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Loo G, Puar T, Foo R, Ong TK, Wang TD, Nguyen QN, Chin CT, Chin CW. Unique characteristics of Asians with hypertension: what is known and what can be done? J Hypertens 2024; 42:1482-1489. [PMID: 38509747 PMCID: PMC11296281 DOI: 10.1097/hjh.0000000000003706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 01/28/2024] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
Hypertension remains the leading modifiable risk factor for cardiovascular disease worldwide. Over the past 30 years, the prevalence of hypertension has been increasing in East and Southeast Asia to a greater extent as compared with other Western countries. Asians with hypertension have unique characteristics. This can be attributed to increased impact of obesity on Asians with hypertension, excessive salt intake and increased salt sensitivity, loss of diurnal rhythm in blood pressure and primary aldosteronism. The impact of hypertension on cardiovascular (particularly strokes) and chronic kidney disease is greater in Asians. These unique characteristics underpinned by the diverse socioeconomic backgrounds pose its own challenges in the diagnosis and management of hypertension in Asia.
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Affiliation(s)
- Germaine Loo
- Department of Cardiology, National Heart Centre Singapore
| | - Troy Puar
- Department of Endocrinology, Changi General Hospital
- Cardiovascular Centre and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Medical ACP, Duke-NUS Medical School, Singapore
| | - Roger Foo
- Department of Cardiology, National University Heart Centre, National University Health System
- Cardiovascular Metabolic Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tiong Kiam Ong
- Department of Cardiology, Sarawak Heart Centre, Sarawak, Malaysia
| | - Tzung-Dau Wang
- Cardiovascular Centre and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Chee Tang Chin
- Department of Cardiology, National Heart Centre Singapore
- Cardiovascular ACP, Duke-NUS Medical School, Singapore
| | - Calvin W.L. Chin
- Department of Cardiology, National Heart Centre Singapore
- Cardiovascular ACP, Duke-NUS Medical School, Singapore
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Bray EP, Georgiou RF, Hives L, Iqbal N, Benedetto V, Spencer J, Harris C, Clegg A, Williams N, Rutter P, Watkins C. Non-pharmacological interventions for the reduction and maintenance of blood pressure in people with prehypertension: a systematic review protocol. BMJ Open 2024; 14:e078189. [PMID: 38253457 PMCID: PMC10806604 DOI: 10.1136/bmjopen-2023-078189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Prehypertension is defined as blood pressure that is above the normal range but not high enough to be classed as hypertension. Prehypertension is a warning of development of hypertension as well as a risk for cardiovascular disease, heart attack and stroke. In the UK, non-pharmacological interventions are recommended for prehypertension management but no reviews have focused on the effectiveness of these types of interventions solely in people with prehypertension. Therefore, the proposed systematic review will assess the clinical effectiveness and cost-effectiveness of non-pharmacological interventions in reducing or maintaining blood pressure in prehypertensive people. METHODS AND ANALYSIS This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The databases/trial registries that will be searched to identify relevant randomised controlled trials (RCTs) and economic evaluations include Medline, EMBASE, CINAHL, PsycINFO, CENTRAL, the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, Cochrane Library, Scopus and the International HTA Database. Search terms have been identified by the team including an information specialist. Three reviewers will be involved in the study selection process. Risk of bias will be evaluated using the Cochrane risk-of-bias tool for RCTs and the Consensus Health Economic Criteria list for economic evaluations. Findings from the included studies will be tabulated and synthesised narratively. Heterogeneity will be assessed through visual inspection of forest plots and the calculation of the χ2 and I2 statistics and causes of heterogeneity will be assessed where sufficient data are available. If possible, we plan to investigate differential effects on specific subgroups and from different types of interventions using meta-regression. Where relevant, the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) will be used to assess the certainty of the evidence found. ETHICS AND DISSEMINATION Ethical approval is not needed. Results will be published in a peer-reviewed journal, disseminated via the wider study website and shared with the study sites and participants. REGISTRATION DETAILS The review is registered with PROSPERO (CRD420232433047).
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Affiliation(s)
- Emma P Bray
- Stroke Research Team, University of Central Lancashire, Preston, UK
| | | | - Lucy Hives
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Nafisa Iqbal
- Stroke Research Team, University of Central Lancashire, Preston, UK
| | - Valerio Benedetto
- Synthesis, Economic Evaluation and Decision Science Group, University of Central Lancashire, Preston, UK
| | - Joseph Spencer
- Research Facilitation and Delivery Unit, University of Central Lancashire, Preston, UK
| | - Cath Harris
- Synthesis, Economic Evaluation and Decision Science Group, University of Central Lancashire, Preston, UK
| | - Andrew Clegg
- Synthesis, Economic Evaluation and Decision Science Group, University of Central Lancashire, Preston, UK
| | - Nefyn Williams
- Primary Care, Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Paul Rutter
- Pharmacy Practice, School of Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Caroline Watkins
- Stroke Research Team, University of Central Lancashire, Preston, UK
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Hives L, Georgiou RF, Spencer J, Benedetto V, Clegg A, Rutter P, Watkins C, Williams N, Bray EP. Risk reduction intervention for raised blood pressure (REVERSE): protocol for a mixed-methods feasibility study. BMJ Open 2023; 13:e072225. [PMID: 37258072 DOI: 10.1136/bmjopen-2023-072225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Around 40% of adults have pre-hypertension (blood pressure between 120-139/80-89), meaning they are at increased risk of developing hypertension and other cardiovascular disease-related conditions. There are limited studies on the management of pre-hypertension; however, guidance recommends that it should be focused on lifestyle modification rather than on medication. Self-monitoring of blood pressure could allow people to monitor and manage their risk status and may allow individuals to modify lifestyle factors. The purpose of this study is to determine the feasibility and acceptability, to both healthcare professionals and people with pre-hypertension, of blood pressure self-monitoring. METHODS AND ANALYSIS A prospective, non-randomised feasibility study, with a mixed-methods approach will be employed. Eligible participants (n=114) will be recruited from general practices, pharmacies and community providers across Lancashire and South Cumbria. Participants will self-monitor their blood pressure at home for 6 months and will complete questionnaires at three timepoints (baseline, 6 and 12 months). Healthcare professionals and participants involved in the study will be invited to take part in follow-up interviews and a focus group. The primary outcomes include the willingness to engage with the concept of pre-hypertension, the acceptability of self-monitoring, and the study processes. Secondary outcomes will inform the design of a potential future trial. A cost-analysis and cost-benefit analysis will be conducted. ETHICS AND DISSEMINATION Ethics approval has been obtained from London-Fulham NHS Research Ethics Committee, the University of Central Lancashire Health Ethics Review Panel and the HRA. The results of the study will be disseminated via peer-reviewed publications, feedback to service users and healthcare professionals, and to professional bodies in primary care and pharmacy. TRIAL REGISTRATION NUMBER ISRCTN13649483.
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Affiliation(s)
- Lucy Hives
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Rachel F Georgiou
- Stroke Research Team, School of Nursing, University of Central Lancashire, Preston, UK
| | - Joseph Spencer
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Valerio Benedetto
- Health Technology Assessment Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
- Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Andrew Clegg
- Health Technology Assessment Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
- Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Paul Rutter
- Faculty of Science and Health, School of Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Caroline Watkins
- Stroke Research Team, School of Nursing, Facility of Health and Care, University of Central Lancashire, Preston, UK
| | - Nefyn Williams
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Emma P Bray
- Stroke Research Team, School of Nursing, Facility of Health and Care, University of Central Lancashire, Preston, UK
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Iddrisu AK, Besing Karadaar I, Gurah Junior J, Ansu B, Ernest DA. Mixed effects logistic regression analysis of blood pressure among Ghanaians and associated risk factors. Sci Rep 2023; 13:7728. [PMID: 37173375 PMCID: PMC10182051 DOI: 10.1038/s41598-023-34478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Blood pressure (BP) control is a global health issue with an increase in BP beyond the normal BP leading to different stages of hypertension in humans and hence the need to identify risk factors of BP for efficient and effective control. Multiple BP measurement have proven to provide BP readings close to the true BP status of the individual. In this study, we used multiple BP measurement data on 3809 Ghanaians to determine risk factors associated with BP. The data were obtained from World Health Organization study on Global AGEing and Adult Health. We defined high blood pressure (HBP) as [Formula: see text] 130/80 mmHg or normal as [Formula: see text] 130/80 mmHg. We provide summary statistics and also used the Chi-Square test to assess significance of association between HBP versus risk factors of HBP. The aim of this study is to identify risk factors of BP using the mixed effects logistic regression model. Data were analyzed using R version 4.2.2. The results showed that the risk of high blood pressure (HBP) decreases across the three measurement periods. There is reduced risk (OR = 0.274, 95% CI = 0.2008, 0.405) of HBP among male participants relative to female participants. The risk (OR = 2.771, 95% CI = 1.8658, 4.1145) of HBP increased by 2.771-folds among those who are 60 years and above relative to those below the age of 60 years. Those whose work involves/requires vigorous exercise has 1.631-fold increase in the risk (OR = 1.631, 95% CI = 1.1151, 2.3854) of HBP relative to those whose work does not involve vigorous exercise. There is approximately 5-folds increased in the risk (OR = 4.896, 95% CI = 1.9535, 12.2268) of among those who have ever been diagnosed with diabetes. The results also revealed high risk (OR = 1.649, 95%CI = 1.1108, 2.4486) of HBP among those who have formal education. The risk (OR = 1.009, 95% CI = 1.0044, 1.0137) of HBP increases with increasing weight and a reduced risk (OR = 0.996, 95% CI = 0.9921, 0.9993) of HBP with increasing height. We found that sad experience, either mild, moderate or severe, is associated with a reduced risk of HBP. Those who have vegetable servings at least 2 cups per day have increased risk of HBP and those who have fruits servings at least 2 cups per day is associated with a reduced risk of HBP, however this is not statistically significant. To achieve success in BP control, programs should be designed with the aim of reducing weight, educate those with formal eduction on issues relating to HBP. Those whose work requires vigorous exercise are recommended to have regular check-ups to ensure that pressure build-up in the lungs is cleared. SBP is lower for women at young age but continue to increase after menopause as their BP increase becomes salt-sensitive. Hence there is need to give more attention to menopausal women so as to improve BP. Both young and old individuals are recommended to practice regular exercise since this has shown to reduce risk of being overweight or becoming diabetic and reduces the risk of HBP at yong age and old age. Also, to improve blood pressure control, programs for management of blood pressure or hypertension should focus more short stature individuals since such people are more likely to experience HBP.
