Trends in Prevalence, Awareness, Treatment, and Control of Hypertension in Rural Northeast China: 2008 to 2018

Prevalence, awareness, treatment, control of hypertension among adults inhabited in the coastal area of Tianjin, China

Hypertension has long been a worldwide health concern. Our aim was to investigate the prevalence, awareness, treatment, and control rates of hypertension and analyze the factors related to hypertension among adult residents of the coastal areas of Tianjin, China. This was a cross-sectional study. Adults aged 35 to 75 years were selected for the study using cluster random sampling methods. Detailed information was collected via face-to-face surveys and medical checkups. We assessed the rates of hypertension in the total population and sub-populations and used multivariable logistic regression to identify the factors associated with the prevalence and the control of hypertension. In total, 6305 participants aged 55.22 ± 10.37 years were included in this study. Approximately 49.8% (95% confidence interval [CI]: 48.5%-51.1%) of the population had hypertension; the prevalence increased with age and body mass index (all P < .001). Multivariable logistic regression showed that the odds ratio of hypertension was 5.93 times more in participants aged 65 to 75 years than in those aged 35 to 44 (95% CI: 4.85-7.26, P < .001). The odds ratio of hypertension was 3.63 times more in obese participants than in those of normal weight (95% CI: 3.08-4.28, P < .001). Additionally, the awareness, treatment, control, and control under-treatment rates of hypertension were 89.7%, 83.6%, 54.4%, and 60.5%, respectively. Factors associated with having controlled hypertension included sex, body mass index, and dyslipidemia (all P < .01). Our study identified that in the coastal area of Tianjin, China, about half have hypertension, also the region has high rates of hypertension awareness, treatment and control, and more than half of hypertension patients receiving treatment have controlled hypertension.

Trends in prevalence of obesity and its association with hypertension across socioeconomic gradients in rural Yunnan Province, China

BACKGROUND

This study aimed to uncover the changing prevalence of obesity and its association with hypertension across socioeconomic gradients in rural southwest China.

METHODS

Data were collected from two cross-sectional health interviews and surveys from 2011 to 2021 among individuals aged ≥ 35 years in rural China. Each participant's height, weight, waist circumference, and blood pressure were measured. The overall prevalence of obesity, central obesity, and hypertension was directly standardized by age based on the total population of the two surveys. Multivariate logistic regression was used to analyze the association between obesity and prevalence of hypertension and an individual socioeconomic position (SEP) index was constructed using principal component analysis.

RESULTS

From 2011 to 2021, the prevalence of obesity, central obesity, and hypertension increased substantially, from 5.9%, 50.2%, and 26.1-12.1%, 58.0%, and 40.4% (P < 0.01), respectively. These increasing rates existed in all subcategories, including sex, age, ethnicity, education, annual household income, access to medical services, and SEP (P < 0.05). In both 2011 and 2021, lower education level and poor access to medical services correlated with higher prevalence of central obesity, while higher SEP correlated with higher prevalence of obesity and central obesity (P < 0.01). Prevalence of obesity was higher in the Han ethnicity participants and individuals with poor access to medical services than in their counterparts (P < 0.01). Whereas the prevalence of central obesity was lower in Han participants than in ethnic minority participants in 2011 (P < 0.01), this trend reversed in 2021 (P < 0.01). A positive relationship between annual household income and prevalence of obesity and central obesity was only found in 2021 (P < 0.01). Obese and centrally obese participants were more likely to be hypertensive in both survey years (P < 0.01).

CONCLUSIONS

Future interventions to prevent and manage obesity in rural China should give increased attention to high income, less educated, poor access to medical services, and high SEP individuals. The implementation of these obesity interventions would also help reduce the prevalence of hypertension.

