Hypertension prevalence, awareness, treatment, control, and associated factors in Southwest China: an update

Awareness of Hypertension, Hypercholesterolemia, and Diabetes Mellitus and Associated Characteristics in Russian Adults

Russia has higher cardiovascular disease (CVD) mortality compared to other European countries. The major CVD risk factors are age, male sex, and three conditions, namely hypertension, hypercholesterolemia, and diabetes mellitus (DM). This study aimed to assess awareness of these three conditions among Russian adults (N = 3803) and the associated socio-demographic, lifestyle, and health characteristics. We used cross-sectional data from a randomly drawn population-based sample of Russians aged 35-69 years, who participated in the Know Your Heart (KYH) study conducted in Arkhangelsk and Novosibirsk between 2015-2018. Participants' self-reported awareness of hypertension, hypercholesterolemia, and DM was assessed against the measures at the KYH health check (blood pressure, cholesterol, HbA1c and/or use of medication for each condition). Prevalence estimates for the awareness were age- and sex-standardized to the Standard European Population. Socio-demographic, lifestyle, and health-related correlates of the awareness were investigated using logistic regression modelling. Among participants with hypertension (N = 2206), hypercholesterolemia (N = 3171), and DM (N = 329) recorded at a health check, 79%, 45%, and 61% self-reported these conditions, respectively. Higher awareness of hypercholesterolemia and hypertension was associated with older age, female sex, nonsmoking status, obesity, and history of CVD diagnoses. Low household income and history of CVD diagnoses were associated with being aware of DM. The awareness rates of hypertension were relatively high, whereas awareness rates of hypercholesterolemia and DM were relatively low. CVD prevention and early intervention could be improved in Russia through increasing the awareness of the risk factors.

Factors associated with non-treatment of hypertension and gender differences at baseline in the ELSA-Brasil cohort

The treatment of arterial hypertension (AH) contributes to the reduction of morbidity and mortality. Gender differences are likely to play a role, as non-treatment is associated with clinical and sociodemographic aspects. The aim of this study was to investigate the factors associated with non-treatment of AH and gender differences in hypertensive individuals from the ELSA-Brasil cohort. The study was conducted with 5,743 baseline hypertensive cohort participants. AH was considered if there was a previous diagnosis or if systolic blood pressure (SBP) was ≥140 and/or diastolic BP (DBP) was ≥90 mmHg. Sociodemographic and anthropometric data, lifestyle, comorbidities, and use of antihypertensive medications were evaluated through interviews and in-person measurements. Treatment with renin-angiotensin-aldosterone system inhibitors (RAASi) or other antihypertensive medications and non-treatment were evaluated with multivariate logistic regression. Non-treatment was observed in 32.8% of hypertensive individuals. Of the 67.7% treated individuals, 41.1% received RAASi. Non-treatment was associated with alcohol consumption in women (OR=1.41; 95%CI: 1.15-1.73; P=0.001), lowest schooling level in men (OR=1.70; 95%CI: 1.32-2.19; P<0.001), and younger age groups in men and women (strongest association in males aged 35-44 years: OR=4.58, 95%CI: 3.17-6.6, P<0.001). Among those using RAASi, a higher proportion of white, older individuals, and with more comorbidities was observed. The high percentage of non-treatment, even in this civil servant population, indicated the need to improve the treatment cascade for AH. Public health policies should consider giving special attention to gender roles in groups at higher risk of non-treatment to reduce inequities related to AH in Brazil.

Bean and Nut Intake Were Protective Factors for Comorbid Hypertension and Hyperuricemia in Chinese Adults: Results from China Nutrition and Health Surveillance (2015-2017)

This study aimed to describe the prevalence of comorbid hypertension and hyperuricemia (HH) and detected the dietary factors for HH in Chinese adults aged 18 to 64 years. All of the data were collected from the China Nutrition and Health Surveillance 2015-2017, with a stratified, multistage, random sampling method on a national scale. A total of 52,627 adult participants aged 18~64 years from the CNHS 2015-2017 were included in this study. HH was identified as SUA level cut-offs for males and females of 420 μmol/L and 360 μmol/L, respectively, with mean systolic blood pressure ≥140 mmHg and/or mean diastolic blood pressure ≥ 90 mmHg and/or received antihypertensive treatment within two weeks. The differences in HH prevalence between or among the subgroups were compared by the Rao-Scott chi-square test. The correlations between HH and covariates or metabolic factors were detected by a weighted two-level multivariate survey logistic regression. The total weighted sufficient intake ratios of beans and nuts, vegetables, and red meat were 59.1%, 46.6%, and 64.8%, respectively. The weighted prevalence of HH in the total participants was 4.7% (95% CI: 4.3-5.0%). The positive effects of bean and nut on HH were observed. The participants who had sufficient bean and nut intake showed lower risk for HH (for the total participants: OR = 0.734, 95% CI = 0.611-0.881). The prevalence of HH might have been a public health problem, and bean and nut intake might be a protective factor for HH in the Chinese population.

Adherence Behaviors and Related Factors Among Elderly Hypertensive Patients in China: Evidence from the China Health and Retirement Longitudinal Study

Background

Non-adherence or partial adherence is the main reason for poor therapeutic effect of hypertension. This paper aims to assess adherence behaviors and related factors among elderly hypertensive patients in China.

Methods

Participants aged ≥60 years, with hypertension, and with complete data in 2018 interviews of the China Health and Retirement Longitudinal Study (CHARLS) were included. The adherence behaviors included medication, blood pressure monitoring and the combined adherence behaviors. Referring to the social-ecological theory, correlates of adherence behaviors were divided into three layers, namely demographic characteristics, health behaviors, living environment and retirement. Univariate and multivariable logistic regression models were performed to identify factors of adherence behaviors.

Results

The prevalence of medication adherence (76.58%) was higher than that of blood pressure monitoring adherence (20.08%), and the full adherence rate was 18.53%. Self-rated health status, smoking status, living area, and health education status were detected to be associated with medication adherence and blood pressure monitoring adherence (all p < 0.05). Gender, sleep duration, health examination, and physical exercise were also detected to be associated with blood pressure monitoring adherence (all p < 0.05). Self-rated health status and health education status were detected to be associated with partially and fully adherence, while age, living area, and life satisfaction were detected to be associated with partially adherence, smoking status, sleep duration, health examination, and pension reliance were detected to be associated with fully adherence (all p < 0.05).

Conclusion

Our study reveals the poor adherence behaviors of elderly hypertensive patients in China. This is most evident among those who were male, 60-69 years old, living in rural areas, self-reported being healthier, those without health examination and health education. Targeting these vulnerable populations, we suggest to strengthen health education, increase the publicity of basic public health services and enhance the self-management ability of hypertensive patients.

Systemic Inflammation Response Index as a Predictor of Stroke Risk in Elderly Patients with Hypertension: A Cohort Study

Objective

This study aimed to evaluate the relationship between the systemic inflammation response index (SIRI) and the risk of stroke and its subtypes in elderly patients with hypertension and to explore its predictive accuracy and any potential effect modifiers.

Methods

The study included 4749 participants with no history of stroke at baseline. Cox regression was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CIs). Interaction tests and subgroup analyses were conducted. The predictive performance of various inflammatory indicators for stroke was compared using the area under the curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Results

During a median follow-up period of 3.2 years, 640 strokes were recorded, of which 526 were ischemic and the remainder hemorrhagic. After adjustment for confounders, compared to the reference group, the HRs (95% CI) of stroke were 1.28 (95% CI, 1.01-1.64) and 1.46 (95% CI, 1.14-1.88) for participants in the second and third tertiles, respectively. We observed interactions between SIRI and homocysteine levels (< 15 vs. ≥ 15 μmol/L) (p for interaction = 0.014) on ischemic stroke risk. Furthermore, the AUC, NRI, and IDI analyses demonstrated that SIRI exhibited better predictive value for stroke risk when compared to other indicators. Similar results were observed for both ischemic and hemorrhagic strokes.

Conclusion

Elevated SIRI levels were significantly associated with the risk of stroke and its subtypes in elderly patients with hypertension, suggesting its potential as a promising indicator for stroke risk in this population. However, larger prospective studies are needed to confirm these findings.

Willingness to be tested for a secondary cause of hypertension: a survey of the Australian general community

BACKGROUND

Primary aldosteronism (PA) represents the most common and potentially curable cause of secondary hypertension. However, PA is not commonly screened for, and up to 34% of patients who screen positive do not complete the full diagnostic process. This suggests that the diagnostic process may pose a barrier to patients and may contribute to the under-diagnosis of PA.

AIMS

To evaluate the willingness of the Australian general public to undergo testing for secondary causes of hypertension and identify enablers or barriers to testing from the patients' perspective.

METHODS

An online survey containing questions on knowledge and attitudes towards hypertension, willingness to be tested and enablers/barriers towards testing was distributed to the Australian community.

RESULTS

Of 520 adult respondents (mean age 50.4 years, SD 27.3 years; 28.8% hypertensive; 56.0% female), the majority of non-hypertensive and hypertensive respondents (82.7% vs 70.0%; P = 0.03) were willing to undergo testing for a secondary cause of hypertension that involved blood and urine tests. Greater knowledge of hypertensive risk modification strategies and complications was predictive of willingness to be tested, whereas age, sex, education level, geographic location, socio-economic status and cardiovascular comorbidities were not. The top three barriers to testing included fear of a serious underlying condition, lack of belief in further testing and increased stress associated with further testing.

CONCLUSION

A high proportion of patients are willing to engage in testing for a secondary cause of hypertension. Education about the risks associated with hypertension and the testing process may overcome several barriers to testing.

