Health behaviour patterns in relation to hypertension: the English Longitudinal Study of Ageing

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.

Membership in Sport or Exercise Groups Predicts Sustained Physical Activity and Longevity in Older Adults Compared to Physically Active Matched Controls

Background

Physical activity tends to decline in older age, despite being key to health and longevity. Previous investigations have focused on demographic and individual factors that predict sustained physical activity.

Purpose

To examine whether engaging in physical activity in the context of sport or exercise group membership can protect against age-related physical activity decline.

Methods

Drawn from the English Longitudinal Study of Ageing, participants were members of sport or exercise groups aged 50 and over (N = 2015) as well as nonmember controls, who were matched at baseline for age, sex, and physical activity levels (N = 1881). Longitudinal mixed effects models were used to assess the effect of sport or exercise group membership on physical activity and longevity across a 14-year follow-up.

Results

Members of sport or exercise groups experienced an attenuated decline in both moderate and vigorous physical activity over a 14-year follow-up compared to physically active matched controls. Sport or exercise group members were also less likely to have died at follow-up, an effect that was mediated through sustained physical activity.

Conclusions

Promoting membership in sport and exercise groups may be a beneficial strategy for supporting sustained physical activity and health among older 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.

Links between blood pressure and medication intake, well-being, stress, physical activity and symptoms reported via a mobile phone-based self-management support system: a cohort study in primary care

OBJECTIVES

To explore relationships between patients' self-monitoring of blood pressure (BP) and their concurrent self-reports of medication intake, well-being, stress, physical activity and symptoms.

DESIGN

This study is a secondary analysis of a prospective study exploring the 8-week effectiveness of a mobile phone-based self-management support system for patients with hypertension.

SETTING

Four primary healthcare centres situated in urban and suburban communities in Sweden.

PARTICIPANTS

50 patients undergoing treatment for hypertension.

PRIMARY AND SECONDARY OUTCOME MEASURES

Associations between systolic (SBP) and diastolic blood pressure (DBP) and 10 self-report lifestyle-related variables were analysed using linear mixed effects modelling.

RESULTS

Medication intake, better well-being, less stress and greater physical activity were associated variously with lower same-day SBP and DBP. The single strongest association was found between medication intake and SBP, where failure to take medications was associated with an estimated 7.44 mm Hg higher SBP. To a lesser degree, medication intake was also associated with DBP, where DBP was 4.70 mm Hg higher in cases where medications were not taken. Well-being and stress were consistently associated with SBP and DBP, whereas physical activity was associated with only SBP. None of the symptoms-dizziness, headache, restlessness, fatigue or palpitations-were significantly associated with BP.

CONCLUSIONS

Our findings that BP was associated with patients' BP management behaviours and experiences of well-being and stress, but not symptoms suggest that enabling persons with hypertension to monitor and track their BP in relation to medication intake, physical activity, well-being, stress and symptoms may be a fruitful way to help them gain first-hand understanding of the importance of adherence and persistence to treatment recommendations.

TRIAL REGISTRATION NUMBER

NCT01510301; Pre-results.

Gender and health behaviours of hypertensive patients: mediating role of control beliefs

Previous studies have reported gender differences in patients' health behaviours but few studied hypertensive patients. The potential underlying factors that may mediate gender influences on health behaviours is also a more critical area worthy of investigation. This study examined health locus of control (HLC) as a pathway of gender effects on health behaviours of hypertensive patients. The Multidimensional HLC Scale (Form C) and Wellness behaviour subscale of Health Behaviour Checklist were completed by 400 hypertensive outpatients in two Nigerian hospitals: Enugu State University Teaching Hospital, Park Lane, Enugu, and Bishop Shanahan Specialist Hospital, Nsukka. Hierarchical multiple regression results showed that gender significantly predicted health behaviours. Gender also significantly predicted internal HLC, chance HLC, and other people HLC, but did not predict doctor HLC. The association between gender and health behaviours was fully mediated by internal HLC, chance HLC and other people HLC. Understanding the explanatory mechanisms linking socio-demographic factors and health behaviours is considered of great importance for future research and healthcare intervention.

Reporting of adherence to healthy lifestyle behaviors among hypertensive adults in the 50 states and the District of Columbia, 2013

Achieving and maintaining a healthy lifestyle is an important part of hypertension management. The purpose of this study was to assess US state-level prevalence of adherence to healthy lifestyle behaviors among those with self-reported hypertension. Using 2013 data from the Behavioral Risk Factor Surveillance System, a state-based telephone survey, we examined the adherence to five healthy lifestyle behaviors related to hypertension management: having a "normal" weight, not smoking, avoiding or limiting alcohol intake, consuming the recommended amount of fruits and vegetables, and engaging in the recommended amount of physical activity. We estimated age-standardized percentages of each healthy lifestyle behavior overall and by state, as well as prevalence of all five healthy lifestyle behaviors. Overall, the prevalence of healthy lifestyle behaviors varied widely among those with self-reported hypertension: 20.5% had a normal weight, 82.3% did not smoke, 94.1% reported no or limited alcohol intake, 14.1% consumed the recommended amounts of fruits or vegetables, and 46.6% engaged in the recommended amount of physical activity. Overall, only 1.7% of adults with self-reported hypertension reported all five healthy lifestyle behaviors, with significant variation by state. Age-standardized prevalence of individuals reporting all five healthy lifestyle behaviors ranged from 0.3% in Louisiana to 3.8% in the District of Columbia. In conclusion, adherence to healthy lifestyle behaviors varied among those with hypertension; fewer than 2% reported meeting current recommendations and standards when assessed collectively. Disparities were observed by demographic and descriptive characteristics, including geography.