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Affiliation(s)
- Abdul-Karim Iddrisu
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana.
| | | | - Joseph Gurah Junior
- Department of Mathematics and ICT, St. Ambrose College of Education, Dormaa-Akwamu, Ghana
| | - Bismark Ansu
- Department of Mathematics and ICT, St. Ambrose College of Education, Dormaa-Akwamu, Ghana
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Sodium Intake and Risk of Hypertension: A Systematic Review and Dose-Response Meta-analysis of Observational Cohort Studies. Curr Hypertens Rep 2022; 24:133-144. [PMID: 35246796 DOI: 10.1007/s11906-022-01182-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE OF THE REVIEW To assess the relationship between sodium intake and hypertension risk in cohort studies, based on a systematic review up to January 21, 2022, that also employed a dose-response meta-analysis. RECENT FINDINGS Dose-response analysis of available cohort studies (n = 11), using a dietary intake or urinary sodium excretion of 2 g/day as the reference category, showed an excess risk starting at 3 g/day. However, we found a linear relationship across the entire range of sodium exposure in an analysis restricted to studies that used 24 h urinary sodium excretion information and had a low risk of bias. This review confirms prior findings based on experimental studies and identified an almost linear relationship between sodium intake/excretion and hypertension risk in cohort studies, reinforcing the validity of recommendations to prevent cardiovascular disease through the reduction of sodium intake in both normotensive and hypertensive adults.
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The longitudinal associations between trajectory of and quantity of alcohol consumption and subsequent changes in blood pressure levels among non-hypertensive adults. Br J Nutr 2021; 126:1380-1388. [PMID: 33441197 DOI: 10.1017/s0007114521000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Given the dynamic characteristic of an individual's drinking behaviours, comprehensive consideration of alcohol consumption variation using repeated measures may improve insight into the nature of its association with blood pressure (BP) change. We examined the association between longitudinal alcohol consumption (trajectory and quantity) and changes in BP and pulse pressure (PP) among Korean aged ≥ 40 years living in rural areas. Totally, 1682 hypertension-free participants who completed all three health examinations (median, 5·3 years) were included. All three visits were used to determine the cumulative trajectory of and quantity of alcohol consumption and the latest two visits and the last visit were used for the recent trajectory and the most recent quantity of alcohol consumption, respectively. Changes in BP and PP from the baseline to the third visit were used as outcome. In men, ≥30 ml/d cumulative average alcohol consumption was associated with the greatest increase in systolic BP (SBP) in both baseline outcome-unadjusted (2·9 mmHg, P = 0·032) and -adjusted models (3·6 mmHg, P = 0·001), and the given association for the most recent alcohol consumption was observed in the baseline outcome-adjusted model (3·9 mmHg, P = 0·003). For PP, similar associations were observed only in the baseline outcome-adjusted model. No meaningful associations in diastolic BP in men and any BP or PP in women existed. The quantity of alcohol consumption rather than the trajectory may be significantly related to raised SBP, and a possible short-term influence of the most recent alcohol consumption may exist when baseline SBP is adjusted in men.
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Umuerri EM, Aiwuyo HO. Prevalence and correlates of prehypertension and hypertension among adults in Delta State, Nigeria: a cross-sectional community-based study. Ghana Med J 2021; 54:48-57. [PMID: 32863413 PMCID: PMC7445701 DOI: 10.4314/gmj.v54i1.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background There are indications that prehypertension precedes hypertension. Like hypertension, it is associated with increased cardiovascular risk. Objective To determine the prevalence, awareness and correlates of prehypertension and hypertension among adults in Delta State, Nigeria. Methods This was a cross-sectional study. We recruited adults aged ≥18 years from two communities in Delta State, Nigeria, using the multi-stage sampling technique. The study instrument was a modified WHO-STEPS questionnaire. Prehypertension and hypertension were defined using the JNC-7 criteria. Ethical approval was obtained before the recruitment of participants. Results Of the 852 adults studied, the mean (±SD) age was 42.64 (±16.07) years, females (55.9%) and urban dwellers (55.8%). The prevalence of prehypertension and hypertension were 42.5% and 29.3%, respectively; both were higher among urban dwellers. The peak age-group for prehypertension and hypertension were 25-34 and 35-44 years, respectively. Awareness of hypertension was low; 12.0% (102/852). Blood pressure category significantly correlated with age, body mass index, place of residence, level of education, employment status and fruit intake. Conclusion The prevalence of prehypertension and hypertension in this study were high. Based on the premise that prehypertension is a precursor of hypertension and occurred more among youths, the higher prevalence of prehypertension gives an inkling to rising prevalence of hypertension. Funding Nil.
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Affiliation(s)
- Ejiroghene M Umuerri
- Department of Medicine, Delta State University, PMB 01, Abraka, Nigeria.,Cardiology Unit, Department of Medicine, Delta State University Teaching Hospital, PMB 07, Oghara, Nigeria
| | - Henry O Aiwuyo
- Cardiology Unit, Department of Medicine, Delta State University Teaching Hospital, PMB 07, Oghara, Nigeria
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Fan LM, Wang F, Zhao M, Cui WL, Cai L. Socioeconomic differentials in trends in the prevalence of hypertension and pre-hypertension and hypertension awareness, treatment, and control in rural Southwestern China. BMC Cardiovasc Disord 2021; 21:259. [PMID: 34039284 PMCID: PMC8157672 DOI: 10.1186/s12872-021-02062-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/14/2021] [Indexed: 01/23/2023] Open
Abstract
Background This study examines the socioeconomic differentials in trends in the prevalence of hypertension and pre-hypertension and hypertension awareness, treatment, and control in rural Southwestern China. Methods Two cross-sectional interviews and health examination surveys were administered in rural Yunnan Province, including 6,350 consenting participants in 2009 and 6,359 consenting participants in 2016 (aged ≥ 35 years). Participant demographics, socioeconomic status (SES), and ethnicity, along with information about hypertension awareness, treatment, and control, were collected using similar questionnaires in the two surveys. The participants’ blood pressure levels were also measured. Results From 2009 to 2016, the prevalence of hypertension substantially increased from 28.4% to 39.5% (P < 0.01), and awareness and control rose from 42.2 and 25.8% to 53.1 (P < 0.01) and 30.6% (P < 0.05), respectively. Although people with a higher education level also had higher awareness and control rates than the lower education level ones, there were no conspicuous differences in the improvement of awareness and control between publics with different education levels over the 7 years studied. Increases were observed in both rates of awareness and control in people with a high level of income (P < 0.01). However, only the awareness rate increased in participants with a low level of income. Furthermore, the prevalence (P < 0.01) and treatment (P < 0.05) of hypertension were higher in the Han people than in ethnic minorities. Conclusions Individual SES has clear associations with trends in the prevalence, awareness, and control of hypertension. Future interventions to improve hypertension prevention and control should be tailored to address individual SES.
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Affiliation(s)
- Lu-Ming Fan
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China
| | - Fang Wang
- Department of Science and Technology, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China
| | - Min Zhao
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China
| | - Wen-Long Cui
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China
| | - Le Cai
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China.