The Epidemic Characteristics of Stroke Death from 2012 to 2021 in Chongqing, China

INTRODUCTION

Stroke has become a major disease that threatens the global population's health and is a major public health problem that needs to be solved in China. Therefore, it is essential to analyze the trend of the mortality of stroke and its epidemic characteristic of stroke death.

METHODS

Death cases of stroke were reported to the national death registry system by the medical staff of all medical institutions, and the population data every year were obtained from District or County's Statistic Bureau in Chongqing. They were analyzed to calculate the mortality, age-standardized mortality rate by Chinese standardization population (ASMRC), age-specific mortality, proportion, and annual percent of change (APC) according to the ICD-10 code. ASMRC was based on the standard population of the 6th census in China, 2010. The stroke mortality of each subgroup was compared using the χ2 test. Trend analysis was presented by APC.

RESULTS

The crude mortality of stroke increased from 96.29 per 100,000 in 2012 to 115.93 per 100,000 significantly, with the APC of 2.02% (t = 2.82, p = 0.022) in Chongqing. ASMRC of stroke was 56.47 per 100,000 in 2012 and 54.70 per 100,000 in 2021, and its trend change was stable (APC = -0.01, t = 0.07, p = 0.947). The crude mortality of stroke in males was higher than that in females every year (p < 0.05). The death proportion of intracerebral hemorrhage dwindled from 60.53% in 2012 to 49.88% in 2021, whereas the death proportion of ischemic stroke increased from 20.92% in 2012 to 39.96% in 2021. The average age of stroke death was delayed from 73.43 years old in 2012 to 76.52 years old in 2021 significantly (t = 18.12, p < 0.001). The percentage of stroke death at home increased from 75.23% in 2012 to 79.23% in 2021, while the percentage of stroke death at hospitals decreased from 17.89% in 2012 to 15.89% in 2021.

CONCLUSION

The crude mortality of stroke surged, and intracerebral hemorrhage was the main death cause of all subtypes. The mortality of stroke in males and rural residents was higher than that in females and urban residents. Most stroke deaths occurred at home. Male and rural residents were crucial populations for stroke prevention and control. There should be improved medical resources in rural areas and enhanced capability of stroke diagnosis and treatment.

Associations between major dietary patterns and blood pressure among Southwest Chinese: A cross-sectional analysis based on the China Multi-Ethnic Cohort (CMEC) study

BACKGROUND AND AIMS

In the less developed multi-ethnic regions (LEMRs) of Southwest China, the associations between dietary patterns and blood pressure (BP) values remain unclear. We aimed to investigate such associations and related effect modifiers.

METHODS AND RESULTS

This study included 81,433 participants from the China Multi-Ethnic Cohort Study. Dietary intakes during the year before the interview were measured with the Quantitative Food Frequency Questionnaire. Three major dietary patterns that were highly in line with geographical and ethnic distributions of the study population, i.e., "Sichuan Basin," "Yunnan-Guizhou Plateau," and "Qinghai-Tibet Plateau," were derived using principal component factor analysis. The multilinear regression model combined with inverse probability of exposure weighting was used to estimate the associations between dietary patterns and BP values. Comparing the highest with the lowest quintiles, the Sichuan Basin dietary pattern (characterized by urban lifestyles) was associated with 2.67 mmHg lower systolic blood pressure (SBP) (95% CI: -3.07 to -2.27) and 0.89 mmHg lower diastolic blood pressure (95% CI: -1.12 to -0.65). In contrast, both the Yunnan-Guizhou Plateau (characterized by agricultural lifestyles) and the Qinghai-Tibet Plateau dietary patterns (characterized by nomadic lifestyles) showed positive associations with BP. In the stratified analysis, the associations between dietary patterns and SBP were significantly stronger in women than in men for all three kinds of dietary patterns.

CONCLUSION

Both major dietary patterns and their associations with BP showed a substantial disparity in LEMRs of Southwest China. Dietary patterns in regions of higher socioeconomic status are more conducive to reducing the rising of BP, especially for women and urban residents, which might provide insights into the BP control in LEMRs of Southwest China.

Systematic literature review and meta-analysis of cardiovascular risk factor management in selected Asian countries

Aim: There is a need to understand the management status of hypertension, dyslipidemia/hypercholesterolemia, and diabetes mellitus in the Asia-Pacific region (APAC). Methods: We conducted a systematic literature review and meta-analysis to summarize the awareness, treatment, and/or control rates of these risk factors in adults across 11 APAC countries/regions. Results: We included 138 studies. Individuals with dyslipidemia had the lowest pooled rates compared with those with other risk factors. Levels of awareness with diabetes mellitus, hypertension, and hypercholesterolemia were comparable. Individuals with hypercholesterolemia had a statistically lower pooled treatment rate but a higher pooled control rate than those with hypertension. Conclusion: The management of hypertension, dyslipidemia, and diabetes mellitus was suboptimal in these 11 countries/regions.

Consumption of very low-mineral water may threaten cardiovascular health by increasing homocysteine in children

Introduction

Homocysteine (Hcy) is a critical factor for cardiovascular injury, and the elevation of Hcy in children will inevitably increase the risk of cardiovascular disease in adulthood. This study explored the effect of very low-mineral water on children’s Hcy and cardiovascular health.

Materials and methods

This was a retrospective cohort study that recruited two groups of 10–13-year-old children who had consumed direct drinking water (DDW) in school for 4 years. The control group (NW) (119 boys, 110 girls) consumed normal DDW (conductivity 345 μs/cm). The very low-mineral water consumption group (VLW) (223 boys, 208 girls) consumed very low-mineral DDW (conductivity 40.0 μs/cm). Serum Hcy, Hcy metabolites, cofactors of Hcy metabolism, and cardiovascular biomarkers were assessed and standardized by age- and sex-specific Z-scores, and the differences between the two groups were analyzed with independent t-test. The relationships between Hcy metabolism biomarkers and key factors, cardiovascular biomarkers, serum Ca, and mineral intake were analyzed with linear regression.

Results

Compared with the NW group, the VLW group had significantly higher serum Hcy, Apo-B, Apo-B/A1, and oxLDL, and lower serum 1,25,(OH)2D3, vitamin B6 and B12, 5-methyltetrahydrofolate, and Apo-A1. Serum Hcy was positively associated with serum Apo-B and Apo-B/A1, and negatively associated with Ca intake from water and serum 1,25,(OH)2D3.

Conclusion

This study suggested that drinking very low-mineral water may increase Hcy level and oxidative stress, worsen lipid profile, and threaten the cardiovascular system in children. Reducing 1,25,(OH)2D3, and disordering of calcium metabolism might play important roles. This study first established an association between demineralized drinking water and cardiovascular health in children, suggesting a new environmental concern risk to cardiovascular health.

A prospective study on the association between atrial fibrillation and blood pressure in an elderly Chinese population

BACKGROUND

Intensive blood pressure (BP) lowering in patients with hypertension has been associated with a lowered risk of atrial fibrillation (AF). It is still uncertain what is the optimal BP levels to prevent AF in the general elderly population. In the present prospective study, we investigated the association between incident AF and BP in an elderly Chinese population.

METHODS AND FINDINGS

Elderly (≥65 years) residents were recruited from 6 communities in Shanghai. 9019 participants who did not have AF at baseline and had at least one ECG recording during follow-up were included in the present analysis. During a median of 3.5 years follow-up, the overall incidence rate of AF was 5.6 per 1000 person-years (n = 178). Systolic BP was associated with increased AF risk (age- and sex-adjusted hazard ratio [HR] per 20-mmHg increase for systolic BP 1.21, 95% CI 1.04-1.39, P = 0.01), but risk estimate was attenuated after adjustment for common AF risk factors. In categorical analyses, statistical significance was achieved for HR relative to optimal BP only in stage 2 or 3 systolic and diastolic hypertension (multivariate-adjusted HR 1.76, 95% CI 1.00-3.08, P = 0.05). The association between AF incidence and BP status tended to be stronger in the absence than presence of a history of cardiovascular disease at baseline (P for interaction = 0.06).

CONCLUSION

In this Chinese population of 65 years and older, linear increases in systolic and diastolic BP were not independently associated with increased risk of AF, and only exposure to stage 2 or 3 hypertension carries a higher risk of AF.

Urban–rural disparities in hypertension prevalence, awareness, treatment, and control among Chinese middle-aged and older adults from 2011 to 2015: a repeated cross-sectional study

Background

China has experienced a continuing increase in hypertension prevalence over the past few decades, especially in rural areas. The paper aims to examine the variation of urban–rural disparities in hypertension prevalence, awareness, treatment, and control among Chinese middle-aged and older adults between 2011 and 2015.

Methods

Our team extracted data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of residents aged 45 years and older. In this study, we used the 2011 wave and the 2015 wave of CHARLS. We calculated crude rates and age-adjusted rates of hypertension prevalence, awareness, treatment, and control for the general, urban, and rural populations in each wave and performed chi-square tests to examine urban–rural disparities. We used logistic regression to further confirm these disparities by controlling confounding factors in each wave. We then used generalized estimating equation (GEE) to further examine whether urban–rural disparities changed between 2011 and 2015.

Results

We included 11,129 records in the 2011 wave and 8916 records in the 2015 wave in this study. The mean age was 59.0 years and 5359 (48.2%) participants were male in the 2011 wave. Age-adjusted hypertension prevalence, awareness, treatment, control, and control among treated in the total population were 38.5%, 70.6%, 59.2%, 27.4%, and 46.4% in 2015. Urban–rural disparities in the indicators mentioned above were 5.7%, 13.4%, 15.3%, 9.4% and 5.6% in 2011; which decreased to 4.8%, 2.7%, 5.2%, 4.9% and 3.8% in 2015. Urban–rural disparities in prevalence, awareness and treatment were statistically significant in 2011 but not significant in 2015 adjusted for confounding factors, yet control disparities were statistically significant in both waves. Finally, urban–rural disparities in awareness and treatment had narrowed from 2011 to 2015.

