 2010. Incident hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or current use of antihypertensive medication.

RESULTS

During mean 4.3 years follow-up, a total of 8779 individuals developed hypertension. The age-adjusted incidence of hypertension for Mongolian subjects was 12.64 per 100 person-years, for Han subjects was 9.77 per 100 person-years (P<0.05). The incidence of hypertension was positively correlated with age, physical activity, drinking, body mass index (BMI), family of hypertension and prehypertension in the Han population. In the Mongolian population, hypertension was positively correlated with age, physical activity, education level, drinking, BMI, prehypertension and family history of hypertension. The rates of awareness, treatment and control of hypertension for newly developed cases among both Han and Mongolian populations were low. (36.5% vs. 42.3%, 13.1% vs. 18.2%, 0.7% vs. 1.3%, P<0.05, respectively).

CONCLUSIONS

The incidence rate of hypertension is higher in the Mongolian populations than that in the Han populations, and hypertension in both ethnic populations was associated with similar risk factors. Our results suggest that most newly-diagnosed cases of hypertension are not adequately treated. Improvements in hypertension prevention and control programs in rural China are urgently needed.

Adverse trends of cardiovascular risk factors among low risk populations (1983-1994)--a cohort study of workers and farmers in Guangzhou, China

BACKGROUND

The levels and trends of cardiovascular risk factors vary greatly throughout China. We examine 10-year trends of cardiovascular risk factors (1983-1994) and the factors related to these trends among low-risk cohorts of workers and farmers in Guangzhou, China.

METHODS

This is a cohort study of 3,131 workers and 3,493 farmers aged 25-64 years at baseline with 10 years of follow-up. We performed a longitudinal analysis to account for the aging of the cohorts and the repeated measures of the same individual.

RESULTS

At baseline the prevalence of overweight (including obese) ranged from 1.0% to 11.8%, hypertension ranged from 3.8% to 10.5%, and mean serum total cholesterol (TC) ranged from 155.4 mg/dl to 187.2 mg/dl. Although prevalence of smoking declined, blood pressure levels and body mass index (BMI) increased significantly, and lipid profiles changed unfavorably during the 10-year follow-ups. The prevalence of hypertension increased from 5.0 percentage points (female farmers) to 12.3 percentage points (male farmers). Mean TC increased significantly (e.g., +22.8 mg/dl and +17.0 mg/dl in male and female farmers, respectively). In the longitudinal data analyses, increase in BMI was associated with increase in blood pressure levels and TC. Significant adverse trends of risk factors persisted after adjustment for aging, education, BMI, smoking, and alcohol intake.

CONCLUSION

Urgent action is needed to prevent and reverse the unhealthy trends occurring among these low risk Chinese workers and farmers.

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

BACKGROUND

To determine the incidence of hypertension and its risk factors among rural Chinese women with prehypertension and normotension.

METHODS

A population-based sample of 12,060 rural Chinese women aged > or = 35 years and free from hypertension at baseline were followed from 2004-2006 to 2008. Incident hypertension was defined as systolic blood pressure (SBP) > or = 140 mm Hg, diastolic blood pressure (DBP) > or = 90 mm Hg, or current use of antihypertensive medication.

RESULTS

Over a median follow-up of 28 months (range, 14-47 months), 23.4% of women developed hypertension. The age-adjusted incidence rate was higher in prehypertension than in normotension (11.2/100 person-years vs. 7.9/100 person-years, P < 0.05). Among women with prehypertension, independent predictors of incident hypertension were baseline age, Mongolian ethnicity, low physical activity, baseline body mass index (BMI), baseline salt intake and family history of hypertension. Among women with normal blood pressure (BP), independent predictors were baseline age, low physical activity, baseline BMI and baseline salt intake. The awareness, treatment, and control rates for newly developed hypertension were 33.2, 23.0, and 2.1%, respectively.

CONCLUSIONS

These data indicate that the incidence of hypertension is high among rural Chinese women and it is associated with many risk factors, and the data also suggest that most newly developed hypertension cases are not treated. This high incidence of hypertension may be related to rapid social changes in our country and may apply to other areas of the developing world. These results call for urgent improvements in hypertension prevention, detection and treatment.

Incidence and predictors of hypertension among rural Chinese adults: results from Liaoning province

OBJECTIVE We wanted to determine the incidence of hypertension and its risk factors among rural Chinese adults.

METHODS

A population-based sample of 24,360 rural Chinese adults aged 35 years and older and free from hypertension at baseline was observed from 2004-2006 to 2008. Incident hypertension was defined as a systolic pressure of 140 mm Hg or greater, diastolic pressure of 90 mm Hg or greater, or current use of antihypertensive medication.