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CAI C, LIU FC, LI JX, HUANG KY, YANG XL, CHEN JC, LIU XQ, CAO J, CHEN SF, SHEN C, YU L, LU FH, WU XP, ZHAO LC, LI Y, HU DS, HUANG JF, ZHOU XY, LU XF, GU DF. Effects of the total physical activity and its changes on incidence, progression, and remission of hypertension. J Geriatr Cardiol 2021; 18:175-184. [PMID: 33907547 PMCID: PMC8047184 DOI: 10.11909/j.issn.1671-5411.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Moderate to vigorous physical activity is recommended to prevent hypertension according to the current guidelines. However, the degree to which the total physical activity (TPA) and its changes benefit normotensives and hypertensives is uncertain. We aimed to examine the effects of TPA and its changes on the incidence, progression, and remission of hypertension in the large-scale prospective cohorts. METHODS A total of 73,077 participants (55,101 normotensives and 17,976 hypertensives) were eligible for TPA analyses. During a mean follow-up of 7.16 years (394,038 person-years), 12,211 hypertension cases were identified. TPA was estimated as metabolic equivalents and categorized into quartiles. Cox proportional hazards regression and multivariable logistic regression were used to estimate associations of TPA and changes in TPA with incident hypertension and progression/remission of hypertension. RESULTS Compared with the lowest quartile of TPA, normotensives at the third and the highest quartile had a decreased risk of incident hypertension, with hazard ratios (HRs) of 0.86 [95% confidence interval (CI): 0.81-0.91] and 0.81 (95% CI: 0.77-0.86), respectively. Hypertensives at the highest quartile of TPA demonstrated a decreased risk of progression of hypertension [odds ratio (OR) = 0.87, 95% CI: 0.79-0.95], and an increased probability of hypertension remission (OR = 1.17, 95% CI: 1.05-1.29). Moreover, getting active from a sedentary lifestyle during the follow-up period could reduce 25% (HR = 0.75, 95% CI: 0.58-0.96) risk of incident hypertension, whereas those becoming sedentary did not achieve benefit from initially being active. CONCLUSIONS Our findings indicated that increasing and maintaining TPA levels could benefit normotensives, whereas higher TPA levels were needed to effectively control progression and improve remission of hypertension. Physical activity played undoubtedly an essential role in both primary and secondary prevention of hypertension.
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Affiliation(s)
- Can CAI
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Fang-Chao LIU
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jian-Xin LI
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ke-Yong HUANG
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xue-Li YANG
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Ji-Chun CHEN
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiao-Qing LIU
- Division of Epidemiology, Guangdong Provincial People’s Hospital and Cardiovascular Institute, Guangzhou 510080, China
| | - Jie CAO
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shu-Feng CHEN
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Chong SHEN
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Ling YU
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou 350014, China
| | - Fang-Hong LU
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan 250062, China
| | - Xian-Ping WU
- Sichuan Center for Disease Control and Prevention, Chengdu 610041, China
| | - Lian-Cheng ZHAO
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ying LI
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Dong-Sheng HU
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen 518060, China
| | - Jian-Feng HUANG
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiao-Yang ZHOU
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Xiang-Feng LU
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Dong-Feng GU
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Tian X, Wang A, Zuo Y, Chen S, Mo D, Zhang L, Wu S, Luo Y. Baseline and change in serum uric acid predict the progression from prehypertension to hypertension: a prospective cohort study. J Hum Hypertens 2021; 36:381-389. [PMID: 33758347 DOI: 10.1038/s41371-021-00522-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/24/2021] [Accepted: 03/03/2021] [Indexed: 11/09/2022]
Abstract
Evidence is lacking about the role of serum uric acid (SUA) in the progression from prehypertension to hypertension. Herein, we aimed to investigate the association of both baseline and dynamic change in SUA with the risk of hypertension developing from prehypertension. The study enrolled 11,488 participants with prehypertension during 2006-2010 from the Kailuan study. Change in SUA was assessed as % change of SUA from 2006 (baseline) to 2010. Participants were categorized into four groups by quartiles of baseline and change in SUA, separately. Multivariable logistic regressions were used to calculation the odds ratio (OR) and 95% confidence interval (CI). During a median follow-up of 7.06 years, 2716 (23.64%) participants developed hypertension from prehypertension. In the multivariable-adjusted model, the OR for hypertension comparing participants in the highest versus the lowest quartile of baseline SUA were 1.18 (95% CI, 1.02-1.36). Increased SUA over time was also associated with elevated risk of hypertension (OR in the highest quartile was 1.41 [95% CI, 1.23-1.62] versus the lowest quartile), especially in those with baseline SUA ≥ median (OR, 1.48; 95% CI, 1.21-1.81). Moreover, the addition of SUA to a conventional risk model had an incremental effect on the predictive value for hypertension (integrated discrimination improvement 0.30%, P < 0.0001; category-free net reclassification improvement 12.36%, P < 0.0001). Both high initial SUA and increased SUA over time can independently predict the progression from prehypertension to hypertension. Strategies aiming at controlling SUA level in prehypertensive subjects may impede the onset of hypertension.
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Affiliation(s)
- Xue Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yingting Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Dapeng Mo
- Department of Neurological Intervention, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Licheng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China.
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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11
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Gambardella J, Morelli MB, Wang XJ, Santulli G. Pathophysiological mechanisms underlying the beneficial effects of physical activity in hypertension. J Clin Hypertens (Greenwich) 2020; 22:291-295. [PMID: 31955526 DOI: 10.1111/jch.13804] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Jessica Gambardella
- Department of Medicine, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York, New York.,Department of Molecular Pharmacology, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The "Norman Fleischer" Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, New York, New York.,International Translational Research and Medical Education Consortium (ITME), Naples, Italy
| | - Marco Bruno Morelli
- Department of Medicine, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York, New York.,Department of Molecular Pharmacology, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The "Norman Fleischer" Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, New York, New York
| | - Xu-Jun Wang
- Department of Medicine, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York, New York.,Department of Molecular Pharmacology, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The "Norman Fleischer" Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, New York, New York
| | - Gaetano Santulli
- Department of Medicine, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York, New York.,Department of Molecular Pharmacology, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The "Norman Fleischer" Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, New York, New York.,International Translational Research and Medical Education Consortium (ITME), Naples, Italy.,Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
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12
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Zheng J, Xie Y, Wang Y, Guo R, Dai Y, Sun Z, Xing L, Zhang X, Sun Y, Zheng L. Short- and long-term systolic blood pressure changes have different impacts on major adverse cardiovascular events: Results from a 12.5 years follow-up study. Int J Cardiol 2019; 306:190-195. [PMID: 31767387 DOI: 10.1016/j.ijcard.2019.11.122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 09/27/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Systolic blood pressure increased in middle-aged person contributes significantly to the risk of major adverse cardiovascular events (MACE). Meanwhile, different patterns (short- or long-term change) of SBP increase may result in differential risk and lead to differences in predictive ability. METHODS A total of 19,544 and 22,610 participants in the Fuxin Cardiovascular Cohort Study underwent measurement of SBP at 2 examinations for short- and long-term change study population. Cox proportional hazards models were used to relate future clinical outcomes with change in SBP. RESULTS During a median follow-up period of 12.5 years, 1064 (772 stroke, 247 myocardial infarction, 528 CVD deaths) and 1316 (958 stroke, 301 myocardial infarction, 660 CVD deaths) MACE were identified during short- and long-terms SBP change, respectively. For SBP increased participants, short-term change in SBP was associated with future MACE (hazard ratio [HR]: 1.241 per 1-SD increase; 95% confidence interval [CI]: 1.146-1.344; P < 0.001), long-term change in SBP (HR: 1.218; 95% CI: 1.123-1.322; P < 0.001). For prehypertension participants, long-term changes conferred a strong impact than short-term. For hypertensive participants, short-term changes conferred a strong impact than long-term. CONCLUSIONS Having a SBP rise in short- or long-term both confer an increased risk of MACE and its subgroups. Furthermore, short- and long-term SBP increase patterns adds different additional information beyond one single baseline examination. Change in SBP may be a prognostic surrogate marker and future studies are needed to clarify the possible mechanism for predicting MACE.
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Affiliation(s)
- Jia Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang 110004, PR China
| | - Yanxia Xie
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang 110004, PR China
| | - Yali Wang
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang 110004, PR China
| | - Rongrong Guo
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang 110004, PR China
| | - Yue Dai
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang 110004, PR China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, PR China
| | - Liying Xing
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang 110005, PR China
| | - Xingang Zhang
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, PR China
| | - Yingxian Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, PR China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang 110004, PR China.
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13
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Wang Y, Dai Y, Zheng J, Xie Y, Guo R, Guo X, Sun G, Sun Z, Sun Y, Zheng L. Sex difference in the incidence of stroke and its corresponding influence factors: results from a follow-up 8.4 years of rural China hypertensive prospective cohort study. Lipids Health Dis 2019; 18:72. [PMID: 30909919 PMCID: PMC6434616 DOI: 10.1186/s12944-019-1010-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/08/2019] [Indexed: 02/08/2023] Open
Abstract
Background Few studies investigate sex difference in stroke incidence in rural China hypertensive population. Methods A total of 5097 hypertensive patients aged ≥35 years (mean age, 56.3 ± 11.2 years; 43.8% men) were included in our analysis with a median follow-up 8.4 years in Fuxin county of Liaoning province in China. Cox proportional hazard models were used to analyze the association between the potential factors and incident stroke. Results We observed 501 new strokes (310 ischemic, 186 hemorrhagic, and 5 unclassified stroke) during the follow-up. The overall incidence of stroke was 1235.21 per 100,000 person-years; for men, the rates were 1652.51 and 920.80 for women. This sex difference in all stroke can be explained by approximately 25% through age, systolic blood pressure, body mass index, low-density lipoprotein-cholesterol, current smoking, current drinking, antihypertensive drugs, education and physical activity. Subgroup analysis indicated that in hemorrhagic stroke this sex difference was more remarkable (63.89% can be explained). Conclusions The incidence of stroke was higher in men than that in women and this difference was partly explained by several traditional cardiovascular risk factors.