Conclusions

Awareness, treatment, and control rates were sub-optimal among both urban and rural adults. Prevention and management of hypertension among both urban and rural adults should be further strengthened. Awareness and treatment increased more rapidly among rural adults, indicating some achievement had been made in enhancing the healthcare system in rural areas. More efforts are needed in attaining urban–rural equity of healthcare services.

Role of blood pressure on stroke-related mortality: a 45-year follow-up study in China

Background:

Hypertension is associated with stroke-related mortality. However, the long-term association of blood pressure (BP) and the risk of stroke-related mortality and the influence path of BP on stroke-related death remain unknown. The current study aimed to estimate the long-term causal associations between BP and stroke-related mortality and the potential mediating and moderated mediating model of the associations.

Methods:

This is a 45-year follow-up cohort study and a total of 1696 subjects were enrolled in 1976 and 1081 participants died by the latest follow-up in 2020. COX proportional hazard model was used to explore the associations of stroke-related death with baseline systolic blood pressure (SBP)/diastolic blood pressure (DBP) categories and BP changes from 1976 to 1994. The mediating and moderated mediating effects were performed to detect the possible influencing path from BP to stroke-related deaths. E value was calculated in the sensitivity analysis.

Results:

Among 1696 participants, the average age was 44.38 ± 6.10 years, and 1124 were men (66.3%). After a 45-year follow-up, a total of 201 (11.9%) stroke-related deaths occurred. After the adjustment, the COX proportional hazard model showed that among the participants with SBP ≥ 160 mmHg or DBP ≥ 100 mmHg in 1976, the risk of stroke-related death increased by 217.5% (hazard ratio [HR] = 3.175, 95% confidence interval [CI]: 2.297–4.388), and the adjusted HRs were higher in male participants. Among the participants with hypertension in 1976 and 1994, the risk of stroke-related death increased by 110.4% (HR = 2.104, 95% CI: 1.632–2.713), and the adjusted HRs of the BP changes were higher in male participants. Body mass index (BMI) significantly mediated the association of SBP and stroke-related deaths and this mediating effect was moderated by gender.

Conclusions:

In a 45-year follow-up, high BP and persistent hypertension are associated with stroke-related death, and these associations were even more pronounced in male participants. The paths of association are mediated by BMI and moderated by gender.

Prevalence, awareness, and associated factors of high blood pressure among female migrant workers in Central South China

BACKGROUND

Although many young Chinese women migrate to urban regions for better opportunities, little is known about the prevalence and awareness of having high blood pressure (HBP) in this population. This study investigated the prevalence, awareness, and factors associated with HBP among young female migrant workers in Central South China.

METHODS

We conducted a cross-sectional study to identify HBP (2017 ACC/AHA guidelines) among female migrant workers aged 18-45 years in Central South China. Demographics, anthropometric measurements, hypertension-related lifestyle, awareness of HBP, and blood pressure were recorded. Logistic regression analysis was used to identify the factors associated with HBP (blood pressure ≥ 130/80 mmHg).

RESULTS

Overall, 232 female migrants participated in the study (mean age 34.4; standard deviation: 6.4 years). The prevalence of HBP was 27.2% (95% CI [21.6-33.2]), and 88.9% of the participants were unaware of their HBP status. Having rural medical insurance (odds ratio [OR] = 20.7; 95% confidence interval 95% CI [2.1-204.8]), awareness of having HBP (OR = 5.1; 95% CI [1.4-18.5]), physical inactivity (OR = 2.9; 95% CI [1.1-7.9]), and being overweight/obese (OR = 2.7; 95% CI [1.3-6.1]) were independently associated with HBP.

CONCLUSIONS

This study revealed a high prevalence of HBP among young Chinese female migrant workers, as well as a high frequency of being unaware of their condition and some associated factors (rural medical insurance, awareness of having HBP, physical inactivity, and overweight/obesity). The uncontrolled HBP among young Chinese female migrant workers suggested that health education needs further promotion in such a population.

Long-term Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rate in the Middle East and North Africa: a Systematic Review and Meta-analysis of 178 Population-Based Studies

PURPOSE OF REVIEW

This study investigated and pooled the long-term trends in prevalence, awareness, treatment, and control of hypertension (HTN) in the Middle East and North Africa (MENA) region. In this systematic review and meta-analysis, we searched MEDLINE/PubMed, Web of Science, Google Scholar, EMBASE, and Scopus between database inception and November 2020. All cross-sectional studies that investigated the prevalence of pre-HTN, HTN, awareness, treatment, and control in the MENA counties were included. The selection study, data extraction, and quality assessment were conducted by two investigators independently. Heterogeneity between studies was assessed using Cochran's Q test and I-squared, and due to sever heterogeneity between studies, the random effect model was used to pool the estimates. Sensitivity analysis was performed to estimate the long-term trends in prevalence, awareness, treatment, and control rates of HTN according to definition of HTN as systolic blood pressure of 140 mm Hg or more, or diastolic blood pressure of 90 mm Hg or more, or being on pharmacological treatment for HTN.

RECENT FINDINGS

Overall, 178 studies met the inclusion criteria. Studies comprised 2,262,797 participants with a mean age of 45.72 ± 8.84 years. According to random effect model, the pooled prevalence of pre-HTN and HTN was 33% (95% CI 28, 39) and 26% (25, 27), respectively. Over the past three decades, prevalence of hypertension increased significantly in the region. The pooled awareness, treatment, and control rates were 50% (48, 53), 41% (38, 44), and 19% (17, 21), receptively. The pooled awareness, treatment, and control rates of HTN were lower significantly in men than women. According to definition of HTN as blood pressures above 140/90 mm Hg, over the past three decades, although the awareness and treatment rates did not change significantly, the control rates improved significantly in the region. The findings showed that HTN is a significant public health problem in the MENA region. Although there are low levels of pooled awareness, treatment, and control rates, the control rates improved over the past three decades in the region.

Relationship between chronic diseases and depression: the mediating effect of pain

BACKGROUND

Chronic diseases have a high incidence in China and may cause pain and depression. However, the association of chronic diseases with pain and the incidence of depression has not been comprehensively investigated.

METHODS

The study population was obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The cross-sectional data from15,213 persons were included. CHARLS provides nationally representative data from21,097 individuals aged 45 years and older in approximately 150 districts and 450 villages. The main outcome was the incidence of depression. The main independent variable was chronic disease (no chronic disease, one chronic disease, and two or more chronic diseases). The mediators were the degree of pain (no pain, mild pain, and moderate to severe pain) and whether measures were taken to relieve pain (measures taken and no measures taken). We performed chi-square and binary logistic regression analyses of the associations of chronic disease with pain and the incidence of depression. The mediation model was examined using the Sobel test.

RESULTS

Patients with more chronic diseases had more severe pain (OR = 3.697, P < 0.001, CI = 2.919-4.681) and were more likely to develop depression (OR = 2.777, P < 0.001, CI = 2.497-3.090). The degree of pain partially mediated the interaction between chronic disease and depression in this study (t = 7.989, P < 0.001). The incidence of depression was high in people who were female, less educated, unmarried, living in rural areas, and working.

CONCLUSIONS

The degree of pain had a partial mediating effect on chronic disease and depression. Pain relief measures should be considered when treating patients with depression.

Dihydroartemisinin Attenuates Pulmonary Hypertension Through Inhibition of Pulmonary Vascular Remodeling in Rats

Pulmonary arterial hypertension (PAH) is a malignant disease characterized by pulmonary arterial remodeling because of the abnormal proliferation and migration of pulmonary arterial smooth muscle cells. Dihydroartemisinin (DHA), an artemisinin derivative used to treat malaria, is able to inhibit fibrosis, neovascularization, and tumor proliferation. In this study, we hypothesized that DHA can be beneficial in treating PAH. To test this hypothesis, a rat model of pulmonary hypertension induced with monocrotaline (MCT) was used. Compared with MCT treatment alone, treatment with 50 or 100 mg/kg DHA significantly reduced the mean pulmonary arterial pressure (30.11 ± 2.48 mm Hg vs. 21.35 ± 3.04 mm Hg and 19.18 ± 1.98 mm Hg, respectively, both P < 0.01), right ventricular transverse diameter (4.36 ± 0.41 mm vs. 3.72 ± 0.24 mm and 3.67 ± 0.27 mm, respectively, both P < 0.01), pulmonary artery medial wall thickness (57.93 ± 11.14% vs. 34.45 ± 4.39% and 25.01 ± 6.66%, respectively, both P < 0.01), and increased tricuspid annular plane systolic excursion (1.34 ± 0.17 mm vs. 1.62 ± 0.3 mm and 1.62 ± 0.16 mm, respectively, both P < 0.05). We also found that DHA inhibited platelet-derived growth factor-BB-mediated pulmonary arterial smooth muscle cells proliferation and migration in a dose-dependent manner. Moreover, DHA downregulated β-catenin levels while upregulating the levels of axis inhibition protein 2 (Axin2) and glycogen synthase kinase 3β (GSK-3β). Our findings suggest that DHA, which may be a potential candidate for PAH therapy, attenuates experimental pulmonary hypertension possibly by inhibiting pulmonary vascular remodeling.

Combined management can decrease blood pressure: an investigation of health-seeking behaviors among hypertensive patients in urban communities in China

Background

Hypertensive patients can freely choose informal medical facilities, such as pharmacies, community health service centres, and cardiology clinics in secondary or tertiary hospitals, as routine places for medical treatment in China currently. The proportions, influencing factors and effects of different health-seeking behaviours on blood pressure (BP) among hypertensive patients in urban communities are not clear. The aim of the study was to investigate health-seeking behaviours and the effects of different health-seeking behaviours on BP among hypertensive patients in urban communities in China.