RESULTS

During a mean follow-up period of 28 months, 29.6% of men and 23.4% of women developed hypertension. The age-adjusted incidence was higher in men (12.75 per 100 person-years) than in women (10.04 per 100 person-years). Among men, independent predictors of incident hypertension were baseline age (hazard ratio [HR] = 1.11; 95% confidence interval [CI], 1.10-1.13), Mongolian ethnicity (HR = 1.09; 95% CI, 1.01-1.18), use of alcohol, (HR = 1.14; 95% CI, 1.06-1.23), high income vs low income (HR = 1.11; 95% CI, 1.00-1.22; and HR = 1.11; 95% CI, 1.03-1.20), prehypertension vs normotension (HR = 1.18; 95% CI, 1.08-1.28), overweight and obesity (HR = 1.28; 95% CI, 1.17-1.40), baseline salt intake (HR = 1.00; 95% CI, 1.00-1.01) and family history of hypertension (HR = 1.14; 95% CI, 1.03-1.27). With the exception of use of alcohol and mean income, the results were similar for women, except that low physical activity was shown as a risk factors as well. The awareness, treatment, and control rates for newly developed hypertension were 29.9%, 19.5%, and 1.5%, respectively.

CONCLUSIONS

These data indicate that the incidence of hypertension is high among these rural Chinese adults and that it is associated with many risk factors. Our findings further suggest that most newly developed hypertension cases are not treated. The increases in hypertension are probably related to rapid social changes in our country and may apply to other areas of the developing world. These findings call for urgent improvements in hypertension prevention and control programs in rural China.

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.

Incidence and predictors of hypertension over 8 years among Chinese men and women

OBJECTIVE

To determine the 8-year incidence of hypertension and its risk factors among Chinese adults.

METHODS

A population-based sample of 10,525 Chinese adults aged > or = 40 years and free from hypertension at baseline was followed up from 1991 to 1999-2000. Incident hypertension was defined as systolic pressure > or = 140 mmHg, diastolic pressure > or = 90 mmHg, or current use of antihypertensive medication.

RESULTS

Over a mean of 8.2 years of follow-up, 28.9% of men and 26.9% of women developed hypertension. Among men, independent predictors of incident hypertension were baseline age [relative risk (RR) per 5 years: 1.10; 95% confidence interval (CI): 1.07, 1.13], living in urban regions versus rural regions (RR: 0.74; 95% CI: 0.64, 0.85), alcohol drinking versus non-drinking (RR: 1.13; 95% CI: 1.02, 1.24), prehypertension versus normotension (RR: 1.70; 95% CI: 1.53, 1.88), heart rate (RR of third versus first tertile: 1.27; 95% CI: 1.13, 1.44), body mass index (RR of third versus first tertile: 1.28; 95% CI: 1.12, 1.46) and low versus high physical activity (RR: 1.27; 95% CI: 1.10, 1.47). Results were similar for women, with current smoking in place of alcohol drinking and opposite results for region. The population-attributable risk of modifiable risk factors was between 25 and 50%.

CONCLUSIONS

These data indicate that the incidence of hypertension is high among these Chinese adults, and suggest that 25-50% of new hypertension cases could be prevented with risk factor modification. Given the excess cardiovascular mortality associated with hypertension, these data call for urgent improvements in hypertension prevention and control programs in China.

Prevalence and risk factors of overweight and obesity in China

OBJECTIVE

To examine the prevalence and risk factors of overweight and obesity in China.

RESEARCH METHODS AND PROCEDURES

A cross-sectional survey was conducted in a nationally representative sample of 15,540 Chinese adults in 2000-2001. Body weight, height, and waist circumference were measured by trained observers. Overweight and obesity were defined according to the World Health Organization classification. Central obesity was defined according to guidelines of the International Diabetes Federation.

RESULTS

Mean BMI and waist circumference were 23.1 kg/m2 and 79.6 cm, respectively, for men and 23.5 kg/m2 and 77.2 cm, respectively, for women. The prevalences of overweight and obesity were 24.1% and 2.8% in men and 26.1% and 5.0% in women, respectively. The prevalence of central obesity was 16.1% in men and 37.6% in women. The prevalences of overweight, obesity, and central obesity were higher among residents in northern China compared with their counterparts in southern China and among those in urban areas compared with those in rural areas. Lifestyle factors were the most important risk factors to explain the differences in overweight and central obesity between northern and southern residents. Among women, lifestyle and diet were the most important risk factors to explain the differences between urban and rural residents, whereas socioeconomic status, lifestyle, and diet were all important among men.