Influence of hypertension and global or abdominal obesity on left ventricular hypertrophy: A cross-sectional study

Although hypertension and obesity are both risk factors for left ventricular hypertrophy (LVH), the extent of their impact on LVH in the general population is still unclear, and the predictive value of obesity indicators for LVH remains to be elucidated. In this study, obesity-related indicators, including waist circumference (WC), waist-height ratio (WHTR), and waist-hip ratio (WHR), were used to define abdominal obesity (AO), whereas body mass index (BMI) was used to measure general obesity (GO). The effects of hypertension and obesity on LVH were estimated using logistic regression analysis, as was the relative risk of LVH based on the presence of obesity, hypertension, or both. Subgroup analyses were performed based on sex and age. Of the 9134 participants (≥35 years old), 915 (10.0%) developed LVH. After adjusting for covariates, the odds ratios (95% confidence intervals) for LVH were 3.94 (3.27-4.75) in patients with hypertension, 1.90 (1.60-2.26) in those with GO, and 1.45 (1.25-1.69), 1.69 (1.43-2.00), and 1.54 (1.33-4.75) in individuals with AO defined based on WC, WHTR, and WHR, respectively. Analysis by sex showed similar values in women, but AO based on WC and WHR were not significantly associated with LVH in men. Further, after adjusting for potential confounding factors, concomitant hypertension and obesity had an increased risk of developing LVH in all age ranges, particularly in patients aged 35-45 years (risk increased 14.14-fold, 10.84-fold, 7.97-fold, and 9.95-fold for BMI-based GO and WC-, WHTR-, and WHR-based AO, respectively), and in both men and women but particularly in men (risk increased 7.71-fold, 4.67-fold, 5.83-fold, and 5.58-fold, respectively). In summary, all obesity indicators (BMI, WC, WHTR, and WHR) had predictive value for LVH in women; however, only BMI and WHTR should be considered for men. Furthermore, monitoring for the occurrence and progression of LVH is imperative for rural Chinese patients with concomitant hypertension and obesity, especially men and those aged 35-45 years.

Prevalence, awareness, treatment, and control of hypertension in China, 2004-18: findings from six rounds of a national survey

OBJECTIVE

To assess the recent trends in prevalence and management of hypertension in China, nationally and by population subgroups.

DESIGN

Six rounds of a national survey, China.

SETTING

China Chronic Disease and Risk Factors Surveillance, 2004-18.

PARTICIPANTS

642 523 community dwelling adults aged 18-69 years (30 501 in 2004, 47 353 in 2007, 90 491 in 2010, 156 836 in 2013, 162 293 in 2015, and 155 049 in 2018).

MAIN OUTCOME MEASURES

Hypertension was defined as a blood pressure of ≥140/90 mm Hg or taking antihypertensive drugs. The main outcome measures were hypertension prevalence and proportion of people with hypertension who were aware of their hypertension, who were treated for hypertension, and whose blood pressure was controlled below 140/90 mm Hg.

RESULTS

The standardised prevalence of hypertension in adults aged 18-69 years in China increased from 20.8% (95% confidence interval 19.0% to 22.5%) in 2004 to 29.6% (27.8% to 31.3%) in 2010, then decreased to 24.7% (23.2% to 26.1%) in 2018. During 2010-18, the absolute annual decline in prevalence of hypertension among women was more than twice that among men (-0.83 percentage points (95% confidence interval -1.13 to -0.52) v -0.40 percentage points (-0.73 to -0.07)). Despite modest improvements in the awareness, treatment, and control of hypertension since 2004, rates remained low in 2018, at 38.3% (36.3% to 40.4%), 34.6% (32.6% to 36.7%), and 12.0% (10.6% to 13.4%). Of 274 million (95% confidence interval 238 to 311 million) adults aged 18-69 years with hypertension in 2018, control was inadequate in an estimated 240 million (215 to 264 million). Across all surveys, women with low educational attainment had higher prevalence of hypertension than those with higher education, but the finding was mixed for men. The gap in hypertension control between urban and rural areas persisted, despite larger improvements in diagnosis and control in rural than in urban areas.

CONCLUSIONS

The prevalence of hypertension in China has slightly declined since 2010, but treatment and control remain low. The findings highlight the need for improving detection and treatment of hypertension through the strengthening of primary care in China, especially in rural areas.