Methods

A cross-sectional survey of hypertension was conducted in urban communities in Chengdu. A total of 437 hypertensive patients seeking medical help regularly were sequentially enrolled to complete a the questionnaire on health-seeking behaviours.

Results

The average age was 67.1 ± 7.5 years old. The control rate of BP was 41.0%, and the systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 144.2 ± 17.9 mm Hg and 75.4 ± 10.4 mm Hg, respectively. Among the hypertensive patients investigated, 62.8% chose community health service centre, 5.2% chose informal medical facilities, 21.5% chose cardiology clinics in secondary or tertiary hospitals, and 10.5% chose both community health service centre and cardiology clinics as the usual places for medical treatment. There were significant differences in education levels, proportions of home BP monitoring, establishment of chronic disease archives in the community, medication adherence and side effects of drugs among the four groups. The control rates of BP were 39.4%, 23.8%, 43.0% and 54.8% (P = 0.100), respectively. The SBPs were 145.1 ± 18.0, 150.9 ± 19.8, 143.8 ± 17.5 and 136.3 ± 15.1 mm Hg (P = 0.007), respectively, and it was significantly lower in the combined management group than in the other three groups. Compared with patients choosing community health service centre, patients in the combined management group had a significantly lower BP level (β = −0.119, P = 0.038) adjusting for age, sex, education level, establishment of chronic disease archives, medication adherence and number of antihypertensive drugs.

Conclusions

Combined management with both community health service centre and higher-level hospitals can decrease BP.

Challenges experienced by patients with hypertension in Ghana: A qualitative inquiry

BACKGROUND

Hypertension (HPT) is an essential public health problem affecting both lower and middle-income countries disproportionately. Evidence suggests that HPT is the leading risk factor for cardiovascular diseases and chronic kidney disease. Yet, challenges faced by patients with HPT in Ghana are not sufficiently explored. This study, documents the challenges patients with HPT face in Ghana.

METHODS

We used an explorative descriptive qualitative design. Face-to-face in-depth interviews were conducted with 15 patients with HPT. Interviews were recorded and transcribed verbatim. A thematic content analysis procedure was followed to analyse the data.

RESULTS

Four main themes emerged from interviews; three of which pertained to dimensions of challenges and a fourth which pertained to coping strategies. These include: [1] impairment in physical activities and mobility constraints [2]. Psychological challenges such as suicidal ideations, sadness, fear, anxiety, and reduced sexual affection [3]. Socio-economic challenges identified include loss of friends and social network, difficulty in job demands, and financial burden, and [4] coping strategies such as health system support, social support, and religiosity were identified.

CONCLUSION

Patients with HPT experience an array of challenges. We suggest that health care facilities incorporate post HPT diagnosis counseling sessions for HPT patients in the study area. Also, the National Health Insurance Authority (NHIA) should re-examine their scope of services; thus, drugs, laboratory services, and electrocardiogram services to avoid the issue of co-payment. Collaboration between healthcare professionals and family relations of patients with HPT ought to also be strengthened to ensure optimal care.

Factors associated with awareness, treatment and control of hypertension among 3579 hypertensive adults in China: data from the China Health and Nutrition Survey

BACKGROUND

The prevalence of hypertension is high and rising in China, but most people with hypertension do not have their blood pressure under control. This study investigated hypertension awareness, treatment, and control and their associated factors among Chinese adults.

METHODS

Data collected from the 2011 China Health and Nutrition Survey (CHNS) from 12,991 Chinese adults were used. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, self-reported prior diagnosed hypertension, or taking antihypertensive medications. Hypertension awareness, treatment, and control were defined as a self-reported diagnosis of hypertension, current use of antihypertensive medication, and blood pressure < 140/90 mmHg, respectively. Multivariate logistic regression was performed to examine factors associated with hypertension awareness, treatment, and control.

RESULTS

Overall, 3579 (27.6%) of the CHNS adult participants had hypertension, of whom 55.7% were aware of their diagnosis, 46.5% were treated with antihypertensive medications, but only 20.3% had their blood pressure under control. Higher hypertension treatment was associated with older age (OR = 2.57; 95%CI, 1.65-4.02), urban residency (1.50; 1.14-1.97), living in the Eastern region (1.52; 1.14-2.01), and being overweight/obese (1.99; 1.39-2.84). Hypertension awareness was associated with similar factors as hypertension treatment but was also associated with being female (1.37, 1.12-1.66). Poor hypertension control was associated with being overweight/obese (0.56; 0.42-0.76) and minority ethnicity (0.52; 0.31-0.86).

CONCLUSION

Hypertension is a major public health challenge in China. The prevalence of hypertension awareness, treatment, and control are still low despite existing public health policies and programs to reduce the burden of hypertension. More intensive hypertension screening and treatment programs are warranted in China.

Trends of Status of Hypertension in Southern China, 2012-2019

Purpose

Little is known about the recent trends of hypertension in southern China. The aim of the study was to investigate the trends of hypertension in Guangdong Province between 2012 and 2019.

Methods

We conducted two cross-sectional surveys in 2012 and 2019 in southern China, which included 10,970 and 27,483 participants, respectively, aged 35 to 75 years old using a method of stratified, multistage, and cluster sampling. Hypertension was defined as a mean systolic/diastolic blood pressure (SBP/DBP) ≥140/90mmHg, or a self-reported condition, or any pharmacological treatment in the last 2 weeks. In addition, according to the 2017 ACC/AHA guideline for high blood pressure, we estimated the prevalence and control rate of hypertension.

Results

According to the 2010 Chinese guideline, the age-standardized rate of hypertension prevalence was 34.7% in 2012 and 36.9% in 2019 with a slight increase, while the prevalence of prehypertension was stable (14.5% vs 14.3%). Over the period of our study, 45.6% and 60.7% of hypertensive patients knew their diagnosis in 2012 and 2019, and 40.8% and 51.5% were using antihypertensive medications, respectively. The control rates increased from 15.1% to 23.6%. Hypertension prevalence was 64.5% in 2012 and 63.2% in 2019, and the control rate increased from 3.0% to 4.8% during the study period under the 2017 ACC/AHA guideline.

Conclusion

Although the past 7 years have seen some progress in hypertension management, the rates of hypertension awareness, treatment, and control in southern Chinese remained regrettably low, and the prevalence rate was still high.

Comparison and Analysis of Epidemiologic Characteristics of Stroke in Sichuan Province, China

Previous studies have shown that there is a geographic variation in the prevalence of stroke, with a lower prevalence of stroke in Sichuan province. And a stroke transition was found during the period of economic development as well. However, as the center of Southwest China, with a greatly developed economy, whether the geographic variation remained with lower burden of stroke in Sichuan province is unknown. Therefore, in this study, we analyzed the secular stroke status in Sichuan province to help explore the potential reasons for geographic disparity. From a cross-sectional study conducted based on eight national disease surveillance points (DSPs) in Sichuan province in 2013, the epidemiologic data of stroke were collected. Data of risk factors were obtained from a cross-sectional study based on 12 national DSPs in Sichuan province in 2013. The results showed that the age-standardized prevalence, incidence, and mortality of stroke in Sichuan province were 338.6/100,000 people [95% confidence interval (CI), 267.8–409.4], 147.1/100,000 person-years (95% CI = 100.6–193.6), and 72.4/100,000 person-years (95% CI = 40.0–104.8), respectively, which were significantly lower than those determined from the contemporary data of China in 2013. The analysis of the risk factors showed that the weights of contribution of the potential risk factors to stroke were in consistency with those published reports from other areas. In conclusion, the disparity of lower stroke burden in Sichuan than the average China remained, although with the great developments in Sichuan province over all those decades. In addition to traditional modifiable factors, we suggest that unknown or intrinsic differences such as genetic factors might play an important role in geographic disparity, which should be investigated in future studies.

Effect of mobile applications on blood pressure control and their development in China: a systematic review and meta-analysis

OBJECTIVES

Mobile applications (apps) facilitate aspects of people's lives and are useful auxiliary tools for controlling risk factors for chronic diseases. This meta-analysis and systematic review aimed to explore the effect of app-assisted interventions on blood pressure (BP) control in Chinese adults and summarize the common functions of these apps.

STUDY DESIGN

This is a systematic review and meta-analysis.

METHODS

The search was conducted in four databases (PubMed, Embase, China National Knowledge Infrastructure database, and China Biology Medicine database). The identified articles were reviewed independently by two researchers. A random-effects model was used to compute the effect size. Studies were assessed for risk of bias and the transparency and quality of the apps.

RESULTS

Eighteen studies (n = 2965) were included in the final analysis. App-based interventions achieved additional decreases in BP levels (systolic BP [SBP]: -8.12 mmHg, 95% confidence interval [CI]: -11.47 to -4.77 mmHg, P < 0.001; diastolic BP [DBP]: -6.67 mmHg, 95% CI: -8.92 to -4.41 mmHg, P < 0.001). However, the results showed considerable heterogeneity (SBP: I² = 97%, P < 0.001; DBP: I² = 96%, P < 0.001). Four studies reported the BP control rate. The pooled results demonstrated a better control rate achieved via app-based interventions (risk ratio: 1.33; 95% CI: 1.18 to 1.49, P < 0.001) without heterogeneity (I² = 0%). The transparency and replicability assessment revealed unsatisfying results, and only three studies reported more than half of the 16 items in the mHealth checklist. Few studies described the replicability, data security, and infrastructure of the apps used. We identified 16 app functions, with the top three functions being doctor-patient communication (16/16), health education (15/16), and personalized guidance (12/16).