DISCUSSION

Our study indicates that overweight and obesity have become important public health problems in China. Environmental risk factors may be the main reason for regional differences in the prevalence of overweight and obesity in China.

Hypertension: trends in prevalence, incidence, and control

Hypertension is the leading cause of cardiovascular disease worldwide. Prior to 1990, population data suggest that hypertension prevalence was decreasing; however, recent data suggest that it is again on the rise. In 1999-2002, 28.6% of the U.S. population had hypertension. Hypertension prevalence has also been increasing in other countries, and an estimated 972 million people in the world are suffering from this problem. Incidence rates of hypertension range between 3% and 18%, depending on the age, gender, ethnicity, and body size of the population studied. Despite advances in hypertension treatment, control rates continue to be suboptimal. Only about one third of all hypertensives are controlled in the United States. Programs that improve hypertension control rates and prevent hypertension are urgently needed.

Blood pressure and the global burden of disease 2000. Part 1: Estimates of blood pressure levels

OBJECTIVE

To provide global estimates of blood pressure by age and sex for adults aged > or = 30 years, by WHO subregion.

DESIGN AND METHODS

Data were obtained from studies identified in a literature review of population-based surveys. These were complemented by data from MONICA and INTERSALT studies. Estimates of the shape of the age-systolic blood pressure (SBP) association were made from survey data utilizing parametric and non-parametric analyses. A linear sex-specific association of SBP with age was demonstrated from 30 to 70 years in females and 20 to 70 years for males in each subregion. Mean age- and sex-specific estimates of SBP were estimated for each WHO subregion separately, based on study and country-weighted SBP data.

RESULTS

Analyses were based on data from about 230 surveys and over 660 000 participants. Age-specific mean SBP values ranged from 114 to 164 mmHg for females, and 117-153 mmHg for males. Females typically had lower SBP levels than males in the 30-44-year age groups, but in all subregions, SBP levels rose more steeply with age for females than males. Therefore, SBP levels in those aged > or = 60 years tended to be higher in females. Subregions with consistently high mean SBP levels included parts of eastern Europe and Africa. Mean SBP levels were lowest in south-east Asia and parts of the western Pacific.

CONCLUSIONS

These global estimates of blood pressure by age, sex and subregion show considerable variation in estimated levels. The lack of data in developing countries is substantial, and this is an important limitation given the role of blood pressure in increasing cardiovascular disease levels.

Prevalence of the metabolic syndrome and overweight among adults in China

BACKGROUND

The metabolic syndrome and obesity are major risk factors for cardiovascular disease. Little information exists on the prevalence of the metabolic syndrome in China. We aimed to provide up-to-date estimates of the prevalence of the metabolic syndrome and overweight in the general adult population in China.

METHODS

We did a cross-sectional survey in a nationally representative sample of 15,540 Chinese adults aged 35-74 years in 2000-01. Metabolic syndrome was defined according to guidelines from the US National Cholesterol Education Program. Overweight was defined as body-mass index of 25.0 kg/m2 or greater.

FINDINGS

The age-standardised prevalence of metabolic syndrome was 9.8% (95% CI 9.0-10.6) in men and 17.8% (16.6-19.0) in women. The age-standardised prevalence of overweight was 26.9% (25.7-28.1) in men and 31.1% (29.7-32.5) in women. The prevalence of the metabolic syndrome and overweight was higher in northern than in southern China, and higher in urban than rural residents.

INTERPRETATION

Our results indicate that a large proportion of Chinese adults have the metabolic syndrome and that overweight has become an important public health problem in China. These findings emphasise the urgent need to develop national strategies for the prevention, detection, and treatment of overweight and the metabolic syndrome, to reduce the societal burden of cardiovascular disease in China.

Salt and hypertension: a phylogenetic perspective

Our hunter-gatherer ancestors appeared to survive on little salt. When today's rural dwellers move to urban environments, they increase their salt intake and the salt-sensitive among them become prone to age-related increase in blood pressure and hypertension. This paper reviews our knowledge of the mechanisms of salt disposal and plasma volume regulation, salt consumption in human evolution, salt intake and prevalence of hypertension, and the results of interventions aimed at modulating both. Finally, it discusses current hypotheses on the mechanisms of selective pressure that may have favored the emergence of a salt-sensitive, hypertensive genotype. Similar to 'thrifty' genes, which supported energy savers in times of scarcity, but may now be causing obesity and type 2 diabetes, 'thirsty' genes, by acting on salt and water retention, might have helped individuals survive the challenge of volume-depleting illnesses, especially when combined with stress-inducing situations, but may now cause high BP and related damage in the post-reproductive age.