Association of occupational noise exposure with hypertension: A cross-sectional study

The effects of chronic occupational noise exposure on hypertension are debated. We aimed to investigate the association between occupational noise exposure and the prevalence of hypertension. The cross-sectional data were collected from 2017 to 2018 using occupational physical examination data from a local aircraft manufacturing enterprise in Xi'an. We categorized occupational noise exposure as high (≥85 dBA) and low noise exposure (< 85 dBA). Logistic regression analysis was performed to evaluate the association between occupational noise exposure and hypertension, and associations were further evaluated using subgroup analyses for age, sex, and body mass index (BMI). Of the 4746 participants (median age, 43 years; 73.4% men), 9.57% (454/4746) had hypertension and 32.4% (1540/4746) were exposed to high noise. Compared to the participants with low occupational exposure to noise, the adjusted odds ratio (OR) for hypertension prevalence was 1.30 (1.05-1.62) for those with high occupational noise exposure. Subgroup analyses revealed that the noise-hypertension association only existed in young participants (OR, 1.70; 95% CI, 1.21-2.40). This study revealed a harmful association between high occupational noise exposure and hypertension in young adults. The study suggests occupational noise exposure as a target for worksite interventions to prevent hypertension.

Chronological attenuation of NPRA/PKG/AMPK signaling promotes vascular aging and elevates blood pressure

Hypertension is common in elderly population. We designed to search comprehensively for genes that are chronologically shifted in their expressions and to define their contributions to vascular aging and hypertension. RNA sequencing was conducted to search for senescence-shifted transcripts in human umbilical vein endothelial cells (HUVECs). Small interfering RNA (siRNA), small-molecule drugs, CRISPR/Cas9 techniques, and imaging were used to determine genes' function and contributions to age-related phenotypes of the endothelial cell and blood vessel. Of 25 genes enriched in the term of "regulation of blood pressure," NPRA was changed most significantly. The decreased NPRA expression was replicated in aortas of aged mice. The knockdown of NPRA promoted HUVEC senescence and it decreased expressions of protein kinase cGMP-dependent 1 (PKG), sirtuin 1 (SIRT1), and endothelial nitric oxide synthase (eNOS). Suppression of NPRA also decreased the phosphorylation of AMP-activated protein kinase (AMPK) as well as the ratio of oxidized nicotinamide adenine dinucleotide (NAD⁺ )/reduced nicotinamide adenine dinucleotide (NADH) but increased the production of reactive oxygen species (ROS). 8-Br-cGMP (analog of cGMP), or AICAR (AMPK activator), counteracted the observed changes in HUVECs. The Npr1^+/- mice presented an elevated systolic blood pressure and their vessels became insensitive to endothelial-dependent vasodilators. Further, vessels from Npr1^+/- mice increased Cdkn1a but decreased eNos expressions. These phenotypes were rescued by intravenously administrated 8-Br-cGMP and viral overexpression of human PKG, respectively. In conclusion, we demonstrate NPRA/PKG/AMPK as a novel and critical signaling axis in the modulation of endothelial cell senescence, vascular aging, and hypertension.

Simple renal cyst as an independent risk factor for hypertension

A simple renal cyst (SRC) may increase the risk for hypertension. The authors examined the relationship between a SRC and hypertension in participants receiving physical examinations at Hebei Medical University. This study enrolled 66 883 participants who received physical examinations at our center from January 2012 to December 2017. Demographic data, medical history related to hypertension, hematological indexes, hypertension, and SRC subtype based on ultrasound examinations were examined. The relationship between SRC and hypertension was analyzed using univariate and multivariate logistic regression analysis in different models. Subgroup analysis and propensity score (PS) matching were also performed. Based on SRC subtype (unitary vs. multiple, small vs. large, unilateral vs. bilateral), a comprehensive scoring system was established to determine the effect of SRC load on hypertension. The results of univariate and multivariate analysis indicated that SRC was a risk factor for hypertension (P < .01). Subgroup and interaction analysis showed the homogeneity that SRC was an independent risk factor for hypertension in multiple subgroups (P > .05). A SRC remained an independent risk factor for hypertension after PS matching (P < .01). Based on a scoring system that considered different SRC subtypes, the risk for hypertension increased with renal cyst load (P < .01). In conclusions, a SRC was an independent risk factor for hypertension, and there was a positive correlation between SRC load and hypertension. The risk of hypertension increased gradually with the size, number, and location of a SRC. Careful follow‐up or excision should be considered for patients with SRCs.

Combining econometric analysis and simulation modeling to evaluate Population-Based health policies for chronic disease prevention and control

Objectives

Population-based health policies play an important role in preventing and controlling chronic disease. Policymakers need to understand both the short- and long-term impacts of different policies to optimize resource allocation. The objective of this study is to develop a framework that combines econometric analysis and simulation modeling for a comprehensive evaluation of population-based health policies.