The Association Between Online Health Information-Seeking Behaviors and Health Behaviors Among Hispanics in New York City: A Community-Based Cross-Sectional Study

Background

Hispanics are the fastest-growing minority group in the United States and they suffer from a disproportionate burden of chronic diseases. Studies have shown that online health information has the potential to affect health behaviors and influence management of chronic disease for a significant proportion of the population, but little research has focused on Hispanics.

Objective

The specific aim of this descriptive, cross-sectional study was to examine the association between online health information–seeking behaviors and health behaviors (physical activity, fruit and vegetable consumption, alcohol use, and hypertension medication adherence) among Hispanics.

Methods

Data were collected from a convenience sample (N=2680) of Hispanics living in northern Manhattan by bilingual community health workers in a face-to-face interview and analyzed using linear and ordinal logistic regression. Variable selection and statistical analyses were guided by the Integrative Model of eHealth Use.

Results

Only 7.38% (198/2680) of the sample reported online health information–seeking behaviors. Levels of moderate physical activity and fruit, vegetable, and alcohol consumption were low. Among individuals taking hypertension medication (n=825), adherence was reported as high by approximately one-third (30.9%, 255/825) of the sample. Controlling for demographic, situational, and literacy variables, online health information–seeking behaviors were significantly associated with fruit (β=0.35, 95% CI 0.08-0.62, P=.01) and vegetable (β=0.36, 95% CI 0.06-0.65, P=.02) consumption and physical activity (β=3.73, 95% CI 1.99-5.46, P<.001), but not alcohol consumption or hypertension medication adherence. In the regression models, literacy factors, which were used as control variables, were associated with 3 health behaviors: social networking site membership (used to measure one dimension of computer literacy) was associated with fruit consumption (β=0.23, 95% CI 0.05-0.42, P=.02), health literacy was associated with alcohol consumption (β=0.44, 95% CI 0.24-0.63, P<.001), and hypertension medication adherence (β=–0.32, 95% CI –0.62 to –0.03, P=.03). Models explained only a small amount of the variance in health behaviors.

Conclusions

Given the promising, although modest, associations between online health information–seeking behaviors and some health behaviors, efforts are needed to improve Hispanics’ ability to access and understand health information and to enhance the availability of online health information that is suitable in terms of language, readability level, and cultural relevance.

Associations Between Hypertension and Body Mass Index and Waist Circumference in U.S. Adults: A Comparative Analysis by Gender

INTRODUCTION

The body mass index (BMI) and waist circumference (WC) are a risk of hypertension, but their potentially multiplicative effect on hypertension is underexplored.

AIM

To examine modifying effects of BMI and WC on hypertension using a nationally representative U.S. adult sample stratified by gender.

METHODS

Data were derived from the 2009-2010 NHANES. Overweight and obesity were based on BMI of 25.0-29.9 and ≥30 kg/m(2), respectively. High-risk WC was based on ≥102.0 and ≥88.0 cm for males and females, respectively. Hypertension was determined by systolic/diastolic blood pressure of ≥140/≥90 mmHg, or taking prescribed medications. Logistic regression was used to examine the association between hypertension and BMI and WC by gender. Interaction terms were added to examine if BMI modified the effect of WC on hypertension.

RESULTS

Both BMI and WC were significant predictors of hypertension in overall population. Gender-specific models indicated that BMI played an important role in hypertension risk among males, but WC in females. The interaction effects were present among males implying that the association of WC with hypertension was stronger if subjects were overweight or obese. This effect, however, was not present in females.

CONCLUSION

BMI and WC may influence hypertension differently among males and females.

Analysis on associated factors of uncontrolled hypertension among elderly hypertensive patients in Southern China: a community-based, cross-sectional survey

Background

The prevalence of hypertension in China has risen dramatically in recent decades, but it is not well understood if hypertension is adequately controlled in the elderly population in Southern China. A provincial survey was performed in order to estimate the prevalence of hypertension control and the associated factors in the elderly population.

Methods

A cross-sectional survey was conducted in 6 community health service centers across 12 counties in Southern China from October 2010 to April 2011. Recruitment included a total of 10644 hypertensive subjects aged 60 or older. Basic lab tests and physical examinations were administrated on each subject. In addition, each subject completed a standardized questionnaire.