Trends in Prevalence, Awareness, Treatment and Control of Hypertension in the Middle-Aged Population of China, 1992-1998

The objective of this study was to analyze the trends in prevalence, awareness, treatment and control of hypertension in the middle-aged population of China. There were about 1,000 participants each from 13 different study populations that were examined in surveys conducted from 1992-1994 (n=18,746) and in 1998 (n=13,504) in conjunction with the China Multi-Center Study of Cardiovascular Epidemiology. Half the subjects were men and half were women; their ages ranged from 35 to 59 years. Hypertension was defined as systolic blood pressure > or =140 mmHg, diastolic blood pressure > or =90 mmHg, and/or current treatment with antihypertensive medications. Hypertension awareness and treatment were assessed with a standardized questionnaire. Hypertension control was defined as blood pressure measurements of less than 140/90 mmHg. The results showed that 24.0% of participants had hypertension in 1998, an increase of 2.3% from 1992-1994 (p <0.05). The prevalence of hypertension was 25.4% higher in urban than in rural areas, and was higher in men than in women. Among hypertensives, 42.6% were aware of their hypertension (a 5.3% increase compared with 1992-1994, p <0.05), 31.1% were treated (a 3.8% increase, p <0.05), and 6.0% were controlled (a 2.6% increase, p <0.05). The rates of awareness, treatment and control were higher in women than men, and higher in urban than rural areas. For treated hypertensives, the rate of control increased from 12.7% in 1992-1994 to 19.9% in 1998 (p <0.05). These findings indicate that hypertension prevalence is increasing in China. Control rates, while improving, still remain low. This implies that effective public health measures are needed to enhance the awareness, treatment, and control rates in the Chinese population.

Geographic variations in the prevalence, awareness, treatment and control of hypertension in China

OBJECTIVE

To compare the prevalence, awareness, treatment and control of hypertension in north and south, and urban and rural residents of China.

DESIGN

A cross-sectional survey conducted in 2000-2001.

SETTING AND PARTICIPANTS

A multistage cluster sampling method was used to select a nationally representative sample of 15 540 men and women aged 35-74 years from the general Chinese population.

MAIN OUTCOME MEASURES

Three blood pressure measurements were obtained by trained observers using a standardized mercury sphygmomanometer. Information on history of hypertension and use of antihypertensive medications was obtained by use of a standard questionnaire. Hypertension was defined as a mean systolic blood pressure >or= 140 mmHg and/or diastolic blood pressure >or= 90 mmHg and/or use of antihypertensive medications.

RESULTS

The age-standardized prevalence of hypertension was significantly higher among residents living in north than in south China (33.8 versus 23.3%, P < 0.001), but similar in those living in urban and rural areas (29.0 versus 28.1%, P = 0.3). Average systolic and diastolic blood pressure levels were consistently higher in north than in south residents. Residents in north China had higher percentages of awareness but lower percentages of control compared with their counterparts in south China. Percentages of awareness, treatment and control of hypertension were significantly higher in urban than in rural residents.

CONCLUSIONS

Our study documents a marked north-south gradient in the prevalence of hypertension in China. The previously reported urban-rural difference in the prevalence of hypertension was not noted, perhaps due to a rapid increase in the prevalence of hypertension in rural China.

Reducing the global burden of cardiovascular disease: the role of risk factors

During the last century, cardiovascular disease (CVD) has burgeoned from a relatively minor disease worldwide to a leading cause of morbidity and mortality. By 2020 it is projected that CVD will surpass infectious disease as the worlds leading cause of death and disability. Some of this increase in the relative importance of CVD is due to improved public health measures and medical care leading to longer life spans and reduced mortality from other causes. However, a substantial portion of the increasing global impact of CVD is attributable to economic, social, and cultural changes that have led to increases in risk factors for CVD. These changes are most pronounced in the countries comprising the developing world. Because the majority of the worlds population lives in the developing world, the increasing rate of CVD in these countries is the driving force behind the continuing dramatic worldwide increase in CVD. In order to blunt the impact of the global explosion in CVD, it will be crucial to attempt to understand and reduce the global increase in CVD risk factors. In this review, the authors describe the changes responsible for the global epidemic of CVD, with particular attention to the contributions of established risk factors and their impact on the growth of CVD among the worlds various economic sectors. The authors outline the major challenges facing countries in different economic sectors, and discuss ways to address these challenges with the goal of reducing the global burden of CVD.