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Gao Q, Li L, Bai J, Fan L, Tan J, Wu S, Cai J. Association of stage 1 hypertension defined by the 2017 ACC/AHA guideline with cardiovascular events and mortality in Chinese adults. Chin Med J (Engl) 2024; 137:63-72. [PMID: 37319412 PMCID: PMC10766249 DOI: 10.1097/cm9.0000000000002669] [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: 08/06/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline lowered the threshold defining hypertension to 130/80 mmHg. However, how stage 1 hypertension defined using this guideline is associated with cardiovascular events in Chinese adults remains unclear. This study assessed the association between stage 1 hypertension defined by the 2017 ACC/AHA guideline and clinical outcomes in the Chinese population. METHODS Participants with stage 1 hypertension ( n = 69,509) or normal BP ( n = 34,142) were followed in this study from 2006/2007 to 2020. Stage 1 hypertension was defined as a systolic blood pressure of 130-139 mmHg or a diastolic blood pressure of 80-89 mmHg. None were taking antihypertensive medication or had a history of myocardial infarction (MI), stroke, or cancer at baseline. The primary outcome was a composite of MI, stroke, and all-cause mortality. The secondary outcomes were individual components of the primary outcome. Cox proportional hazards models were used for the analysis. RESULTS During a median follow-up of 11.09 years, we observed 10,479 events (MI, n = 995; stroke, n = 3408; all-cause mortality, n = 7094). After multivariable adjustment, the hazard ratios for stage 1 hypertension vs. normal BP were 1.20 (95% confidence interval [CI], 1.13-1.25) for primary outcome, 1.24 (95% CI, 1.05-1.46) for MI, 1.45 (95% CI, 1.33-1.59) for stroke, and 1.11 (95% CI, 1.04-1.17) for all-cause mortality. The hazard ratios for participants with stage 1 hypertension who were prescribed antihypertensive medications compared with those without antihypertensive treatment during the follow-up was 0.90 (95% CI, 0.85-0.96). CONCLUSIONS Using the new definition, Chinese adults with untreated stage 1 hypertension are at higher risk for MI, stroke, and all-cause mortality. This finding may help to validate the new BP classification system in China.
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Affiliation(s)
- Qiannan Gao
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Liuxin Li
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, Hebei 063000, China
| | - Jingjing Bai
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Luyun Fan
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Jiangshan Tan
- Emergency Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, Hebei 063000, China
| | - Jun Cai
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
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Mai H, Li C, Chen K, Wu Z, Liang X, Wang Y, Chen T, Chen F. Hypertension Subtypes, Mortality Risk, and Differential Effects Between Two Hypertension Guidelines. Front Med (Lausanne) 2022; 9:814215. [PMID: 35865177 PMCID: PMC9295617 DOI: 10.3389/fmed.2022.814215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/15/2022] [Indexed: 11/27/2022] Open
Abstract
Aim: To examine which hypertension subtypes are primarily responsible for the difference in the hypertension prevalence and treatment recommendations, and to assess their mortality risk if 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guideline were adopted among Chinese adults. Methods We used the nationally representative data of China Health and Retirement Longitudinal Study (CHARLS) to estimate the differences in the prevalence of isolated systolic hypertension (ISH), systolic diastolic hypertension (SDH) and isolated diastolic hypertension (IDH) between the 2017 ACC/AHA and the 2018 China Hypertension League (CHL) guidelines. We further assessed their mortality risk using follow-up data from the China Health and Nutrition Survey (CHNS) by the Cox model. Results The increase from the 2017 ACC/AHA guideline on hypertension prevalence was mostly from SDH (8.64% by CHL to 25.59% by ACC/AHA), followed by IDH (2.42 to 6.93%). However, the difference was minuscule in the proportion of people recommended for antihypertensive treatment among people with IDH (2.42 to 3.34%) or ISH (12.00 to 12.73%). Among 22,184 participants with a median follow-up of 6.14 years from CHNS, attenuated but significant associations were observed between all-cause mortality and SDH (hazard ratio 1.56; 95% CI: 1.36,1.79) and ISH (1.29; 1.03,1.61) by ACC/AHA but null association for IDH (1.15; 0.98,1.35). Conclusion Adoption of the 2017 ACC/AHA may be applicable to improve the unacceptable hypertension control rate among Chinese adults but with cautions for the drug therapy among millions of subjects with IDH.