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Affiliation(s)
- Yali Wang
- Department of Clinical Epidemiology, Library, Department of Health Policy and Hospital Management, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Yue Dai
- Department of Clinical Epidemiology, Library, Department of Health Policy and Hospital Management, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Jia Zheng
- Department of Clinical Epidemiology, Library, Department of Health Policy and Hospital Management, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Yanxia Xie
- Department of Clinical Epidemiology, Library, Department of Health Policy and Hospital Management, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Rongrong Guo
- Department of Clinical Epidemiology, Library, Department of Health Policy and Hospital Management, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Xiaofan Guo
- Department of Cardiology, the First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Guozhe Sun
- Department of Cardiology, the First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, 110004, People's Republic of China
| | - Yingxian Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, 110004, People's Republic of China.
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Library, Department of Health Policy and Hospital Management, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China.
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14
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Choi JY, Yun EK, Yeun EJ, Jeong ES. Factors influencing blood pressure classification for adults: Gender differences. Int J Nurs Pract 2018; 25:e12706. [PMID: 30450629 DOI: 10.1111/ijn.12706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 08/25/2018] [Accepted: 10/05/2018] [Indexed: 11/29/2022]
Abstract
AIM Hypertension is a common condition contributing to many diseases. Factors influencing blood pressure (BP) classification for adults have changed over time. This study aimed to identify factors influencing BP classification according to gender. METHODS Data from the Sixth Korean National Health and Nutrition Examination Survey (2014) were used in this descriptive, cross-sectional study. Participants were 1555 adults (589 men, 966 women). Measures included demographic, health-related, and lifestyle factors. RESULTS Compared with the male normal BP group, in the male prehypertension group, body mass index, problem drinking, and reduced sleep duration were higher; and in the male hypertension group, age, poor subjective health status, body mass index, diabetes, problem drinking, smoking, and sodium intake were higher. Compared with the female normal BP group, age, and body mass index were higher in the female prehypertension group; and age, poor subjective health status, body mass index, menopause, and diabetes were higher in the female hypertension group. CONCLUSION Hypertension and prehypertension prevention interventions for adults should be distinguished according to gender.
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Affiliation(s)
- Jin Yi Choi
- Department of Nursing, College of Biomedical and Health Science, Konkuk University, Chungju, Republic of Korea
| | - Eun Kyoung Yun
- College of Nursing Science and East-West Nursing Research Institute, Kyung Hee University, Seoul, Republic of Korea
| | - Eun Ja Yeun
- Department of Nursing, College of Biomedical and Health Science, Konkuk University, Chungju, Republic of Korea
| | - Eun Sook Jeong
- Department of Nursing, Graduate School, Kyung Hee University, Seoul, Republic of Korea
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15
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Noone C, Dwyer CP, Murphy J, Newell J, Molloy GJ. Comparative effectiveness of physical activity interventions and anti-hypertensive pharmacological interventions in reducing blood pressure in people with hypertension: protocol for a systematic review and network meta-analysis. Syst Rev 2018; 7:128. [PMID: 30131071 PMCID: PMC6103808 DOI: 10.1186/s13643-018-0791-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/31/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The prevalence of hypertension is a major public health challenge. Despite it being highly preventable, hypertension is responsible for a significant proportion of global morbidity and mortality. Common methods for controlling hypertension include prescribing anti-hypertensive medication, a pharmacological approach, and increasing physical activity, a behavioural approach. In general, little is known about the comparative effectiveness of pharmacological and behavioural approaches for reducing blood pressure in hypertension. A previous network meta-analysis suggested that physical activity interventions may be just as effective as many anti-hypertensive medications in preventing mortality; however, this analysis did not provide the comparative effectiveness of these disparate modes of intervention on blood pressure reduction. The primary objective of this study is to use network meta-analysis to compare the relative effectiveness, for blood pressure reduction, of different approaches to increasing physical activity and different first-line anti-hypertensive therapies in people with hypertension. METHODS A systematic review will be conducted to identify studies involving randomised controlled trials which compare different types of physical activity interventions and first-line anti-hypertensive therapy interventions to each other or to other comparators (e.g. placebo, usual care) where blood pressure reduction is the primary outcome. We will search the Cochrane Library, MEDLINE and PsycInfo. For studies which meet our inclusion criteria, two reviewers will extract data independently and assess the quality of the literature using the Cochrane Risk of Bias Tool. Network meta-analyses will be conducted to generate estimates of comparative effectiveness of each intervention class and rankings of their effectiveness, in terms of reduction of both systolic and diastolic blood pressure. DISCUSSION This study will provide evidence regarding the comparability of two common first-line treatment options for people with hypertension. It will also describe the extent to which there is direct evidence regarding the comparative effectiveness of increasing physical activity and initiating anti-hypertensive therapy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017070579.
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Affiliation(s)
- C. Noone
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - C. P. Dwyer
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - J. Murphy
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - J. Newell
- School of Mathematics, Statistics & Applied Mathematics, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - G. J. Molloy
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
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16
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van der Merwe WM. Diastolic pressure above optimal is the most important predictor of subsequent hypertension in normotensive patients younger 50 years. J Clin Hypertens (Greenwich) 2017; 19:601-602. [PMID: 28439963 DOI: 10.1111/jch.13012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Jiang M, Gong D, Fan Y. Serum uric acid levels and risk of prehypertension: a meta-analysis. ACTA ACUST UNITED AC 2017; 55:314-321. [DOI: 10.1515/cclm-2016-0339] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/21/2016] [Indexed: 11/15/2022]
Abstract
AbstractElevated serum uric acid (SUA) levels may increase the risk of prehypertension. However, the findings from these studies remain conflicting. The objective of this study was to determine the relationship between SUA levels and risk of prehypertension by conducting a meta-analysis. We conducted a comprehensive literature search of PubMed, Embase, China National Knowledge Infrastructure, VIP, and the Wangfang database without language restrictions through May 2015. Observational studies assessing the relationship between SUA levels and prevalence of prehypertension were included. Pooled adjust odds ratio (OR) and corresponding 95% confidence intervals (CI) of prehypertension were calculated for the highest vs. lowest SUA levels. Prehypertension was defined as systolic blood pressure (BP) ranging from 120 to 139 mmHg or diastolic BP ranging from 80 to 89 mmHg. Eight cross-sectional studies with a total of 21,832 prehypertensive individuals were included. Meta-analysis showed that elevated SUA levels were associated with increased risk of prehypertension (OR: 1.84; 95% CI: 1.42–2.38) comparing the highest vs. lowest level of SUA levels. Subgroup analyses showed that elevated SUA levels significantly increased the risk of prehypertension among men (OR: 1.60; 95% CI: 1.12–2.21) and women (OR: 1.59; 95% CI: 1.17–2.16). Elevated SUA levels are positively associated with the risk of prehypertension in the general population. However, more well-designed longitudinal studies are needed before a definitive conclusion can be drawn due to the cross-sectional studies included are susceptible to bias.
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18
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Paquissi FC, Manuel V, Manuel A, Mateus GL, David B, Béu G, Castela A. Prevalence of cardiovascular risk factors among workers at a private tertiary center in Angola. Vasc Health Risk Manag 2016; 12:497-503. [PMID: 28008265 PMCID: PMC5167297 DOI: 10.2147/vhrm.s120735] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The burden of cardiovascular diseases (CVD) is increasing in most countries of sub-Saharan Africa. However, as there is a scarcity of data, little is known about CVD in Angola. This study aimed to determine the prevalence of prehypertension, hypertension, prediabetes, diabetes, overweight, and obesity among workers at a private tertiary center in Angola. Methods A cross-sectional study was conducted among 781 workers of Clínica Girassol, a tertiary health care center in Angola, during the month of November 2013. Demographic, anthropometric, and clinical variables were analyzed. Results Of the 781 participants studied, 50.44% were males and 78.11% were under 40 years old. The prevalence of hypertension and prehypertension was 17.93% (95% confidence interval [CI]: 15.24%–20.74%) and 54.03% (95% CI: 50.58%–57.62%), respectively. Among hypertensive subjects, 83.57% (117) were unaware of the diagnosis. Hypertension was associated with age (≥40 years) (odds ratio [OR]: 6.21; 95% CI: 4.18–9.24; P<0.001) and with overweight and obesity (OR: 2.32; 95% CI: 1.56–3.44; P<0.001). The prevalence of diabetes and prediabetes was 2.69% (95% CI: 1.54%–3.97%) and 7.94% (95% CI: 6.02%–9.99%), respectively. The prevalence of overweight was 34.44% (95% CI: 31.11%–37.90%) and 19.85% (95% CI: 17.03%–22.79%) for obesity. There was an association between overweight and obesity and the female sex (OR: 1.71; 95% CI: 1.29–2.28; P<0.001). The prevalence of family history of CVD, smoking, and alcoholism was 52.24%, 4.87%, and 45.33%, respectively. Conclusion There was a high prevalence of cardiovascular risk factors in apparently healthy workers at the private tertiary center in Angola.