CONCLUSIONS

We showed app-based interventions had a positive effect on BP management in Chinese adults. However, there was high heterogeneity among the included studies, which merits further exploration when more standardized research has been conducted. The functions of the apps varied widely, and further development of apps for BP management should abide by appropriate reporting guidelines.

Roles of arterial pressure volume index and arterial velocity pulse index trajectories in risk prediction in hypertensive patients with heart failure with preserved ejection fraction

Background: Arterial pressure volume index (API) and arterial velocity pulse index (AVI) contribute to the development of vascular damage and cardiovascular disease. However, the relationship between common API/AVI trajectories and cardiovascular outcomes in hypertensive patients with heart failure with preserved ejection fraction (HFpEF) is unknown.Methods: A total of 488 consecutive hypertensive patients with HFpEF who repeatedly underwent API/AVI measurements were prospectively examined. We then applied API/AVI measurements into actual clinical practice. Latent mixture modeling was performed to identify API/AVI trajectories. Hazards ratios (HRs) were measured using Cox proportional hazard models.Results: We identified four distinct API/AVI trajectory patterns: low (7.6%), moderate (43.8%), high (28.9%), and very high (19.7%). Compared with the low group, higher API trajectories were associated with increased risk of total cardiovascular events (high group, adjusted HR: 2.91, 95% confidence interval [CI]: 1.97-4.26; very high group, adjusted HR: 2.46, 95%CI: 1.18-3.79). Consistently, higher AVI trajectories were also associated with a higher risk of total cardiovascular events (high group, adjusted HR: 2.58, 95%CI: 1.23-5.47; very high group, adjusted HR: 3.12, 95%CI: 1.83-6.08), compared with the low trajectory group.Conclusion: High API/AVI trajectories are strong predictors of cardiovascular risk in hypertensive patients with HFpEF. Among these patients, measuring API/AVI may improve risk stratification and provide additional information to tailor treatment strategies.

[Factors associated with arterial hypertension: a systematic review]

A systematic review of demographic, socioeconomic, behavioral and anthropometric factors associated with hypertension. We included observational studies, of populations aged 18 or older, from the past ten years, published in English, Portuguese or Spanish from Pubmed, Web of Science, Scopus and Lilacs bases. The most found factors related to the greater chance of having hypertension were age and the Body Mass Index (BMI). Other factors associated with the disease were: gender (male), education (lower education), income (lower income) and waist circumference (high). Never having smoked, never having consumed alcohol and white skin color were characteristics related to a lower chance of having hypertension. As demonstrated, demographic, socioeconomic, behavioral and anthropometric characteristics are important factors associated with a greater chance of having hypertension in the adult population. However, while most of the factors associated with it are amenable to intervention, broader health promotion policies will be needed to reduce socioeconomic inequalities in the prevalence of the disease.

The differences in self-perceptions of aging, health-related quality of life and their association between urban and rural Chinese older hypertensive patients

Background

Most hypertensive clients are elderly, whose health-related quality of life (HRQL) may be associated with self-perceptions of aging (older individuals’ beliefs about their own aging). Meanwhile, culture and health disparities between rural and urban populations are substantial. Whether there are differences in self-perceptions of aging, HRQL, and their association among elderly hypertensive clients in urban and rural areas remains unknown. The objective of this study was to investigate and compare self-perceptions of aging and HRQL and their association among urban and rural older Chinese hypertensive clients.

Methods

A cross-sectional investigation was conducted in 15 urban community clinics and 22 village clinics from Suzhou, China. Older hypertensive adults were invited to complete a self-administered questionnaire addressing socio-demographic and clinical information, HRQL and self-perceptions of aging.

Results

There were 492 urban participants and 537 rural participants included in the analyses. The physical (40.0 ± 12.1 vs. 30.9 ± 8.9, P <  0.001) and mental (51.5 ± 8.3 vs. 46.0 ± 7.8, P <  0.001) HRQL scores of urban participants were all higher than those of rural ones. Urban participants’ scores on dimensions of “timeline cyclical”, “consequences negative”, and “control negative” of self-perceptions of aging questionnaire (APQ) were lower than those of rural participants (P <  0.001, respectively), while the scores on dimensions of “consequences positive” and “control positive” were higher (P <  0.001, respectively). Adjusted multivariate linear regression showed that participants who had worse self-perceptions of aging had poorer HRQL. Some APQ dimensions associated with urban or rural hypertensive elders’ HRQL were different.

Conclusions

Older hypertensive clients in rural areas have poorer self-perceptions of aging and HRQL than those in urban areas. Health care professionals should pay more attention to HRQL and self-perceptions of aging of older hypertensive clients in rural areas.

Poor Awareness of Hypertension in France: The CONSTANCES Population-Based Study

OBJECTIVES

We aimed to assess the hypertension (HTN) awareness and associated factors in France.

METHODS

We conducted a cross-sectional analysis using data from the CONSTANCES population-based cohort involving 87,808 volunteer participants included between 2012 and 2018. HTN was defined as average blood pressure (BP) over 140/90 or use of BP medication, awareness as self-reported HTN. Multivariable logistic regression models were used to identify the associated factors.

RESULTS

Overall, 27,160 hypertensive participants (men = 16,569) above 18 years old were analyzed. Hypertension awareness rate was 37.5%. In the multivariable regression model, awareness was predicted by female gender, age, prior cardiovascular disease (CVD), presence of diabetes mellitus (DM), presence of chronic kidney disease (CKD), level of education, and obesity or overweight. Older participants (P < 0.001), females (P < 0.001), participants with comorbidities (P < 0.001), were more likely to be aware when compared with younger participants, males and participants without comorbidities, respectively. The unawareness among participants without cardiometabolic factors (CMF, i.e., CVD, DM, CKD) was higher than participants with CMF (67% vs. 41%, respectively, P < 0.001). Moreover, some differences appeared in both genders in the association between awareness of HTN and health and lifestyle factors.

CONCLUSION

Our findings show that HTN awareness is low. Particular attention should be given to young men without comorbidities as these characteristics were predictors of poor awareness. Immediate action is required to improve HTN awareness in France.

The interaction between serum uric acid and triglycerides level on blood pressure in middle-aged and elderly individuals in China: result from a large national cohort study

Background

The purpose of the research was to explore the extent of interaction between triglycerides (TG) and serum uric acid (SUA) level with blood pressure (BP) in middle-aged and elderly individuals in China.

Methods

Data were selected from the China Health and Retirement Longitudinal Study (CHARLS), a cross-sectional study. 3345(46.99%) men with average ages of 60.24 ± 9.24 years and 3774 (53.01%) women with average ages of 59.91 ± 9.95 years were included in the study. Differences between gender, or between categories of blood pressure levels were evaluated by t-test or chi-square test. The adjusted associations between various characteristics and BP status were first compared using linear regression models, as appropriate. Then, A general linear model adjusted for confounding factors (socio-demographic characteristics [age, educational levels, marital status, place of residence], health behaviors [cigarette smoking, alcohol drinking, eating habits, social and leisure activities, accidental injury, physical activities], medical history [history of cardiovascular diseases, hepatitis history, antidiabetic drugs, history of antilipidemic medication, anti-hypertensive therapy], metabolic measures [C-reactive protein (CRP), hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), estimated glomerular filtration rate (eGFR), body mass index (BMI)]) was used to examine the synergistic effect of SUA and TG level on BP in middle-aged and elderly individuals in China.

Results

Age-adjusted partial Pearson’s correlation coefficient showed that SUA and TG level positively correlated with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in both men and women. Multiple linear regression analysis showed the TG level was significantly and positively associated with SBP and DBP in both men (SBP: β =0.068, P = 0.001; DBP: β =0.064, P = 0.002) and women (SBP: β =0.061, P = 0.002; DBP: β =0.084, P = 0.000), but SUA were significantly and positively associated with SBP in both men (SBP: β =0.047, P = 0.013) and women (SBP: β =0.040, P = 0.028), regardless of other confounding factors. After adjusting for related potential confounders, evidence of interaction between SUA and TG level on SBP (men: β = − 1.090, P = 0.726; women: β = − 0.692, P = 0.861) and DBP (men: β = − 1.026, P = 0.572; women: β = − 0.794, P = 0.842) was not observed.

Conclusion

The interaction effect of SUA and TG level on BP was not observed in our study. Moreover, high SUA level was significantly associated with SBP, while high TG level was strongly related to both DBP and SBP.

The Association of Body Fat Percentage With Hypertension in a Chinese Rural Population: The Henan Rural Cohort Study

Background: Obesity is an important risk factor for hypertension. Previous studies have explored the association between body fat percentage (BFP) and hypertension, but evidence on the consistency of the association remains uncertain and limited. The aim of this study was to explore the relationship between BFP and hypertension in a Chinese rural population.

Methods: The present cross-sectional study including 38,913 eligible individuals was conducted in rural areas of Henan province. BFP was measured by bioelectrical impedance methods using Omron body fat and weight measurement device. Logistic regression models and restricted cubic spline regression models were performed to investigate the relationship between BFP and hypertension. Receiver operating characteristic (ROC) analyses were used to compare the discriminating power of adiposity indices.

Results: The age-standard prevalence of hypertension was 23.74 and 17.87% in males and females, respectively. Compared with the first quartile of BFP, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for hypertension in the highest BFP quartile were 3.30 (95% CI: 2.85, 3.83) in males and 2.66 (95% CI: 2.36, 2.99) in females, and the adjusted ORs increased along with increasing BFP levels. The areas under ROC and 95% CIs of BFP were 0.673 (0.665, 0.682) in males and 0.696 (0.689, 0.703) in females, respectively.