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Affiliation(s)
- Hui Mai
- Department of Neurology, Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Chao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
- *Correspondence: Chao Li
| | - Kangyu Chen
- Division of Life Sciences and Medicine, Department of Cardiology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Zhenqiang Wu
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Xuanyi Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Yongjuan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Tao Chen
- Department of Public Health, Policy and Systems, Institute of Population Health, Whelan Building, Quadrangle, The University of Liverpool, Liverpool, United Kingdom
- Tao Chen
| | - Fengjian Chen
- Department of Neurology, Central People's Hospital of Zhanjiang, Zhanjiang, China
- Fengjian Chen
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Chen K, Su H, Wang Q, Wu Z, Shi R, Yu F, Yan J, Yuan X, Qin R, Zhou Z, Hou Z, Li C, Chen T. Similarities in Hypertension Status but Differences in Mortality Risk: A Comparison of 2017 ACC/AHA and 2018 Chinese Hypertension Guidelines. Front Cardiovasc Med 2022; 9:784433. [PMID: 35265676 PMCID: PMC8898956 DOI: 10.3389/fcvm.2022.784433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Few studies investigated the concordance in hypertension status and antihypertensive treatment recommendations between the 2018 Chinese Hypertension League (CHL) guidelines and the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines and assessed the change of premature mortality risk with hypertension defined by the ACC/AHA guidelines. Methods We used the baseline data of the China Health and Retirement Longitudinal Study (CHARLS) to estimate the population impact on hypertension management between CHL and ACC/AHA guidelines. Mortality risk from hypertension was estimated using the data from China Health and Nutrition Survey (CHNS). Cox proportional hazards model was used to estimate the hazard ratios (HRs) and their 95% confidence intervals(CIs). Results Among 13,704 participants analyzed from the nationally representative data of CHARLS, 42.64% (95% CI: 40.35, 44.96) of Chinese adults were diagnosed by both CHL and ACC/AHA guidelines. 41.25% (39.17, 43.36) did not have hypertension according to either guideline. Overall, the concordance in hypertension status was 83.89% (81.69, 85.57). A high percentage of agreement was also found for recommendation to initiate treatment among untreated subjects (87.62% [86.67, 88.51]) and blood pressure (BP) above the goal among treated subjects (71.68% [68.16, 74.95]). Among 23,063 adults from CHNS, subjects with hypertension by CHL had a higher risk of premature mortality (1.75 [1.50, 2.04]) compared with those without hypertension. The association diminished for hypertension by ACC/AHA (1.46 [1.07, 1.30]). Moreover, the excess risk was not significant for the newly defined Grade 1 hypertension by ACC/AHA (1.15 [0.95, 1.38]) when compared with BP <120/80 mmHg. This contrasted with the estimate from CHL (1.54 [1.25, 1.89]). The same pattern was observed for total mortality. Conclusions If ACC/AHA guidelines were adopted, a high degree of concordance in hypertension status and initiation of antihypertensive treatment was found with CHL guidelines. However, the mortality risk with hypertension was reduced with a non-significant risk for Grade 1 hypertension defined by the ACC/AHA.