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Affiliation(s)
| | | | | | | | | | - Gertrudes Béu
- Service of Endocrinology, Department of Medicine, Clínica Girassol, Luanda, Angola
| | - Anselmo Castela
- Service of Endocrinology, Department of Medicine, Clínica Girassol, Luanda, Angola
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Progression from prehypertension to hypertension and risk of cardiovascular disease. J Epidemiol 2016; 27:8-13. [PMID: 28135198 PMCID: PMC5328734 DOI: 10.1016/j.je.2016.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Subjects with prehypertension (pre-HT; 120/80 to 139/89 mm Hg) have an increased risk of cardiovascular disease (CVD); however, whether the risk of pre-HT can be seen at the pre-HT status or only after progression to a hypertensive (HT; ≥140/90 mm Hg) state during the follow-up period is unknown. METHODS The Jichi Medical Cohort study enrolled 12,490 subjects recruited from a Japanese general population. Of those, 2227 subjects whose BP data at baseline and at the middle of follow-up and tracking of CVD events were available (median follow-up period: 11.8 years). We evaluated the risk of HT in those with normal BP or pre-HT at baseline whose BP progressed to HT at the middle of follow-up compared with those whose BP remained at normal or pre-HT levels. RESULTS Among the 707 normotensive patients at baseline, 34.1% and 6.6% of subjects progressed to pre-HT and HT, respectively, by the middle of follow-up. Among 702 subjects with pre-HT at baseline, 26.1% progressed to HT. During the follow-up period, there were 11 CVD events in normotensive patients and 16 CVD events in pre-HT patients at baseline. The subjects who progressed from pre-HT to HT had 2.95 times higher risk of CVD than those who remained at normal BP or pre-HT in a multivariable-adjusted Cox hazard model. CONCLUSION This relatively long-term prospective cohort study indicated that the CVD risk with pre-HT might increase after progression to HT; however, the number of CVD events was small. Therefore, the results need to be confirmed in a larger cohort.
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Parthaje PM, Unnikrishnan B, Thankappan KR, Thapar R, Fatt QK, Oldenburg B. Prevalence and Correlates of Prehypertension Among Adults in Urban South India. Asia Pac J Public Health 2015; 28:93S-101S. [PMID: 26596285 DOI: 10.1177/1010539515616453] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prehypertension is one of the most common conditions affecting human beings worldwide. It is associated with several complications including hypertension. The blood pressure between normal and hypertension is prehypertension as per the Seventh Report Joint National Committee (JNC-7) classification. The current study was done to measure the magnitude of prehypertension and to study their sociodemographic correlates in the urban field practice area of Kasturba Medical College, Mangalore, India, among 624 people aged ≥20 years. The measurements of blood pressure were done (JNC 7 criteria) with the anthropometric measurements and lifestyle factors. Data analysis was done using Statistical Package for Social Sciences version 16. Adjusted odds ratios were calculated. Overall, 55% subjects had prehypertension and 30% had hypertension. Prehypertension was higher among males. Those from the higher age groups, those from upper socioeconomic status, obese individuals, and those with lesser physical activity had significantly higher association with prehypertension, and it was least among those who never used tobacco and alcohol.
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Affiliation(s)
| | | | | | - Rekha Thapar
- Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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21
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Gao J, Sun H, Liang X, Gao M, Zhao H, Qi Y, Wang Y, Liu Y, Li J, Zhu Y, Zhao Y, Wang W, Ma L, Wu S. Ideal cardiovascular health behaviors and factors prevent the development of hypertension in prehypertensive subjects. Clin Exp Hypertens 2015; 37:650-5. [DOI: 10.3109/10641963.2015.1047938] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Grossman A, Ben-Assuli O, Zelber-Sagi S, Golbert R, Matalon A, Yeshua H. The management of pre-hypertension in primary care: Is it adequate? Blood Press 2015; 24:237-41. [PMID: 25875919 DOI: 10.3109/08037051.2015.1032515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pre-hypertension (pHT) is frequently diagnosed in the primary care setting, but its management by primary care physicians (PCPs) is not well characterized. METHODS All individuals aged 30-45 years who were insured by Clalit Health services in the Tel Aviv district and had their blood pressure (BP) measured from January 2006 to December 2010 were evaluated. Individuals were divided into three groups based on their initial BP value: optimal (< 120/80 mmHg), normal (systolic BP 120-129 or diastolic 80-84 mmHg) and borderline (130-139/85-89 mmHg). Groups were compared regarding clinical and laboratory follow-up performed by their PCP. RESULTS Of the 20,214 individuals included in the study, 6576 (32.5%) had values in the pHT range. Of these, 2126 (32.3% of those with pHT) had BP values defined as "borderline" and 4450 (67.6% of those with pHT) had BP values defined as "normal". The number of follow-up visits by the PCP and repeat BP measurement were similar in those with "optimal" BP and pHT. A third and fourth BP measurement were recorded more frequently in those with pHT. In those with pHT, there were more recorded BP measurements than in those with borderline BP (3.35 ± 3 vs. 3.23 ± 2.6), but the time from the initial to the second measurement and a record of a third and fourth measurement were the same in the two groups. CONCLUSION Identification of pHT does not lead to a significant change in follow-up by PCPs, irrespective of BP values in the pHT range.
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Affiliation(s)
- A Grossman
- Institute of Endocrinology and Metabolism , Petah Tikva , Israel
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23
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Park JB, Kario K, Wang JG. Systolic hypertension: an increasing clinical challenge in Asia. Hypertens Res 2015; 38:227-36. [PMID: 25503845 PMCID: PMC4396396 DOI: 10.1038/hr.2014.169] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/14/2014] [Accepted: 10/26/2014] [Indexed: 12/21/2022]
Abstract
Systolic hypertension, the predominant form of hypertension in patients aged over 50-60 years, is a growing health issue as the Asian population ages. Elevated systolic blood pressure is mainly caused by arterial stiffening, resulting from age-related vascular changes. Elevated systolic pressure increases the risk of cardiovascular disease, mortality and renal function decline, and this risk may increase at lower systolic pressure levels in Asian than Western subjects. Hence, effective systolic pressure lowering is particularly important in Asians yet blood pressure control remains inadequate despite the availability of numerous antihypertensive medications. Reasons for poor blood pressure control include low awareness of hypertension among health-care professionals and patients, under-treatment, and tolerability problems with antihypertensive drugs. Current antihypertensive treatments also lack effects on the underlying vascular pathology of systolic hypertension, so novel drugs that address the pathophysiology of arterial stiffening are needed for optimal management of systolic hypertension and its cardiovascular complications.
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Affiliation(s)
- Jeong Bae Park
- Department of Medicine/Cardiology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Guo X, Zhang X, Guo L, Li Z, Zheng L, Yu S, Yang H, Zhou X, Zhang X, Sun Z, Li J, Sun Y. Association between pre-hypertension and cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Curr Hypertens Rep 2014; 15:703-16. [PMID: 24234576 DOI: 10.1007/s11906-013-0403-y] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The quantitative associations between prehypertension or its separate blood pressure (BP) ranges and the risk of main cardiovascular diseases (CVDs) have not been reliably documented. METHODS We performed a comprehensive search of PubMed (1966 to June 2012) and the Cochrane Library (1988 to June 2012) without language restrictions. Prospective studies were included if they reported multivariate-adjusted risk ratios (RRs) and corresponding 95 % confidence intervals (CIs) of desirable outcomes, including fatal or non-fatal incident stroke, coronary heart disease, myocardial infarction (MI) or total CVD events, with respect to prehypertension or its separate BP ranges (low range: 120–129/80–84 mmHg; high range: 130–139/85–89 mmHg) at baseline with normal BP (<120/80 mmHg) as reference. Pooled RRs were estimated using a random-effects model or a fixed-effects model. RESULTS Twenty-nine articles met our inclusion criteria, with 1,010,858 participants. Both low-range and high-range prehypertension were associated with a greater risk of developing or dying of total CVD (low-range: RR: 1.24; 95 % CI: 1.10 to 1.39; high range: RR: 1.56; 95 % CI: 1.36 to 1.78), stroke (low-range: RR: 1.35; 95 % CI: 1.10 to 1.66; high-range: RR: 1.95; 95 % CI: 1.69 to 2.24) and myocardial infarction (MI) (low range: RR: 1.43; 95 % CI: 1.10 to 1.86; high range: RR: 1.99; 95 % CI: 1.59 to 2.50). The whole range prehypertension had a 1.44-fold (95 % CI: 1.35 to 1.53), 1.73-fold (95 % CI: 1.61 to 1.85), and 1.79-fold (95 % CI: 1.45 to 2.22) risk of total CVD, stroke, and MI, respectively. There was no evidence of publication bias. CONCLUSIONS Prehypertensive patients have a greater risk of incident stroke, MI and total CVD events. The impact was markedly different between the low and high prehypertension ranges
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Abstract
As the worldwide prevalence of hypertension continues to increase, the primary prevention of hypertension has become an important global public health initiative. Physical activity is commonly recommended as an important lifestyle modification that may aid in the prevention of hypertension. Recent epidemiologic evidence has demonstrated a consistent, temporal, and dose-dependent relationship between physical activity and the development of hypertension. Experimental evidence from interventional studies has further confirmed a relationship between physical activity and hypertension as the favorable effects of exercise on blood pressure reduction have been well characterized in recent years. Despite the available evidence strongly supporting a role for physical activity in the prevention of hypertension, many unanswered questions regarding the protective benefits of physical activity in high-risk individuals, the factors that may moderate the relationship between physical activity and hypertension, and the optimal prescription for hypertension prevention remain. We review the most recent evidence for the role of physical activity in the prevention of hypertension and discuss recent studies that have sought to address these unanswered questions.