Conclusions: BFP was significantly positively associated with the prevalence of hypertension in both males and females in the Chinese rural population. Controlling of body fat should be emphasized in rural areas of China.

Clinical Trial Registration: Registration number: ChiCTR-OOC-15006699. http://www.chictr.org.cn/showproj.aspx?proj=11375

Multimorbidity Analysis of 13 Systemic Diseases in Northeast China

Background: Multimorbidity not only affects the quality of patients’ lives, but can also bring a heavy economic burden to individuals, families and society. The purpose of this study was to reveal the connections between diseases, especially the important role each disease played in the entire multimorbidity network. Methods: A total of 1,155,734 inpatients were enrolled through multistage stratified random sampling in Jilin Province in 2017. Categorical variables were compared using the Rao–Scott-χ2 test. Weighted networks were adopted to present the complex relationships of multimorbidity. Results: The distributions of the number of diseases differed significantly by gender, age and health insurance scheme (P < 0.001). Diseases of the respiratory system had the highest weight in multimorbidity in young people. Endocrine, nutritional and metabolic diseases and circulatory system diseases were often associated with other systemic diseases in middle aged and old people. Conclusions: Multimorbidity with respiratory system diseases in young people should not be overlooked. Additionally, effective prevention efforts that target endocrine, nutritional and metabolic diseases and circulatory system diseases are needed in middle aged and old people.

Body mass index and serum uric acid level: Individual and combined effects on blood pressure in middle-aged and older individuals in China

Few studies on the individual and combined analysis between serum uric acid (SUA) and body mass index (BMI) and blood pressure (BP) were conducted in individuals aged ≥45 years. We aimed to assess the extent to which BMI and SUA and their interaction affect BP in Chinese middle-aged and older adults.Data were selected from the China Health and Retirement Longitudinal Study (CHARLS). A total of 5888 individuals aged 45 to 96 was included. Differences between BMI, or between categories of blood pressure were evaluated by t test or chi-square test. The trend of related variables according to four BMI categories was also tested using contrast analysis. The adjusted associations between various characteristics and BP status were first compared using linear regression models, as appropriate. Then, general linear models adjusting for related potential confounders were used to examine the synergistic effect of SUA and BMI level on BP for middle-aged and elderly individuals in China.Age-adjusted partial Pearson correlation coefficient showed that BMI was significantly and positively correlated with BP both in male and female, SUA positively correlated with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in males with BMI <24.0 kg/m and females with BMI <24.0 kg/m. However, SUA level significantly and positively correlated with DBP, but not with SBP, in females with BMI ≥24.0 kg/m. Multiple linear regression analysis showed that BMI was independently associated with BP both in male and female, SUA significantly and positively associated with SBP in both males and females with BMI <24.0 kg/m, However, SUA level positively correlated with DBP in females with BMI <24.0 kg/m, but not with males with BMI <24.0 kg/m, independent of other confounding factors. A general linear model analysis adjusted for confounding factors did not reveal interaction between BMI, SUA levels and SBP (β=-1.404, P = .686 in males; β=-2.583, P = .575 in females) and DBP (β=-2.544, P = .263 in males; β=-2.619, P = .622 in females).No interaction between BMI, SUA levels, and BP was observed in either males or females; However, BMI was independently associated with BP both in male and female, SUA independently associated with SBP both in males and females with BMI <24.0 kg/m, and SUA independently associated with DBP in females with BMI ≥24.0 kg/m.

Prevalence, awareness, treatment, and control of hypertension in southwestern China

This study investigated the prevalence, awareness, treatment, and control of hypertension and associated factors among urban adults in southwestern China. The study was conducted from 2013–2014 and used a multistage cluster sampling method to select a representative sample of 11,517 people in southwestern China, aged 35–79 years. Hypertension was defined as either systolic blood pressure of 140 mmHg or greater, diastolic blood pressure of 90 mm Hg or greater, or self-reported current treatment for hypertension with antihypertensive medications. In the study population, hypertension prevalence was found to be 38.4%, with rates of 40.0% and 37.5% for men and women, respectively (p = 0.03). Hypertension prevalence increased with age in both men and women (trend p both <0.01). Among hypertensive patients, 47.9% were aware of their hypertension, 40.1% were undergoing antihypertensive treatment, and 10.3% achieved BP control. A multiple-factor analysis revealed that age, male gender, low educational achievement, family history of hypertension, overweight or obesity, abdominal obesity, and hypertriglyceridemia were positively related to hypertension, while physical exercise was negatively related to hypertension. The prevalence of hypertension among urban adults aged 35 to 79 years in southwestern China was high, while levels of awareness, treatment, and control of hypertension were low. Multifaceted interventional measures are needed to solve the unmet needs.

Patterns of Raised Blood Pressure in Vietnam: Findings from the WHO STEPS Survey 2015

This study aims to describe the prevalence of raised blood pressure and the situation of management for raised blood pressure among the adult population in Vietnam. It also aims to examine the association between diversified socioeconomic and behavioral factors of raised blood pressure and awareness of raised blood pressure. Data were obtained from the STEPS survey conducted in Vietnam in 2015. Survey sample was nationally representative with a total of 3,856 people aged 18-69 years old. The study outcomes included raised blood pressure and awareness of and control of raised blood pressure. Multiple logistic regression was used to examine the association of socioeconomic and behavior risk factors with the outcome variables. The overall prevalence of raised blood pressure in Vietnam in 2015 was 18.9% (95% CI: 17.4%-20.6%). The prevalence of raised blood pressure was higher among men. Significantly correlated factors with raised blood pressure were age, sex, body mass index, and diabetes status. Levels of awareness of raised blood pressure were higher among the older age group and overweight people and lower among ethnic minority groups. Raised blood pressure in Vietnam is a serious problem due to its magnitude and the unacceptably high unawareness rate in the population. Public health actions dealing with the problems of raised blood pressure are urgent, while taking into account its relationship with sex and socioeconomic status. It is clear that the interventions should address all people in society, with a focus on disadvantaged groups which are the rural and ethnic minority peoples.

Prevalence of hypertension, diabetes, and dyslipidemia, and their additive effects on myocardial infarction and stroke: a cross-sectional study in Nanjing, China

Background

This study aimed to investigate the prevalence and risk factors for hypertension, diabetes, and dyslipidemia, and to evaluate their additive effects on myocardial infarction (MI) and stroke in Nanjing in East China.

Methods

A multistage, stratified random cluster sampling method was used to select representative participants. All eligible participants completed questionnaires, physical measurements, and blood tests. Multivariable and univariable logistic regression analyses were used to identify associated risk factors and evaluate additive effects on cardiovascular events, respectively.

Results

Hypertension was the most prevalent chronic disease among 11,036 participants enrolled (18.5%), followed by dyslipidemia (8.3%) and diabetes (6.0%). The prevalence of hypertension was higher in men than in women while no sex-related difference was observed in the prevalence of diabetes and dyslipidemia. Older age and higher body mass index were risk factors for all three diseases. Sex, central obesity, smoking, number of family members, salt intake, and family history of hypertension were associated with hypertension; central obesity, smoking, alcohol assumption, and family history of diabetes correlated with diabetes; and female sex, higher education, and alcohol assumption were risk factors for dyslipidemia. Hypertension complicated with dyslipidemia conferred more risk of MI and stroke than independent effects. Diabetes also contributed to risk based on hypertension or dyslipidemia.

Conclusions

The burden of hypertension and diabetes has stopped increasing. However, total cholesterol (TC) concentration in the population has not been well controlled. A more comprehensive approach to managing dyslipidemia, hypertension, and diabetes needs to be developed, especially for individuals with multiple cardiovascular risk factors.

Health-Related Quality of Life of Hypertension Patients: A Population-Based Cross-Sectional Study in Chongqing, China

Purpose: Hypertension is a major risk factor for cardiovascular diseases and stroke, and it requires lifelong medication. This study aimed to investigate the factors impacting on Health-Related Quality of Life (HRQoL) among hypertensive patients in Chongqing, China, and to provide evidence-based strategies to improve their HRQoL. Methods: This cross-sectional survey was conducted in Chongqing, China. Of 600 randomly selected patients, 586 patients agreed to participate and 567 patients completed the survey. A SF-36 (Medical Outcomes Study (MOS) Short Form Health Survey questionnaire) that included eight domains: physical functioning, role limitations due to physical problems, body pain, general health, vitality, social function, role limitations due to emotional problems, and mental health was used to measure HRQoL. Linear regressions were used; each domain of HRQoL was measured in the stratification of sex. Results: Self-perceived relatively low economic burden caused by hypertension and regular physical activity had a positive impact on HRQoL (p < 0.05) for both men and women. For women, younger age was associated with higher scores of measuring physical functioning and body pain. Living with more than three family members had a positive impact on domains, including physical functioning. Emotional self-regulation had a positive association with women’s mental health. Alcohol use for men was associated with higher scores in physical and mental health measures, and emotional self-regulation showed some positive impact on general health. Conclusion: Perceived economic burden caused by hypertension was the most common factor impacting on patients’ HRQoL. Female patients were more susceptible when compared to male patients. Health intervention strategies need to be further explored and adapted to the context of improving HRQoL for patients who suffer from hypertension and other chronic non-communicable diseases.

Prevalence and income-related equity in hypertension in rural China from 1991 to 2011: differences between self-reported and tested measures

Background

Along with economic growth and living standard improvement, hypertension has become one of the most prevalent chronic diseases in China. Self-reported measures and tested measures of hypertension may differ significantly due to the low awareness of prevalence. The objective of this study is to figure out whether and how self-reported measures differ from tested measures in terms of prevalence and equity.