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Affiliation(s)
- Kangyu Chen
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hao Su
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Qi Wang
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Zhenqiang Wu
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Rui Shi
- Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Fei Yu
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ji Yan
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xiaodan Yuan
- Department of Health Education, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Rui Qin
- Department of Health Education, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ziai Zhou
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Zeyi Hou
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Chao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
- *Correspondence: Chao Li
| | - Tao Chen
- Department of Public Health, Policy and Systems, Institute of Population Health, The University of Liverpool, Liverpool, United Kingdom
- Tao Chen
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Li W, Xu L, Zhao H, Zhu S. Analysis of clinical distribution and drug resistance of klebsiella pneumoniae pulmonary infection in patients with hypertensive intra cerebral hemorrhage after minimally invasive surgery. Pak J Med Sci 2022; 38:237-242. [PMID: 35035432 PMCID: PMC8713240 DOI: 10.12669/pjms.38.1.4439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/12/2021] [Accepted: 07/30/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: To investigate the clinical distribution and drug resistance of Klebsiella pneumoniae pulmonary infection in patients with hypertensive intracerebral hemorrhage after minimally invasive surgery. Methods: A total of 658 patients with hypertensive intracerebral hemorrhage who underwent minimally invasive surgery admitted to the intensive care unit (ICU) and the Department of Neurology of Affiliated Hospital of Hebei University from January 2015 to January 2020 were enrolled and divided into two groups: the observation group and the control group. Three hundred and thirty-three cases with postoperative pulmonary infection were included into the observation group, and 325 cases without postoperative pulmonary infection were divided into the control group. The intubation time, neurological deficiency score and Glasgow coma scale (GCS) of the two groups were analyzed and compared. Automatic microbial identification system was utilized to isolate bacteria from patients in the observation group, identify Klebsiella pneumoniae, and analyze Klebsiella pneumoniae infection, clinical department distribution, and age distribution. The Kirby-Bauer method was adopted to carry out the drug susceptibility test of Klebsiella pneumoniae infection. Results: The intubation time and neurological deficiency score of patients with hypertensive cerebral hemorrhage in the observation group were significantly higher than those in the control group (p<0.05), while the GCS score was significantly lower than that in the control group (p<0.05). A total of 403 strains of pathogenic bacteria were isolated from 325 patients in the observation group, of which 52 strains of Klebsiella pneumoniae were detected in 52 patients with postoperative pulmonary infection, accounting for 12.90%. The detection rates of Klebsiella pneumoniae in ICU and neurology department were 53.85% and 46.15%, respectively. Klebsiella pneumoniae had the highest detection rate (40.38%) in people aged 70 years and above. Moreover, fifty-two strains of Klebsiella pneumoniae showed low drug resistance rate (<20%) to cefoperazone/sulbactam, piperacillin/tazobactam, cefoxitin, imipenem, meropenem, amikacin, ciprofloxacin, and levofloxacin. Conclusion: For patients with hypertensive cerebral hemorrhage who have pulmonary infection after minimally invasive surgery, risk factors causing infection should be identified in time, their Klebsiella pneumoniae infection should be correctly monitored, and antibiotics should be taken rationally to effectively promote the elimination of brain edema in patients and protect the cranial nerve function of patients.