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Zhao X, Yang X, Zhang X, Li Y, Zhao X, Ren L, Wang L, Gu C, Zhu Z, Han Y. Dietary Salt Intake and Coronary Atherosclerosis in Patients With Prehypertension. J Clin Hypertens (Greenwich) 2014; 16:575-80. [PMID: 24953888 DOI: 10.1111/jch.12362] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 05/01/2014] [Accepted: 05/08/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Xin Zhao
- Cardiovascular Research Institute and Department of Cardiology; Shenyang Northern Hospital; Shenyang China
| | - Xiaoxu Yang
- Cardiovascular Research Institute and Department of Cardiology; Shenyang Northern Hospital; Shenyang China
- Liaoning Medical College; Jinzhou China
| | - Xiaolin Zhang
- Cardiovascular Research Institute and Department of Cardiology; Shenyang Northern Hospital; Shenyang China
| | - Yi Li
- Cardiovascular Research Institute and Department of Cardiology; Shenyang Northern Hospital; Shenyang China
| | - Xiaochuan Zhao
- Cardiovascular Research Institute and Department of Cardiology; Shenyang Northern Hospital; Shenyang China
- Liaoning Medical College; Jinzhou China
| | - Lili Ren
- Cardiovascular Research Institute and Department of Cardiology; Shenyang Northern Hospital; Shenyang China
- Liaoning Medical College; Jinzhou China
| | - Li Wang
- Cardiovascular Research Institute and Department of Cardiology; Shenyang Northern Hospital; Shenyang China
- Liaoning Medical College; Jinzhou China
| | - Chonghuai Gu
- Cardiovascular Research Institute and Department of Cardiology; Shenyang Northern Hospital; Shenyang China
- Liaoning Medical College; Jinzhou China
| | - Zhiming Zhu
- Chongqing Institute of Hypertension; Daping Hospital; Third Military Medical University; Chongqing China
| | - Yaling Han
- Cardiovascular Research Institute and Department of Cardiology; Shenyang Northern Hospital; Shenyang China
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Zheng L, Sun Z, Zhang X, Li J, Hu D, Chen J, Sun Y. Predictive value for the rural Chinese population of the Framingham hypertension risk model: results from Liaoning Province. Am J Hypertens 2014; 27:409-14. [PMID: 24308978 DOI: 10.1093/ajh/hpt229] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A prediction model from the US Framingham Heart Study (FHS) population has been established to estimate an individual's risk of developing hypertension. However, this model has not been widely tested in other cohorts. In this study, we examined the predictive capability of the FHS prediction model in a rural Chinese population. METHODS A total of 24,434 rural Chinese adults aged ≥35 years, without prevalent hypertension, diabetes mellitus, stroke, and coronary heart disease at baseline, were followed for the incidence of hypertension. Standard clinical examinations of blood pressure, weight and height, smoking status, and parental history of hypertension were observed biennially. RESULTS The mean age was 47.9 (SD = 10.2) years, and 49.5% of subjects were women. During a median 4.8 years of follow-up, we recorded a total of 8,675 incident hypertension cases. The cumulative 2-year and 4-year hypertension incidence rates were 7.7% and 25.6%, respectively. The C statistics for the 2-year and 4-year incidences of hypertension were 0.537 (95% confidence interval (CI) = 0.524-0.550) and 0.610 (95% CI = 0.602-0.618) for the FHS model, respectively. The Hosmer-Lemeshow χ(2) test results for 2-year and 4-year incidence of hypertension were 2,287.7 (P < 0.0001) and 8,227.1 (P < 0.0001), respectively. Sensitivity analysis indicates that the FHS prediction model still has a poor performance, although the predictive ability was better than for the overall population. CONCLUSIONS The FHS hypertension prediction model is not a valid tool with which to estimate the risk of incidence of hypertension among the rural Chinese population. A new hypertension risk equation for the rural Chinese population is needed.
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Affiliation(s)
- Liqiang Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, P. R. China
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Ethnic differences in the incidence of hypertension among rural Chinese adults: results from Liaoning Province. PLoS One 2014; 9:e86867. [PMID: 24489797 PMCID: PMC3906098 DOI: 10.1371/journal.pone.0086867] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 12/16/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study was conducted to examine the differences in the incidence of hypertension and associated risk factors between Mongolian and Han populations in northeast China. METHODS A population-based sample of 4753 Mongolian subjects and 20,247 Han subjects aged ≥ 35 years and free from hypertension at baseline were followed from 2004-2006 to 2010. Incident hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or current use of antihypertensive medication. RESULTS During mean 4.3 years follow-up, a total of 8779 individuals developed hypertension. The age-adjusted incidence of hypertension for Mongolian subjects was 12.64 per 100 person-years, for Han subjects was 9.77 per 100 person-years (P<0.05). The incidence of hypertension was positively correlated with age, physical activity, drinking, body mass index (BMI), family of hypertension and prehypertension in the Han population. In the Mongolian population, hypertension was positively correlated with age, physical activity, education level, drinking, BMI, prehypertension and family history of hypertension. The rates of awareness, treatment and control of hypertension for newly developed cases among both Han and Mongolian populations were low. (36.5% vs. 42.3%, 13.1% vs. 18.2%, 0.7% vs. 1.3%, P<0.05, respectively). CONCLUSIONS The incidence rate of hypertension is higher in the Mongolian populations than that in the Han populations, and hypertension in both ethnic populations was associated with similar risk factors. Our results suggest that most newly-diagnosed cases of hypertension are not adequately treated. Improvements in hypertension prevention and control programs in rural China are urgently needed.
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Shankarishan P, Borah PK, Mohapatra PK, Ahmed G, Mahanta J. Population attributable risk estimates for risk factors associated with hypertension in an Indian population. Eur J Prev Cardiol 2013; 20:963-71. [PMID: 22997351 DOI: 10.1177/2047487312462146] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little evidence exists regarding the magnitude of contribution of risk factors associated with hypertension in India. Determination of potentially modifiable risk factors is necessary to focus prevention strategies. DESIGN Age-matched case-control study. METHODS A total of 350 hypertensive cases and 350 controls of both sexes in the age group 20-65 years. Hypertension was defined according to JNC VII criteria. Adjusted odds ratio (OR) and population attributable risk percentage (PAR %) for hypertension were calculated. RESULTS In multivariate analysis, tobacco users (either tobacco chewing/smoking or both) (adjusted OR 5.1, 95% CI 3.6-7.3), tobacco chewing (adjusted OR 3.2, 95% CI 2.2-4.6), smoking (adjusted OR 2.9, 95% CI 1.9-4.4), and alcohol consumption (adjusted OR 1.5, 95% CI 1.1-2.2) was the strongest determinants of hypertension. A dose-response relation was found between the number of cigarettes smoked per day (χ2 for trend = 26.07; p < 0.0001) and the amount of alcohol consumption per day (χ2 for trend = 24.26; p < 0.0001) and the risk of hypertension. PARs were 70.3% (95% CI 63.0-77.5) for tobacco use, 45.3% (95% CI 37.1-53.4) for tobacco chewing, 31.5% (95% CI 21.3-40.9) for smoking, and 33.6% (95% CI 22.9-44.4) for alcohol consumption. CONCLUSION Our results indicate that incident hypertension cases are largely attributable to the habit of tobacco use and alcohol consumption. Therefore, changing these selected lifestyle factors needs to be prioritized as a major strategy for reducing incidence of hypertension in our population.