Study design

Both econometric analysis and simulation modeling were used to evaluate the impact of a population-based health policy.

Methods

We identified a cohort of hypertensive patients from the 2011–2013 China Health and Retirement Longitudinal Study and fitted the data into our framework to evaluate the effectiveness of a community-based hypertension-screening program under the Essential Public Health Services (EPHS) policy on the future burden of cardiovascular disease in China.

Results

Using an econometric approach, we identified that the community-based hypertension screening program would lead to a 7.9% improvement in the rate of hypertension control. Using a validated simulation model, we further estimated that if the policy was fully implemented nationwide, it could avert 97,100 cases of myocardial infarction and 215,600 cases of stroke. The policy would cost $2131 on average to save 1 quality-adjusted life year over 10 years.

Conclusions

This study proposed a framework integrating two different methods and assessing both short- and long-term impact of a population-based health policy. Through a case study, we demonstrated that combining econometric analysis and simulation modeling could provide policymakers with a more powerful tool to evaluate health policies for controlling chronic disease.

The Prevalence of Hypertension in the Population without Awareness of the Disease: Data from a Rural Town of Shandong Province, China

Objective

To understand the prevalence of hypertension in the population without awareness of hypertension in a rural area, a cross-sectional study was carried out.

Methods

Blood pressures were measured in residents over 60 years during the National Basic Public Health Service project carrying on in a rural town of Shandong province. Combined with detail information of the hypertension disease history, the status of prevalence of hypertension was calculated. Basic information and clinical laboratory examinations were analyzed with Student' t or t' or chi-square test for univariate analysis. Multinomial logistic analysis was used in exploring multiple variables.

Results

According to the individual history and blood pressure levels, the awareness rate of hypertension in the population over 60 years old was 50.3% (1285/2554, 95% CI: 48.3–52.3%). The prevalence of hypertension was 55.1% (1270/2304, 95% CI: 53.1–57.2%) in the population without awareness of hypertension, in which the proportion of stage 1 hypertension was 58.8% (747/1270), stage 2 hypertension was 28.9% (367/1270), and stage 3 hypertension was 12.3% (156/1270). The prevalence of hypertension in men was 54.4% (611/1124, 95% CI: 51.4–57.3%), which was almost the same as that in women (55.8%, 659/1180, 95% CI: 53.0–58.7%) (X² = 0.515, P=0.473). The prevalence of hypertension increased with age (X²_trend = 11.848, P=0.001). Age, BMI, total cholesterol, triglyceride, and drinking rate were positively correlated with the prevalence of hypertension, that is, the higher the level of these factors, the higher the prevalence of hypertension; on the contrary, LDL and smoking rate might be negatively correlated with the prevalence of hypertension, which means, the higher the prevalence of hypertension, the lower the level of these two indicators. Binary and multinominal logistic results showed that age, BMI, and drinking had stronger effects on the higher blood pressure level.

Conclusions

The awareness rate of hypertension among the elderly in a rural area needs to be further improved. In the prevention and control of hypertension, close attention should be paid to the group of elder, high BMI index, high levels of total cholesterol and triglyceride, and drinking habits.

Dynamic changes in metabolic health status in Chinese adults: Multiple population-based surveys in Shanghai, China

AIMS/INTRODUCTION

Metabolic syndrome (MS) has been increasing worldwide. The secular change in MS components, however, remains unclear. This study aimed to examine the dynamic change in metabolic health status in Chinese adults.

MATERIALS AND METHODS

Three population-based surveys using multistage stratified sampling were performed in Chinese aged 35-74 years in Shanghai in 2002-2003 (n = 12,302), 2009 (n = 7,400), and 2017 (n = 19,023). MS was defined according to the Adult Treatment Panel III criteria for Asian-Americans. Generalized Estimating Equations and Cochran-Armitage Trend Test was used to assess the prevalence trend over the years.