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Affiliation(s)
- Wei Li
- Wei Li, Clinical Laboratory, Affiliated Hospital of Hebei University, Baoding, 071000, Hebei, China
| | - Li Xu
- Li Xu, Clinical Laboratory, Baoding Children's Hospital, Baoding, 071000, Hebei, China
| | - Haige Zhao
- Haige Zhao, Clinical Laboratory, Affiliated Hospital of Hebei University, Baoding, 071000, Hebei, China
| | - Shanshan Zhu
- Shanshan Zhu, Clinical Laboratory, Affiliated Hospital of Hebei University, Baoding, 071000, Hebei, China
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Wu J, Duan W, Jiao Y, Liu S, Zheng L, Sun Y, Sun Z. The Association of Stage 1 Hypertension, Defined by the 2017 ACC/AHA Guidelines, With Cardiovascular Events Among Rural Women in Liaoning Province, China. Front Cardiovasc Med 2021; 8:710500. [PMID: 34458337 PMCID: PMC8387632 DOI: 10.3389/fcvm.2021.710500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines redefined blood pressure levels 130-139/80-89 mmHg as stage 1 hypertension. However, the association of stage 1 hypertension with cardiovascular disease (CVD) and its age-specific differences among the rural women in Liaoning province remains unclear. It needs to be quantified in considering guideline adoption in China. Methods: In total, 19,374 women aged ≥35 years with complete data and no cardiovascular disease at baseline were followed in a rural community-based prospective cohort study of Liaoning province, China. Follow-up for the new cases of CVD was conducted from the end of the baseline survey to the end of the third follow-up survey (January 1, 2008–December 31, 2017). Adjusted Cox proportional hazards models were applied to estimate the Hazard Ratios (HR) and 95% Confidence Intervals (CI) with the normal blood pressure as a reference. Results: During the median follow-up period of 12.5 years, 1,419 subjects suffered all-cause death, 748 developed CVD, 1,224 participants suffered stroke and 241 had Myocardial Infarction (MI). Compared with normal BP, Stage 1 hypertension had a HR (95% CI) of 1.694 (1.202–2.387) in CVD mortality, 1.575 (1.244–1.994) in the incidence of stroke. The results obtained that the risk of CVD mortality and incidence of stroke was significantly associated with stage 1 hypertension in rural women aged ≥45 years after adjusting for other potential factors. However, in participants aged 35–44 years, stage 1 hypertension was not associated with an increased risk of cardiovascular disease. Conclusions: The newly defined stage 1 hypertension is associated with an increased risk of CVD mortality and also incidence of stroke in the rural women aged ≥45 years population of Liaoning province. This study can be a good reference for health policy makers and clinicians workers to make evidence-based decisions toward lowering burden of cardiovascular disease more efficient, timely measures on prevention and control of stage 1 hypertension in China.
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Affiliation(s)
- Jiake Wu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weili Duan
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yundi Jiao
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - SiTong Liu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - LiQiang Zheng
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - YingXian Sun
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - ZhaoQing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
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Cao H, Li B, Liu K, Pan L, Cui Z, Zhao W, Zhang H, Niu K, Tang N, Sun J, Han X, Wang Z, Xia J, He H, Cao Y, Xu Z, Meng G, Shan A, Guo C, Sun Y, Peng W, Liu X, Xie Y, Wen F, Zhang F, Shan G, Zhang L. Association of long-term exposure to ambient particulate pollution with stage 1 hypertension defined by the 2017 ACC/AHA Hypertension Guideline and cardiovascular disease: The CHCN-BTH cohort study. ENVIRONMENTAL RESEARCH 2021; 199:111356. [PMID: 34048743 DOI: 10.1016/j.envres.2021.111356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Evidence regarding the effects of ambient air pollution on new stage 1 hypertension defined by the 2017 ACC/AHA Hypertension Guideline remains sparse. OBJECTIVES To investigate the association of long-term exposure to ambient PM2.5 with stage 1 hypertension and to explore the mediating and modifying effects of PM2.5 on cardiovascular disease (CVD). METHODS A total of 32,135 participants aged 18-80 years were recruited in 2017. The three-year (2014-2016) average PM2.5 concentrations were assessed by a spatial statistical model. Blood pressure (BP) was divided into four categories according to the 2017 ACC/AHA Hypertension Guideline: normal BP (SBP<120 mmHg and DBP<80 