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Bozorgmanesh M, Ghoreishian H, Mohebi R, Azizi F, Hadaegh F. Sex-specific predictors of the prehypertension-to-hypertension progression: community-based cohort of a West-Asian population. Eur J Prev Cardiol 2013; 21:956-63. [PMID: 23478742 DOI: 10.1177/2047487313481757] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/18/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND We aimed to predict prehypertension-to-hypertension progression rate among a West-Asian adult population. METHODS We analyzed data on 3449 adults (mean age 41.0 years), prehypertensive at baseline, attending at least one follow-up visit, contributing 25,079 person-years follow-up. A proportional hazard regression analysis was implemented to model the interval-censored progression-free survival time data using readily-assessable, commonly-available information. Integrated discriminatory improvement (IDI) and net reclassification improvement (NRI) indices were calculated to examine whether simple clinical information could help improve prediction of prehypertension-to-hypertension progression rate based on the blood pressure measures. RESULTS During a median seven-year follow-up 1412 prehypertensive patients progressed to hypertension with annual progression rate (95% confidence intervals (CIs)) being 56.9 (52.9-61.2) per 1000 women and 55.7 (51.7-60.0) per 1000 men (p = 0.007). High-density lipoprotein cholesterol levels were inversely associated with prehypertension-to-hypertension progression rate only among women (hazard ratio (1-SD): 0.93, 95% CIs: 0.86-0.100). Marital status retained its predictability among women even after multivariate adjustments. In both men and women, age, blood pressure measures, waist-to-height ratio, fasting plasma glucose and a history of cardiovascular disease independently predicted prehypertension-to-hypertension rate. The absolute (0.114, 95% CIs: 0.107-0.120) and relative (2.638, 95% CIs: 2.374-2.903) IDI and cutpoint-based (0.213, 95% CIs: 0.156-0.269) and cutpoint-free NRI (0.523, 95% CIs: 0.455-0.591) indicated that the prediction of the prehypertension-to-hypertension progression was improved by multivariable-models compared with blood pressure measures alone. DISCUSSION Easily-assessable, commonly-available information helped improve predictability of blood pressure measures for prehypertension-to-hypertension progression. Women's psycho-social characteristics (marital status) should be considered in prevention of prehypertension-to-hypertension progression.
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Affiliation(s)
- Mohammadreza Bozorgmanesh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Ghoreishian
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Mohebi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Guo X, Zheng L, Li Y, Yu S, Zhou X, Wang R, Zhang X, Sun Z, Sun Y. Gender-specific prevalence and associated risk factors of prehypertension among rural children and adolescents in Northeast China: a cross-sectional study. Eur J Pediatr 2013; 172:223-30. [PMID: 23108847 DOI: 10.1007/s00431-012-1873-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 10/16/2012] [Indexed: 12/27/2022]
Abstract
UNLABELLED Little is known about the prevalence and risk profile of prehypertension among Chinese children and adolescents. The aim of the present study was to investigate the prehypertensive status and its associated risk factors among rural Chinese children and adolescents. We conducted a cross-sectional study including 5,245 children and adolescents (2,732 boys and 2,513 girls) aged 5-18 years in Northeast China. Main anthropometric data and related information were collected. The overall prevalence of prehypertension and hypertension was 15 % and 20.2 %, respectively. The prevalence of prehypertension among boys was 15.7 %, compared to that of 14.2 % among girls (P = 0.256). After adjusting for age, race, weight status, waist circumference, triceps skinfold, family income, smoking and drinking status, boys aged 12-14 and 15-18 years had a 2.86- and 5.97-fold risk of prehypertension, respectively, compared to those aged 5-8 years. Overweight and obese boys had an increased risk of prehypertension in comparison to those with normal weight (overweight: odds ratio [OR] = 1.837, 95 % confidence interval [CI] 1.321-2.556; obese: OR = 2.941, 95 % CI 1.783-4.851). A larger triceps skinfold (≥90th percentile) was significantly related to increased odds of prehypertension (OR = 2.32; 95 % CI, 1.516-3.55) among boys. For girls, only older age was found to be a risk factor for prehypertension. CONCLUSION Pediatric prehypertension is highly prevalent in rural Northeast China. The risk factors for prehypertension differed among boys and girls. A more comprehensive risk profile of prehypertension among children and adolescents needs to be established for early prevention.
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Affiliation(s)
- Xiaofan Guo
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, Heping District, 110001, China
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Fan AZ, Li Y, Elam-Evans LD, Balluz L. Drinking pattern and blood pressure among non-hypertensive current drinkers: findings from 1999-2004 National Health and Nutrition Examination Survey. Clin Epidemiol 2013; 5:21-7. [PMID: 23390368 PMCID: PMC3564478 DOI: 10.2147/clep.s12152] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
CONTEXT AND OBJECTIVE Epidemiological studies show the apparent link between excessive alcohol consumption and hypertension. However, the association between alcohol intake and blood pressure among non-hypertensive individuals is scarcely examined. METHODS This analysis included participants in the 1999-2004 National Health and Nutrition Examination Survey who were aged 20 to 84 years without a diagnosis of cardiovascular disease, hypertension or pregnancy, whose systolic/diastolic blood pressure (SBP/DBP) was lower than 140/90 mmHg, who were not on antihypertensive medication, and who consumed 12 drinks or more during the past 12 months (N = 3957). Average drinking volume (average alcohol intake per day), usual drinking quantity (drinks per day when drinking) and frequency of binge drinking were used to predict SBP/DBP. Covariates included age, gender, race/ethnicity, education level, smoking status, average physical activity level, and daily hours spent on TV/ video/computer. RESULTS Drinking volume was directly associated with higher SBP in a linear dependent manner (an increment of 10 g of alcohol per day increased average SBP by 1 mmHg among both men and women). Drinking above the US Dietary Guidelines (men more than two drinks and women more than one drink per drinking day) was associated with higher SBP. Binge drinking was associated with both higher SBP and higher DBP. Average intake greater than two drinks per day was particularly associated with higher DBP among women (P = 0.0003). CONCLUSION This analysis from a population-based survey indicates a direct association between higher alcohol consumption and a higher prevalence of prehypertension among non-hypertensive drinkers.
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Affiliation(s)
- Amy Z Fan
- Division of Behavioral Surveillance, Public Health Surveillance and Informatics Program Office (PHSIPO), Office of Surveillance, Epidemiology and Laboratory Services (OSELS), Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yan Li
- Division of Public Health, Georgia Department of Community Health, Atlanta, GA, USA
| | - Laurie D Elam-Evans
- Division of Behavioral Surveillance, Public Health Surveillance and Informatics Program Office (PHSIPO), Office of Surveillance, Epidemiology and Laboratory Services (OSELS), Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lina Balluz
- Division of Behavioral Surveillance, Public Health Surveillance and Informatics Program Office (PHSIPO), Office of Surveillance, Epidemiology and Laboratory Services (OSELS), Centers for Disease Control and Prevention, Atlanta, GA, USA
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Guo X, Zheng L, Li Y, Yu S, Sun G, Yang H, Zhou X, Zhang X, Sun Z, Sun Y. Differences in lifestyle behaviors, dietary habits, and familial factors among normal-weight, overweight, and obese Chinese children and adolescents. Int J Behav Nutr Phys Act 2012; 9:120. [PMID: 23031205 PMCID: PMC3522535 DOI: 10.1186/1479-5868-9-120] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 09/25/2012] [Indexed: 12/21/2022] Open
Abstract
Background Pediatric obesity has become a global public health problem. Data on the lifestyle behaviors, dietary habits, and familial factors of overweight and obese children and adolescents are limited. The present study aims to compare health-related factors among normal-weight, overweight, and obese Chinese children and adolescents. Methods We conducted a cross-sectional study consisted of 4262 children and adolescents aged 5–18 years old from rural areas of the northeast China. Anthropometric measurements and self-reported information on health-related variables, such as physical activities, sleep duration, dietary habits, family income, and recognition of weight status from the views of both children and parents, were collected by trained personnel. Results The prevalence rates of overweight and obesity were 15.3 and 6.4%, respectively. Compared to girls, boys were more commonly overweight (17.5% vs. 12.9%) and obese (9.5% vs. 3.1%). Approximately half of the parents with an overweight or obese child reported that they failed to recognize their child’s excess weight status, and 65% of patients with an overweight child reported that they would not take measures to decrease their child’s body weight. Obese children and adolescents were more likely to be nonsnackers [odds ratio (OR): 1.348; 95% confidence interval (CI): 1.039–1.748] and to have a family income of 2000 CNY or more per month (OR: 1.442; 95% CI: 1.045–1.99) and less likely to sleep longer (≥7.5 h) (OR: 0.475; 95% CI: 0.31–0.728) than the normal-weight participants. Conclusions Our study revealed a high prevalence of overweight and obesity in a large Chinese pediatric population. Differences in sleep duration, snacking, family income, and parental recognition of children’s weight status among participants in different weight categories were observed, which should be considered when planning prevention and treatment programs for pediatric obesity.