Method

We have used data from the China Health and Nutrition Survey database from 1991 to 2011 and extracted the data of rural areas using hukou system. Hypertension is categorized into two groups: self-reported hypertension and tested hypertension. To evaluate the equity of self-reported hypertension and tested hypertension, we calculated their Concentration Index (C) and decomposed C based on which we have obtained the horizontal-inequity index (HI) of each year. Probit Model was deployed to analyze the key determinants of hypertension prevalence.

Results

We found that the prevalence of both self-reported hypertension and tested hypertension have sharply increased from 1991 to 2011 in rural China and the population of tested hypertension was significantly larger than that of self-reported hypertension. For self-reported hypertension, prevalence rate increased from 2.72 to 13.2% and for tested hypertension it increased from 11.01 to 25.05%. Both of the Concentration Index (C) and horizontal-inequity index (HI) of self-reported hypertension and tested hypertension appeared to be contradictory. The C and HI of self-reported hypertension in 2011 were 0.032 and 0.060 respectively while the C and HI of tested hypertension were − 0.024 and − 0.015 respectively.

Conclusion

More efforts should be put into for improving the poor’s health, especially in equal access to health services. Symptom-based measures such as tested hypertension should be adopted more widely in empirical studies.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4289-5) contains supplementary material, which is available to authorized users.

Sociodemographic factors in relation to hypertension prevalence, awareness, treatment and control in a multi-ethnic Asian population: a cross-sectional study

OBJECTIVES

Literature suggested that multi-ethnic Western populations experienced differential hypertension outcomes, but evidence is limited in Asia. This study was aimed to determine sociodemographic correlates of hypertension and its awareness, treatment and control among a multi-ethnic Asian population living in Singapore.

SETTING

We used cross-sectional data of participants from the Multi-Ethnic Cohort (MEC) (n=14 530) recruited in Singapore between 2004 and 2010.

PARTICIPANTS

Participants who completed questionnaire and attended health examination, without cardiovascular diseases, cancer, stroke, renal failure, asthma and mental illnesses were included in the study. Multivariable logistic regression models were used to determine sociodemographics factors associated with hypertension, unawareness of having hypertension, untreated and uncontrolled hypertension.

RESULTS

Among 10 215 participants (47.2% Chinese, 26.0% Malay and 26.8% Indian), hypertension prevalence was estimated to be 31.1%. Older age, Malay ethnicity, male, lower educational level and being homemaker or retired/unemployed were factors significantly associated with hypertension. Stratified analysis suggested that age and education were consistently associated with hypertension across all ethnic groups. The proportions of being unaware, untreated and uncontrolled were 49.0%, 25.2% and 62.4%, respectively. Ethnicity and younger age were associated with unawareness; younger age, male and lower educational level were associated with untreated hypertension and older age was associated with uncontrolled hypertension.

CONCLUSIONS

In this study, ethnic differences in relation to hypertension were associated with sociodemographic variability in ethnic groups. Age and educational level were consistent correlates of hypertension in all ethnic groups. Unawareness and uncontrolled hypertension were common in this Asian population and associated with sociodemographic factors. More targeted strategies may be required to overcome the observed disparities.

Excessive physical activity duration may be a risk factor for hypertension in young and middle-aged populations

Physical inactivity is known to cause many health problems globally each year. However, evidence regarding the interaction between excessive physical activity (PA) and blood pressure in young and middle-aged populations is limited.A multistage, stratified, random cluster sampling design was adopted to recruit representative samples. Participants were asked to complete a questionnaire and undergo physical examinations. Associations between prehypertension, hypertension and PA durations were examined by multivariable logistic regression.Overall, 8206 subjects (4110 men, 50.1%) aged 15 to 45 years were enrolled. The prevalence rates of prehypertension and hypertension were 45.7% and 5.0%, respectively. Among the 1913 participants who performed moderate-intensity PA for more than 700 min/wk, 118 had hypertension (6.2%) and 845 had prehypertension (44.2%). Among the 1003 participants who performed vigorous-intensity PA for more than 450 min/wk, 82 had hypertension (8.2%) and 479 had prehypertension (47.8%).Long-term and sustained PA may increase the risk for hypertension in young and middle-aged subjects. An appropriate recommendation of PA duration should be encouraged in this cohort.

Association between Undiagnosed Hypertension and Health Factors among Middle-Aged and Elderly Chinese Population

Undiagnosed hypertension has resulted in significant health and economic burdens. This study sought to investigate the association between health factors and undiagnosed hypertension among hypertensive Chinese and to assess the urban-rural disparity. A total of 6455 diagnosed and undiagnosed hypertensive adults were included. Multivariable logistic regression was conducted to examine the association between health factors and undiagnosed hypertension. The urban–rural disparity was investigated through stratified analysis. Undiagnosed hypertension was prevalent (28.8%), and rural residents were more likely to have undiagnosed hypertension compared to their urban counterparts (30.1% versus 24.7%). Physical examination, healthcare service utilization, body mass index, chronic diseases, headache, and self-rated health status were found to be significantly associated with undiagnosed hypertension. In addition, healthcare service utilization, underweight in body mass index, headache, and self-rating health status were associated with undiagnosed hypertension among the rural sample but not in the urban sample. Undiagnosed hypertension was significantly related to health factors among hypertensive Chinese. The findings provided implications for future hypertension prevention programs. The use of physical examination (e.g., blood pressure measurements) is recommended; special attention may be given to those who are underweight and self-rate their health as good and fair, as they are more likely to be neglected.

Increased Risk of Hypertension in Young Adults in Southwest China: Impact of the 2017 ACC/AHA High Blood Pressure Guideline

PURPOSE OF REVIEW

To examine the impact of the new 2017 ACC/AHA hypertension guideline on the prevalence of hypertension, its constituent ratio, and their associated factors in southwest China.

RECENT FINDINGS

A total of 14,220 permanent residents ≥ 18 years were enrolled in this survey. According to the 2017 ACC/AHA hypertension guideline, the hypertension prevalence was substantially increased (46.9% vs. 24.5%); consistent across different age and gender groups, while the hypertension awareness (23.8% vs. 45.6%); treatment (18.6% vs. 35.5%); control (2.3% vs. 11.2%); and control among treatment (9.6% vs. 24.0%) patients were decreased in southwest of China. In our cohort, 31.1% participants were newly diagnosed as hypertension. Young adults accounted considerable proportion in this newly diagnosed hypertension population. The proportion of young hypertensive individuals substantially increased, whereas those of the older hypertensive subjects decreased. Among the hypertensive subjects aged ≥ 65 years undergoing treatment, 90% of the elderly subjects were not eligible for hypertension control and 32.5% have systolic blood pressure control at 130-149 mmHg, and thus need to intensify antihypertensive treatment according to 2017 ACC/AHA hypertension guideline. Smoking, drinking, body fat percentage, and body mass index were considered the factors associated with hypertension according to the Chinese hypertension guideline but not in the 2017 ACC/AHA hypertension guideline. The adoption of the 2017 ACC/AHA hypertension guideline will substantially increase hypertension prevalence in southwest of China. The new definition of hypertension implies that more young adults will likely suffer from high cardiovascular risks, while additional one third of elder hypertensive subjects will likely need intensified antihypertension treatments.

Association and Interaction Analysis of Body Mass Index and Triglycerides Level with Blood Pressure in Elderly Individuals in China

Objectives

To assess the extent of interaction between body mass index (BMI) and triglyceride (TG) level and its effects on blood pressure (BP) in elderly individuals in China.

Design

Cross-sectional study.

Setting

Data were taken from a cross-sectional study called the China Health and Retirement Longitudinal Study.

Participants

The analytic sample included 3629 subjects aged 45 to 96 years.

Main Outcome Measurements

Data were obtained from the China Health and Retirement Longitudinal Study, which is a cross-sectional study. Age-adjusted partial Pearson's correlation test was used to compare various characteristics and BP. Adjusted associations were first used as linear regression models, as appropriate. Then, general linear models adjusted for related potential confounders were used to examine the synergistic effects of BMI and TG level on BP. Finally, a binary logistic regression model adjusted for confounding factors was used to examine the association between BMI or TG level and hypertension.

Results

Age-adjusted partial Pearson's correlation coefficient showed that the TG level was positively correlated with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in both men and women with BMI < 24.0 kg/m²; however, TG level was positively correlated with DBP in women with BMI ≥ 24.0 kg/m² but not with DBP in men with BMI ≥ 24.0 kg/m². Multiple linear regression analysis showed that BMI level was significantly and positively associated with both SBP and DBP in men and women with BMI < 24.0 kg/m², and TG level was significantly and positively associated with SBP in women with BMI < 24.0 kg/m², independent of other confounding factors. A general linear model analysis with adjustment for confounding factors (age, educational level, marital status, current residence, smoking, eating habits, taking activities, antidiabetic medication, antihypertensive therapy, fasting plasma glucose [FPG], low-density lipoprotein cholesterol [LDL-C], estimated glomerular filtration rate [eGFR], and serum uric acid [SUA]) showed no interaction between BMI and TG level and SBP (men, β = 0.572, P = 0.845; women, β = 0.122, P = 0.923) and DBP (men, β = -0.373, P = 0.810; women, β = 0.272, P = 0.828). A binary logistic regression model analysis with adjustment for confounding factors (age, educational level, marital status, current residence, smoking, drinking, eating habits, taking activities, major accidental injury, physical activity, history of cardiovascular disease, history of liver disease, antilipidemic medication, antidiabetic medication, antihypertensive therapy, FPG, LDL-C, high-density lipoprotein cholesterol [HDL-C], eGFR, and SUA) showed that overweight and obese men and women were more likely to have hypertension (men: odds ratio [OR] = 1.781, 95% confidence interval [CI] = 1.393–2.277; women: OR = 1.653, 95% CI = 1.330–2.055) and women with high TG were more likely to have hypertension (OR = 1.558, 95% CI = 1.219–1.992).