mmHg), elevated BP (SBP 120-129 mmHg and DBP<80 mmHg), stage 1 hypertension (SBP 130-139 mmHg or DBP 80-89 mmHg), and stage 2 hypertension (SBP≥140 mmHg or DBP≥90 mmHg or taking antihypertensive medications). The associations of PM2.5 with BP categories were estimated by two-level generalized linear mixed models. Analyses stratified by age, mediation and interaction analyses of PM2.5 and stage 1 hypertension with CVD were performed. RESULTS We detected a positive significant association between long-term exposure to PM2.5 and stage 1 hypertension. Compared to normal BP, the OR was 1.05 (95% CI: 1.02, 1.08) per 10 μg/m3 increase in PM2.5. The association was stronger than that of elevated BP but weaker than that of stage 2 hypertension. Stage 1 hypertension only partially mediated the association between PM2.5 and CVD, and the mediation proportions ranged from 1.55% to 11.00%. However, it modified the association between PM2.5 and CVD, which was greater in participants with stage 1 hypertension (OR: 1.66; 95% CI: 1.43, 1.93) than in participants with normal BP (OR: 1.32; 95% CI: 1.11, 1.57), with Pinteraction<0.001. In the analysis stratified by age, the above associations were age-specific, and significant associations were only observed in the young and middle-aged (<60 years) groups. CONCLUSIONS Long-term exposure to ambient PM2.5 was significantly associated with stage 1 hypertension. This earlier stage of hypertension may be a trigger BP range for adverse effects of air pollution in the development of hypertension and CVD, especially in young and middle-aged individuals.
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Affiliation(s)
- Han Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, And Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Bingxiao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, And Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Kuo Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, And Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Li Pan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, And School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Ze Cui
- Department of Chronic and Noncommunicable Disease Prevention and Control, Hebei Provincial Center for Disease Prevention and Control, Shijiazhuang, Hebei, China
| | - Wei Zhao
- Department of Chronic and Noncommunicable Disease Prevention and Control, Chaoyang District Center for Disease Prevention and Control, Beijing, China
| | - Han Zhang
- Health Management Center, Beijing Aerospace General Hospital, Beijing, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Naijun Tang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jixin Sun
- Department of Chronic and Noncommunicable Disease Prevention and Control, Hebei Provincial Center for Disease Prevention and Control, Shijiazhuang, Hebei, China
| | - Xiaoyan Han
- Department of Chronic and Noncommunicable Disease Prevention and Control, Chaoyang District Center for Disease Prevention and Control, Beijing, China
| | - Zhengfang Wang
- Health Management Center, Beijing Aerospace General Hospital, Beijing, China
| | - Juan Xia
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, And Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Huijing He
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, And School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yajing Cao
- Department of Chronic and Noncommunicable Disease Prevention and Control, Hebei Provincial Center for Disease Prevention and Control, Shijiazhuang, Hebei, China
| | - Zhiyuan Xu
- Department of Chronic and Noncommunicable Disease Prevention and Control, Chaoyang District Center for Disease Prevention and Control, Beijing, China
| | - Ge Meng
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Anqi Shan
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Chunyue Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, And Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yanyan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, And Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Wenjuan Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, And Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xiaohui Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, And Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yunyi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, And Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Fuyuan Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, And Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Fengxu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, And Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, And School of Basic Medicine, Peking Union Medical College, Beijing, China.