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Affiliation(s)
- Xiaofan Guo
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang 110001, People's Republic of China
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Baumann M, Schmaderer C, Kuznetsova T, Bartholome R, Smits JFM, Richart T, Struijker-Boudier H, Staessen JA. Urinary nitric oxide metabolites and individual blood pressure progression to overt hypertension. ACTA ACUST UNITED AC 2011; 18:656-63. [PMID: 21450631 DOI: 10.1177/1741826710389419] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Baseline blood pressure (BP) is the strongest known determinant of progression to hypertension, but for an individualized prediction of the incidence of hypertension, the identification of additional biomarkers is crucial. In animal models of hypertension, renal nitric oxide (NO) handling modifies the systemic BP responses prior to the development of hypertension. This study aimed to evaluate whether urinary NO metabolites (NOx) predict the progression of hypertension in normotensive subjects. Among 62 participants enrolled in the Flemish Study on Environment, Genes and Health Outcomes, we assessed progression to hypertension over 4.6 years. In a case-control design, 49 normotensive subjects including 10 subjects with high-normal blood pressure were enrolled of whom 25 remained normotensive (controls), whereas 24 'progressed' to hypertension (progressors). Thirteen hypertensive patients served as negative controls. Urinary NOx concentration, renal function and the urinary excretion of electrolytes were assessed at baseline and follow-up. At baseline, progressors showed higher BP values than controls and urinary NOx concentration was significantly lower in progressors as compared to the normotensive controls (p < 0.01). In all initially normotensive subjects baseline urinary NOx concentration was associated with follow-up BP (r = -0.55, p < 0.001) and the relative increase of BP over time (r = -0.47, p < 0.001). In progressors baseline urinary NOx was associated with follow-up BP (r = -0.52, p < 0.009) and the relative increase of BP over time (r = -0.44, p = 0.033). Baseline urinary NOx and BP were independent predictors for the relative BP increase. A urinary NOx threshold of <130.5 mg/L predicted 75% of all progressors. In context with high-normal baseline BP, 87.5% of all progressors were identified. These findings indicate that urinary NO metabolites are associated with BP development in normotensive subjects. Moreover, urinary NOx predicts the progression to hypertension independent of baseline BP suggesting urinary NOx as a biomarker for individual new-onset hypertension.
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Affiliation(s)
- Marcus Baumann
- Department of Nephrology, Klinikum rechts der Isar, Munich Technical University, Munich, Germany.
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Lieb W, Pencina MJ, Jacques PF, Wang TJ, Larson MG, Levy D, Kannel WB, Vasan RS. Higher aldosterone and lower N-terminal proatrial natriuretic peptide as biomarkers of salt sensitivity in the community. ACTA ACUST UNITED AC 2011; 18:664-73. [PMID: 21450637 DOI: 10.1177/1741826710389406] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Salt sensitivity, a trait characterized by a pressor blood pressure response to increased dietary salt intake, has been associated with higher rates of cardiovascular target organ damage and cardiovascular disease events. Recent experimental studies have highlighted the potential role of the natriuretic peptides and aldosterone in mediating salt sensitivity. DESIGN Prospective cohort study. METHODS We evaluated 1575 non-hypertensive Framingham Offspring cohort participants (mean age 55 ± 9 years, 58% women) who underwent routine measurements of circulating aldosterone and N-terminal proatrial natriuretic peptide (NT-ANP) and assessment of dietary sodium intake. Participants were categorized as potentially 'salt sensitive' if their serum aldosterone was >sex-specific median but plasma NT-ANP was ≤sex-specific median value. Dietary sodium intake was categorized as lower versus higher (dichotomized at the sex-specific median). We used multivariable linear regression to relate presence of salt sensitivity (as defined above) to longitudinal changes (Δ) in systolic and diastolic blood pressure on follow-up (median four years). RESULTS Participants who were 'salt sensitive' (N = 437) experienced significantly greater increases in blood pressure (Δ systolic, +4.4 and +2.3 mmHg; Δ diastolic, +1.9 and -0.3 mmHg; on a higher versus lower sodium diet, respectively) as compared to the other participants (Δ systolic, +2.8 and +1.0 mmHg; Δ diastolic, +0.5 and -0.2 mmHg; on higher versus lower sodium diet, respectively; P = 0.033 and P = 0.0127 for differences between groups in Δ systolic and Δ diastolic blood pressure, respectively). CONCLUSIONS Our observational data suggest that higher circulating aldosterone and lower NT-ANP concentrations may be markers of salt sensitivity in the community. Additional studies are warranted to confirm these observations.
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Prevalence and risk factors associated with prehypertension: identification of foci for primary prevention of hypertension. J Cardiovasc Nurs 2011; 25:461-9. [PMID: 20938249 DOI: 10.1097/jcn.0b013e3181dcb551] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND RESEARCH OBJECTIVE Prehypertension (pre-HT) has become an important public health issue in China because it identifies people at higher risk for hypertension (HT) and cardiovascular diseases. The aims of this study were to (1) examine the prevalence of pre-HT, (2) identify risk factors of pre-HT, and (3) identify factors that increase the likelihood of developing HT among the pre-HT group. SUBJECT AND METHODS This was a cross-sectional descriptive study. Community-dwelling residents of an urban district in Wuhan, central China (obtained from stratified random sampling), aged between 35 and 74 years completed the study. Data were collected by using a structured self-reporting questionnaire and a standardized protocol for blood pressure measurement and risk screening. Blood pressure categories were defined according to the results of the seventh report of the Joint National Committee on the Prevention, Detection and Treatment of High Blood Pressure. RESULTS Among the 1,448 participants, 618 (42.7%) had pre-HT. Multivariate logistic regression analysis revealed the risk factors of being overweight (adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 1.26-2.98) or obese (aOR, 8.9; 95% CI, 1.14-62.3) and having above-optimal triglyceride level (aOR, 1.67; 95% CI, 1.24-2.26) were associated with pre-HT. Age and lower educational level were also associated with pre-HT risk. There was a clear trend toward an increased risk of HT among the pre-HT group with every 10-year increment in age starting from 45 years (aORs were 3.47, 6.82, and 7.58, respectively). Participants with Pre-HT currently engaging in sedentary work were also found to have a higher risk of developing HT. Other risk factors for HT included being overweight (aOR, 2.0; 95% CI, 1.50-2.68), a known family history of HT (aOR, 2.54; 95% CI, 1.98-3.26), and presence of diabetes mellitus (aOR, 2.51; 95% CI, 1.66-3.80). CONCLUSION Prehypertension is common among residents in an urban district in central China. Findings of this study serve to identify the at-risk groups. Targeting these people early with therapeutic lifestyle changes may provide important long-term benefit for HT prevention.
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Nery AB, Mesquita ET, Lugon JR, Kang HC, Miranda VAD, Souza BGTD, Andrade JAM, Rosa MLG. Prehypertension and cardiovascular risk factors in adults enrolled in a primary care programme. ACTA ACUST UNITED AC 2011; 18:233-9. [DOI: 10.1177/1741826710389380] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Aline B Nery
- Department of Epidemiology and Biostatistics, Universidade Federal Fluminense (UFF), Niteroi, Rio de Janeiro, Brazil
| | - Evandro T Mesquita
- Department of Internal Medicine, Universidade Federal Fluminense (UFF), Niteroi, Rio de Janeiro, Brazil
| | - Jocemir R Lugon
- Department of Internal Medicine, Universidade Federal Fluminense (UFF), Niteroi, Rio de Janeiro, Brazil
| | - Hye Chung Kang
- Department of Pathology, Universidade Federal Fluminense (UFF), Niteroi, Rio de Janeiro, Brazil
| | | | - Bernardo GT de Souza
- Department of Epidemiology and Biostatistics, Universidade Federal Fluminense (UFF), Niteroi, Rio de Janeiro, Brazil
| | - Juliana AM Andrade
- Department of Internal Medicine, Universidade Federal Fluminense (UFF), Niteroi, Rio de Janeiro, Brazil
| | - Maria Luiza G Rosa
- Department of Epidemiology and Biostatistics, Universidade Federal Fluminense (UFF), Niteroi, Rio de Janeiro, Brazil
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Huang S, Xu Y, Yue L, Wei S, Liu L, Gan X, Zhou S, Nie S. Evaluating the risk of hypertension using an artificial neural network method in rural residents over the age of 35 years in a Chinese area. Hypertens Res 2010; 33:722-6. [PMID: 20505678 DOI: 10.1038/hr.2010.73] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hypertension (HTN) has been proven to be associated with an increased risk of cardiovascular diseases. The purpose of the study was to examine risk factors for HTN and to develop a prediction model to estimate HTN risk for rural residents over the age of 35 years. This study was based on a cross-sectional survey of 3054 rural community residents (N=3054). Participants were divided into two groups: a training set (N1=2438) and a validation set (N2=616). The differences between the training set and validation set were not statistically significant. The predictors of HTN risk were identified from the training set using logistic regression analysis. Some risk factors were significantly associated with HTN, such as a high educational level (EL) (odds ratio (OR)=0.744), a predominantly sedentary job (OR=1.090), a positive family history of HTN (OR=1.614), being overweight (OR=1.525), dysarteriotony (OR=1.101), alcohol intake (OR=0.760), a salty diet (OR=1.146), more vegetable and fruit intake (OR=0.882), meat consumption (OR=0.787) and regular physical exercise (OR=0.866). We established the predictive models using logistic regression model (LRM) and artificial neural network (ANN). The accuracy of the models was compared by receiver operating characteristic (ROC) when the models were applied to the validation set. The ANN model (area under the curve (AUC)=0.900+/-0.014) proved better than the LRM (AUC=0.732+/-0.026) in terms of evaluating the HTN risk because it had a larger area under the ROC curve.
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Affiliation(s)
- Shuqiong Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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