Conclusion

An interactive effect of BMI and TG level on BP was not observed in either men or women; however, independent effects of BMI on BP were observed in both men and women, and an association between TG level and hypertension was observed in women.

Risk factors for new-onset atrial fibrillation: A focus on Asian populations

The incidence of new-onset atrial fibrillation (NOAF) is increasing both in the Asian populations and Western countries. Several demographic and clinical risk factors were independently associated with NOAF, including ageing, male sex, obesity, obstructive sleep apnea syndrome, hypertension, coronary artery disease, renal dysfunction and heart failure. However, some differences in the incidence of NOAF, the prevalence of some risk factors and lifestyle or environmental conditions may exist between Asian and Western countries. Early recognition and holistic management of risk factors in an integrated manner may help reduce the burden of NOAF and its complications. While some risk scores have been developed to predict the risk of NOAF, thus far none are currently recommended or adequately validated to be used as a screening tool especially in the Asian population. The present semi-systematic review article aims to provide a comprehensive overview on the risk factors associated to NOAF, focusing on those explored in the Asian populations.

Gaps in awareness and control of hypertension: a cross-sectional study in Chinese urban adults

Hypertension is a serious public health threat worldwide. This study sought to explore gaps in urban Chinese adults' awareness and control of hypertension. A cross-sectional study was carried out in eight Chinese cities in 2016. Participants were organized into four groups on the basis of blood pressure (BP) and self-reported disease history: healthy group (63.0%), well-controlled BP group (9.1%), unaware hypertension group (14.0%), and poorly controlled BP group (13.9%). Multinomial logistic regression with the healthy group as the reference group showed that younger age and body mass index <24 kg/m² were negatively associated with lack of awareness of hypertension and poor control of BP. Lower salt intake, but not sodium intake, was associated with poor control of BP. Other factors associated with lack of awareness of hypertension included low fish and seafood intake. Low sodium intake contributed to good control of BP. In conclusion, there are gaps in urban Chinese adults' awareness and control of hypertension. A comprehensive strategy for enhancing awareness of hypertension and changing behaviors associated with the condition should be developed and implemented.

Dose-response relationship between visceral fat index and untreated hypertension in Chinese rural population: the RuralDiab study

The study aimed to explore the association of visceral fat index (VFI) with untreated hypertension in different genders and evaluate the practicability of VFI as a marker for discriminating untreated hypertension in Chinese rural population. A total of 12,536 eligible participants aged 35 years and older were derived from the RuralDiab study in China. VFI was assessed with bioelectrical impendence methods and divided into sex-specific quartiles. Logistic regression and restricted cubic spline regression were performed. Receiver operating characteristic curve was applied to analyze the discriminating performance of VFI. Meanwhile, a meta-analysis was conducted to validate the result of this study. Compared with the lowest VFI quartile, the adjusted odds ratios (ORs) and 95% confidence interval (95% CI) in the highest VFI quartile were 3.68 (2.91-4.66) in male and 2.63 (2.12-3.25) in female (P_trend < .01). Nonlinear increasing trends about the risk of untreated hypertension were observed with the continuously increasing VFI in both genders (P_linearity < .01). The sensitivity and specificity in the optimal cutoff values for VFI were 58.37% and 62.26% in male, and 49.09% and 66.67% in female. The area under the curves (95% CI) were 0.64 (0.63-0.66) in male and 0.61 (0.60-0.62) in female. Meta-analysis results displayed the pooled odds ratios (95% CI) of 2.65 (1.79-3.93) in male and 2.27 (1.74-2.95) in female. VFI was significantly positively correlated with the risk of untreated hypertension, and dose-response relationships were observed in both genders in Chinese rural population. However, VFI as a marker had limited potential for discriminating untreated hypertension.

Associations of Blood Pressure with the Factors among Adults in Jilin Province: A Cross-Sectional Study Using Quantile Regression Analysis

Hypertension has become a major public health challenge. However, numerous research results reported in the literature focus primarily on risk factors of hypertension, little is known about how the whole continuum of blood pressure (BP) is associated with risk factors of hypertension. This study aims to reveal quantile-specific associations of BP with its risk factors. A cross-sectional survey based on a sample of 23,050 adults aged 18 to 79 years was conducted in Jilin Province in 2012, and some subjects were excluded due to missing values in BP or having BP control according to the purpose of this study. Quantile regression (QR) was employed to investigate the associations between systolic/diastolic blood pressure (SBP/DBP) and the risk factors. The SBP and DBP in males presented statistically higher than females (P < 0.001). High-salt diet for males manifested a slightly increasing positive association with higher SBP only for high quantiles (≥70), but with a higher DBP for middle part of the quantiles (30~75), compared with bland diet. High-salt diet, drinking and high-density lipoprotein cholesterol (HDL-C) were positively associated with BP measures in males. And the coefficient of total cholesterol (TC) in QR increased with BP in females who used to live in town.

The burden and correlates of hypertension among Chinese rural population in Han, Uygur, and Kazak: a cross-sectional study

The present study was conducted to investigate the prevalence, awareness, treatment, control, and associated risk factors of hypertension among rural population in Xinjiang Province in Northwest China. The Cardiovascular Risk Survey study was conducted on a representative sample of the Northwest China adult population. A four-stage stratified cluster random sampling scheme was adopted to recruit representative samples. The data were collected by trained staff. Multivariable logistic regression models were used to identify the associated risk factors. Overall, 8295 study participants aged 35-101 years were enrolled. The overall hypertension prevalence was 35.01%. The prevalence of hypertension in Han, Uygur, and Kazak population was 36.84%, 33.32%, and 52.57%, respectively. The hypertension awareness, treatment, control, and control among treated participants were 56.1%, 44.7%, 10.9%, and 24.3%, respectively. Multivariate logistic regression showed that age, body mass index, central obesity, ethnic, and drinking status were identified as risk factors for hypertension. Hypertension was found to be highly prevalent in rural adults in Xinjiang, China, especially in Kazak population. Although the levels of awareness, treatment, and control have improved, it was still lower than developed countries. Effective measures should be adopted to promote the prevention and control of hypertension.

Influence of weight status on 24-hour urine composition in adults without urolithiasis: A nationwide study based on a Chinese Han population

Objectives

This study sought to explore the influence of different body weight statuses on 24-hour urine compositions in adults without urolithiasis based on a nationwide study of a Chinese Han population.

Material and methods

Twenty-four-hour urine samples from 584 Chinese Han adults without urolithiasis in six cities were analyzed. The participants were divided into four body weight status types according to their body mass indices (BMIs) according to WHO guidelines. The baseline characteristics and 24-hour urine compositions of the standard weight group were compared with those of the underweight, overweight and obese groups. The influences of different body weight statuses on the 24-hour urine compositions were explored using univariate and multivariate logistic regressions.

Results

The numbers of participants in the underweight, standard weight, overweight and obese status groups were 24, 376, 149 and 35, respectively. The overweight and obese groups suffered significantly higher risks of hypertension and diabetes mellitus than the standard weight group. In the univariate analyses, compared with the standard weight group, the overweight group had significantly higher levels of urine citrate (mean difference [MD] = 0.51 mmol, 95% confidence interval [CI]: 0.15–0.87, P = 0.001), potassium (MD = 6.63 mmol, 95% CI: 1.13–12.14, P = 0.01) and magnesium (MD = 0.38 mmol, 95% CI: 0.08–0.69, P = 0.014). Significant increases in urine citrate (MD = 0.85 mmol, 95% CI: 0.01–1.68, P = 0.046), magnesium (MD = 0.69 mmol, 95% CI: 0.13–1.25, P = 0.016) and phosphate (MD = 2.28 mmol, 95% CI: 0.03–4.54, P = 0.047) were found in the obese group. No significant differences were detected between the standard weight and underweight groups. In the multivariate logistic regression analyses, we only observed significantly higher levels of urine potassium (odds ratio [OR] = 1.02, 95% CI: 1.00–1.04, P = 0.03) in the overweight group and phosphate (OR = 1.32, 95% CI: 1.05–1.66, P = 0.018) in the obese group when compared with the standard weight group.

Conclusions

Nonstone-forming adults with overweight or obese statuses were at higher risks of hypertension and diabetes mellitus. Obese nonstone-formers might have a greater risk of urinary stone formation due to increased urinary phosphate excretion. Additionally, underweight status had no influence on 24-hour urine composition.

Temporal trends in Prevalence, Awareness, Treatment, and Control of Hypertension from 2000 to 2010 in Chengdu, China

This study aimed to describe trends in prevalence, awareness, treatment, and control in hypertension in Chengdu from 2000 to 2010. Two community-based cross sectional surveys were conducted among those aged 40–79 years in 2000 (n = 4850) and 2010 (n = 5456). Demographic characteristics, blood pressure (BP) and associated risk factors were examined. Mean systolic and diastolic BP increased from 117.8 ± 33.9 to 132.1 ± 21.2 mmHg (P < 0.001), and 75.3 ± 19.1 to 79.3 ± 11.2 mmHg (P < 0.001) over past decade, respectively. The prevalence of hypertension increased from 27.7 to 29.4% (P < 0.001). Awareness increased from 37.7 to 42.5% (P < 0.001). The overall treatment rate increased from 20.9 to 28.0% (P < 0.0001), while among subjects aware of hypertension, treatment increased from 46.9 to 65.8% (P < 0.001). In hypertensives, control increased from 6.8 to 6.9% (P = 0.6684). Nevertheless, in hypertensives aware and treated, control decreased from 32.5 to 24.3% (P = 0.020). Hypertension prevalence increased in the last decade, while awareness, treatment and control remained considerably low in Chengdu.