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, And Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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Guo J, Lv J, Guo Y, Bian Z, Zheng B, Wu M, Yang L, Chen Y, Su J, Zhang J, Yao J, Chen J, Chen Z, Yu C, Li L. Association between blood pressure categories and cardiovascular disease mortality in China. PLoS One 2021; 16:e0255373. [PMID: 34329344 PMCID: PMC8323908 DOI: 10.1371/journal.pone.0255373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/15/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Blood pressure (BP) categories are useful to simplify preventions in public health, and diagnostic and treatment approaches in clinical practice. Updated evidence about the associations of BP categories with cardiovascular diseases (CVDs) and its subtypes is warranted. METHODS AND FINDINGS About 0.5 million adults aged 30 to 79 years were recruited from 10 areas in China during 2004-2008. The present study included 430 977 participants without antihypertension treatment, cancer, or CVD at baseline. BP was measured at least twice in a single visit at baseline and CVD deaths during follow-up were collected via registries and the national health insurance databases. Multivariable Cox regression was used to estimate the associations between BP categories and CVD mortality. Overall, 16.3% had prehypertension-low, 25.1% had prehypertension-high, 14.1% had isolated systolic hypertension (ISH), 1.9% had isolated diastolic hypertension (IDH), and 9.1% had systolic-diastolic hypertension (SDH). During a median 10-year follow-up, 9660 CVD deaths were documented. Compared with normal, the hazard ratios (95% CI) of prehypertension-low, prehypertension-high, ISH, IDH, SDH for CVD were 1.10 (1.01-1.19), 1.32 (1.23-1.42), 2.04 (1.91-2.19), 2.20 (1.85-2.61), and 3.81 (3.54-4.09), respectively. All hypertension subtypes were related to the increased risk of CVD subtypes, with a stronger association for hemorrhagic stroke than for ischemic heart disease. The associations were stronger in younger than older adults. CONCLUSIONS Prehypertension-high should be considered in CVD primary prevention given its high prevalence and increased CVD risk. All hypertension subtypes were independently associated with CVD and its subtypes mortality, though the strength of associations varied substantially.
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Affiliation(s)
- Jie Guo
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Beijing, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Bang Zheng
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
| | - Man Wu
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
| | - Ling Yang
- Nuffield Department of Population Health, Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, United Kingdom
| | - Yiping Chen
- Nuffield Department of Population Health, Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, United Kingdom
| | - Jian Su
- Jiangsu Center for Disease Control and Prevention, Nanjing, China
| | | | - Jvying Yao
- Gaoqiao Town Health Center, Tongxiang, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Nuffield Department of Population Health, Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, United Kingdom
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
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The 2017 ACC/AHA stage 1 hypertension is associated with arterial stiffness: a prospective analysis. Aging (Albany NY) 2021; 13:10075-10086. [PMID: 33818417 PMCID: PMC8064197 DOI: 10.18632/aging.202764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/03/2021] [Indexed: 11/25/2022]
Abstract
Objective: To examine the association between stage 1 hypertension defined by the 2017 American College of Cardiology and American Heart Association (ACC/AHA) guideline and risk of developing arterial stiffness. Methods: During 2010-2015, 4595 adults aged ≥40 years without cardiovascular disease were followed up for a median of 4.3 years. BP levels at baseline were categorized into normal, elevated, stage 1 hypertension, and stage 2 hypertension. The development of arterial stiffness was defined as a normal brachial-ankle pulse wave velocity (ba-PWV) at baseline and an increased ba-PWV at follow-up. Results: Compared with participants with normal BP, participants with stage 1 hypertension had a 1.48-fold increased risk of developing arterial stiffness [odds ratio (OR) =2.48; 95% confidence interval (CI) =1.59-3.85] after adjustment for cardiovascular risk factors. The association was more evident in adults aged 40-59 years (OR =4.08; 95% CI =2.06-8.08) than that in those aged ≥60 years (OR =1.47; 95% CI =0.81-2.67). A systolic BP 130~139 mmHg was significantly associated with arterial stiffness independent of diastolic BP (OR =2.90; 95% CI =1.86-4.52). Stage 1 hypertension either at baseline or at follow-up was associated with increased risks compared with normal BP at both baseline and follow-up. Conclusions: The 2017 ACC/AHA stage 1 hypertension was significantly associated with higher risks of arterial stiffness.