Results

The 10644 participants (mean age of 70.3 years) included 5527 women (51.9%), 5117 men (48.1%), 3148 overweight subjects (29.57%), 846 (7.95%) obese subjects, 1654 smokers (15.54%) and 1750 consumers of alcohol (16.44%). The control, treatment and awareness of hypertension were 44.6%, 50.3% and 46.3%, respectively. Most treated hypertensives (68.57%) used combination therapy of antihypertensive medications, and those using long-acting antihypertensive medications had a higher rate of adequately controlled hypertension. Results showed that elderly, living in rural and suburban areas, low education level, family history of hypertension, smoking, excessive salt consumption, lack of physical activity, overweight, obese and diabetes were associated with uncontrolled hypertension.

Conclusions

Lack of adequate hypertension control is relatively high among the elderly in Southern China. Hypertension awareness and early treatment are needed in this population, especially among suburban population, as well as adopting appropriate antihypertensive medication therapy and healthy lifestyles.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-903) contains supplementary material, which is available to authorized users.

Physical activity level and its sociodemographic correlates in a peri-urban Nepalese population: a cross-sectional study from the Jhaukhel-Duwakot health demographic surveillance site

BACKGROUND

Physical inactivity is a leading risk factor for cardiovascular and other noncommunicable diseases in high-, low- and middle-income countries. Nepal, a low-income country in South Asia, is undergoing an epidemiological transition. Although the reported national prevalence of physical inactivity is relatively low, studies in urban and peri-urban localities have always shown higher prevalence. Therefore, this study aimed to measure physical activity in three domains-work, travel and leisure-in a peri-urban community and assess its variations across different sociodemographic correlates.

METHODS

Adult participants (n=640) from six randomly selected wards of the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) near Kathmandu responded to the Global Physical Activity Questionnaire. To determine total physical activity, we calculated the metabolic equivalent of task in minutes/week for each domain and combined the results. Respondents were categorized into high, moderate or low physical activity. We also calculated the odds ratio for low physical activity in various sociodemographic variables and self-reported cardiometabolic states.

RESULTS

The urbanizing JD-HDSS community showed a high prevalence of low physical activity (43.3%; 95% CI 39.4-47.1). Work-related activity contributed most to total physical activity. Furthermore, women and housewives and older, more educated and self-or government-employed respondents showed a greater prevalence of physical inactivity. Respondents with hypertension, diabetes or overweight/obesity reported less physical activity than individuals without those conditions. Only 5% of respondents identified physical inactivity as a cardiovascular risk factor.

CONCLUSIONS

Our findings reveal a high burden of physical inactivity in a peri-urban community of Nepal. Improving the level of physical activity involves sensitizing people to its importance through appropriate multi-sector strategies that provide encouragement across all sociodemographic groups.

Physical activity and risk of metabolic syndrome in an urban Mexican cohort

Background

In the Mexican population metabolic syndrome (MS) is highly prevalent. It is well documented that regular physical activity (PA) prevents coronary diseases, type 2 diabetes and MS. Most studies of PA have focused on moderate-vigorous leisure-time activity, because it involves higher energy expenditures, increase physical fitness, and decrease the risk of MS. However, for most people it is difficult to get a significant amount of PA from only moderately-vigorous leisure activity, so workplace activity may be an option for working populations, because, although may not be as vigorous in terms of cardio-respiratory efforts, it comprises a considerable proportion of the total daily activity with important energy expenditure. Since studies have also documented that different types and intensity of daily PA, including low-intensity, seem to confer important health benefits such as prevent MS, we sought to assess the impact of different amounts of leisure-time and workplace activities, including low-intensity level on MS prevention, in a sample of urban Mexican adults.

Methods

The study population consisted of 5118 employees and their relatives, aged 20 to 70 years, who were enrolled in the baseline evaluation of a cohort study. MS was assessed according to the criteria of the National Cholesterol Education Program, ATP III and physical activity with a validated self-administered questionnaire. Associations between physical activity and MS risk were assessed with multivariate logistic regression models.

Results

The prevalence of the components of MS in the study population were: high glucose levels 14.2%, high triglycerides 40.9%, high blood pressure 20.4%, greater than healthful waist circumference 43.2% and low-high density lipoprotein 76.9%. The prevalence of MS was 24.4%; 25.3% in men and 21.8% in women. MS risk was reduced among men (OR 0.72; 95%CI 0.57–0.95) and women (OR 0.78; 95%CI 0.64–0.94) who reported an amount of ≥30 minutes/day of leisure-time activity, and among women who reported an amount of ≥3 hours/day of workplace activity (OR 0.75; 95%CI 0.59–0.96).

Conclusion

Our results indicate that both leisure-time and workplace activity at different intensity levels, including low-intensity significantly reduce the risk of MS. This finding highlights the need for more recommendations regarding the specific amount and intensity of leisure-time and workplace activity needed to prevent MS.