RESULTS

The prevalence of MS doubled in Chinese adults over the period (P for trend < 0.001). The largest increase occurred in younger men. Among MS components, the prevalence of high waist-circumference (HWC), high blood glucose (HBG) and high blood pressure (HBP) increased in all subjects, whereas the prevalence of high triglycerides (HTG) and low high-density lipoprotein cholesterol (LHC) increased in men but decreased in women. The increase in HBP contributed most to elevated MS, followed by HBG and HWC, resulting in the HBP-HBG-HWC the most common cluster of MS components. Metabolically unhealthy overweight also grew over the period.

CONCLUSIONS

Metabolic health status has been exacerbating in Chinese adults and may increase burden of non-communicable diseases.

Current status of premature mortality from four non-communicable diseases and progress towards the Sustainable Development Goal target 3.4: a population-based study in northeast China, 2004-2017

Background and aim

According to the United Nations’ Sustainable Development Goal (SDG) target 3.4, premature mortality from four non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes mellitus, collectively referred to as NCD4) should achieve a minimum decline of 33% in 2030 relative to 2015. This remains a challenge for China. This study aimed to evaluate the current status and progress towards this target in Liaoning Province, one of the three provinces in northeast China.

Methods

We calculated the premature mortality rates (PMRs) per year and average annual percentage changes (AAPCs) from NCD4 using mortality data between 2004 and 2017. The trend was analyzed in the whole population, as well as in subpopulations of gender (male/female) and inhabiting area (urban/rural). PMRs from NCD4 for 2030 were projected by fitting a linear regression based on the current trend, which was identified by a Joinpoint model.

Findings

In the whole population, only chronic respiratory diseases showed a significant decline (AAPC: − 6.5%, p < 0.05), while only cancer showed a significant increase (AAPC: + 1.3%, p < 0.05); taken together, NCD4 showed a significant increase (AAPC: + 0.6%, p < 0.05). In the subpopulations, while males showed a significant increase in NCD4 (AAPC: + 1.5%, p < 0.05), cardiovascular diseases (AAPC: + 1.7%, p < 0.05), cancer (AAPC: + 1.8%, p < 0.05), and diabetes mellitus (AAPC: + 4.2%, p < 0.05), females showed a significant decline in NCD4 (AAPC: − 1.2%, p < 0.05), cardiovascular diseases (AAPC: − 1.8%, p < 0.05), diabetes mellitus (AAPC: − 2.1%, p < 0.05), but showed a mild increase in cancer (AAPC: + 0.5%, p > 0.05). A comparative analysis of the projected PMRs for 2030 with the 2015 levels revealed that only chronic respiratory diseases are expected to achieve the SDG target 3.4, apart from in the urban male subpopulation.

Conclusion

Except for chronic respiratory diseases, NCD4 cannot be expected to achieve the SDG target 3.4 in the whole population of Liaoning Province. Under these circumstances, special attention should be paid to reducing the risks of cancer and providing preventative interventions for men.

Sex Differences of Combined Effects Between Hypertension and General or Central Obesity on Ischemic Stroke in a Middle-Aged and Elderly Population

Background

Hypertension and obesity are recognized as modifiable risk factors for stroke, but their combined effects are unknown. This study aimed to explore the combined effects of hypertension and general or central obesity on the risk of ischemic stroke in a middle-aged and elderly population.

Methods

The data of 11,731 participants (53.5 ± 10.5 years old) were analyzed from the Northeast China Rural Cardiovascular Health Study, 2012–2013. General obesity (GO) was defined by body mass index (BMI); central obesity (CO) was measured by waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHpR).

Results

The overall prevalence of ischemic stroke was 3.1%. After adjusting for age and sex, the odds ratios for having ischemic stroke were 4.31 (3.14–5.91) among subjects with hypertension, 1.79 (1.40–2.30) with GO, 1.94 (1.54–2.43), 1.98 (1.54–2.53), and 1.65 (1.33–2.06) with CO measured by WC, WHtR and WHpR, respectively. After full adjustment for potential confounders, the combinations of hypertension and obesity indices (including BMI, WC, WHtR and WHpR) were associated with the highest risk of ischemic stroke, especially in women, which were respectively 7.3-fold, 9.3-fold, 9.9-fold and 7.6-fold higher than that of individuals without both conditions.

Conclusion

Our study results suggest that women with both hypertension and obesity, no matter defined by BMI, WC, WHtR or WHpR, were more likely to have ischemic stroke. A better understanding of the combined effects of these risk factors can help promote primary prevention in susceptible subgroups.