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Stage 1 hypertension by the 2017 American College of Cardiology/American Heart Association hypertension guidelines and risk of cardiovascular disease events: systematic review, meta-analysis, and estimation of population etiologic fraction of prospective cohort studies. J Hypertens 2021; 38:573-578. [PMID: 31790053 DOI: 10.1097/hjh.0000000000002321] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Epidemiological studies reported an inconsistent association between stage 1 hypertension (SBP 130-139 mmHg or DBP 80-89 mmHg) defined by the 2017 American College of Cardiology/American Heart Association hypertension guidelines and cardiovascular disease (CVD) events. In addition, the proportion of CVD events that could be prevented with effective control of stage 1 hypertension is unknown. OBJECTIVES To assess the association between stage 1 hypertension and CVD events and estimate the population etiologic fraction. METHODS PubMed, Embase, and Web of Science databases were searched from 1 January 2017 to 22 September 2019. Normal BP was considered SBP less than 120 mmHg and DBP less than 80 mmHg. Hazard ratios and 95% confidence intervals (95% CIs) were pooled by using a random-effects model. RESULTS We included 11 articles (16 studies including 3 212 447 participants and 65 945 events) in the analysis. Risk of CVD events was increased with stage 1 hypertension versus normal BP (hazard ratio 1.38, 95% CI 1.28-1.49). On subgroup analyses, stage 1 hypertension was associated with coronary heart disease (CHD) (hazard ratio 1.30, 95% CI 1.20-1.41), stroke (1.39, 1.27-1.52), CVD morbidity (1.42, 1.32-1.53), and CVD mortality (1.34, 1.05-1.71). The population etiologic fraction for the association of CVD events, CHD, stroke, CVD morbidity, and CVD mortality with stage 1 hypertension was 12.90, 10.48, 12.71, 14.03, and 11.69%, respectively. CONCLUSION Stage 1 hypertension is associated with CVD events, CVD morbidity, CVD mortality, CHD, and stroke. Effective control of stage 1 hypertension could prevent more than 10% of CVD events.
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Zheng L, Dai Y, Fu P, Yang T, Xie Y, Zheng J, Gao J, Niu T. Secular trends of hypertension prevalence based on 2017 ACC/AHA and 2018 Chinese hypertension guidelines: Results from CHNS data (1991-2015). J Clin Hypertens (Greenwich) 2021; 23:28-34. [PMID: 32970919 PMCID: PMC7891671 DOI: 10.1111/jch.14060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 12/01/2022]
Abstract
This study aimed to assess the impact of the 2017 American College of Cardiology and American Heart Association (ACC/AHA) guideline and the 2018 Chinese hypertension guidelines on the different secular trends for hypertension prevalence. A total of 82 665 eligible individuals aged ≥20 years were selected from nine cross-sectional study periods (1991-2015) from the China Health and Nutrition Survey (CHNS). Over the 24-year period, the long-term trend for the prevalence of the 2017 ACC/AHA-defined age-adjusted hypertension showed an increase from 32.2% (95% confidence interval (CI): 31.0%-33.3%) in 1991 to 60.0% (95% CI: 58.6%-61.3%) in 2015 (Ptrend < 0.001). According to the 2018 Chinese guideline for hypertension, the weighted hypertension prevalence increased from 10.0% (95% CI: 9.4%-10.5%) in 1991 to 28.7% (95% CI: 27.9%-29.6%) in 2015 (Ptrend < 0.001). However, slopes of increasing prevalence of hypertension were significantly greater according to the 2017 ACC/AHA guideline than that based on Joint National Committee (JNC 7) report (β = 1.00% vs β = 0.67% per year, respectively, P = 0.041). Based on the 2017 ACC/AHA definition, the prevalence of stage 1 hypertension and elevated blood pressure significantly increase from 22.3% and 6.9% in 1991 to 31.2% and 10.1% in 2015 (all P < 0.05), respectively. The secular trend for the prevalence of hypertension according to the 2017 ACC/AHA guideline showed a greater rate of increase compared with the prevalence based on the 2018 Chinese hypertension guidelines. Public health initiatives should focus on the current status of hypertension in China because of the possible high prevalence of hypertension and concomitant vascular risks.
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Affiliation(s)
- Liqiang Zheng
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangChina
- Department of Clinical EpidemiologyDepartment of LibraryShengjing Hospital of China Medical UniversityShenyangChina
| | - Yue Dai
- Department of Clinical EpidemiologyDepartment of LibraryShengjing Hospital of China Medical UniversityShenyangChina
| | - Peng Fu
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Tiangui Yang
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Yanxia Xie
- Department of Clinical EpidemiologyDepartment of LibraryShengjing Hospital of China Medical UniversityShenyangChina
- Department of ObstetricsNational Office for Maternal and Child Health Surveillance of ChinaWest China Second University HospitalSichuan UniversityChengduChina
| | - Jia Zheng
- Department of Clinical EpidemiologyDepartment of LibraryShengjing Hospital of China Medical UniversityShenyangChina
- Department of Clinical Epidemiologythe Fourth Affiliated Hospital of China Medical UniversityShenyangChina
| | - Jinyue Gao
- Department of Clinical EpidemiologyDepartment of LibraryShengjing Hospital of China Medical UniversityShenyangChina
| | - Tiesheng Niu
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangChina
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11
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Peng Y, Wang Z. Do the 2017 blood pressure cut-offs improve 10-year cardiovascular disease mortality risk prediction? Nutr Metab Cardiovasc Dis 2020; 30:2008-2016. [PMID: 32723581 DOI: 10.1016/j.numecd.2020.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS High blood pressure (BP) is a significant predictor for cardiovascular disease (CVD) mortality. The 2017 American College of Cardiology/American Heart Association guideline reclassified the BP categories; however, its impact on CVD mortality prediction is still unclear. Our study aimed to examine whether the application of new BP cut-offs could improve 10-year CVD mortality prediction among US adults. METHODS AND RESULTS This population-based cohort study linked data from the US National Health and Nutrition Examination Survey (1988-1994 and 1999-2004) and National Death Index (up to December 31, 2015). We constructed original and modified, using new BP cut-offs, Systematic COronary Risk Evaluation models to predict 10-year CVD mortality. We measured model discrimination and calibration using the Harrell's C statistic and calibration plots, respectively. We calculated the net reclassification index to evaluate the reclassification. In addition, we compared the sensitivity, specificity, predictive values (PVs), and likelihood ratios (LRs). Among 28,964 adults (aged ≥ 20 years), 1493 have died of CVD within ten years of follow-up. The modified models had improvements in calibration and reclassification instead of discrimination compared to the original models. The modified models have higher sensitivity and negative PV; however, they have lower specificity, positive PV, positive LR, and negative LR. CONCLUSIONS The modified models failed to improve the discrimination of 10-year CVD mortality. However, they could increase the calibration and reclassification and capture more participants with high CVD risk. More studies are needed on the potential use of the new BP cut-offs in the CVD primary prevention.
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Affiliation(s)
- Yang Peng
- Queensland Centre for Gynaecological Cancer Research, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia.
| | - Zhiqiang Wang
- Menzies School of Health Research, Darwin, Australia
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12
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Zhou YF, Liu N, Wang P, Yang JJ, Song XY, Pan XF, Zhang X, He M, Li H, Gao YT, Xiang YB, Wu T, Yu D, Pan A. Cost-Effectiveness of Drug Treatment for Chinese Patients With Stage I Hypertension According to the 2017 Hypertension Clinical Practice Guidelines. Hypertension 2020; 76:750-758. [PMID: 32713271 PMCID: PMC7429361 DOI: 10.1161/hypertensionaha.119.14533] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Systolic/diastolic blood pressure of 130 to 139/80 to 89 mm Hg has been defined as stage I hypertension by the 2017 Hypertension Clinical Practice Guidelines. Drug treatment is recommended for stage I hypertensive patients aged ≥65 years without cardiovascular disease in the 2017 Hypertension Clinical Practice Guidelines but not in the 2018 Chinese guidelines. However, the cost-effectiveness of drug treatment among this subgroup of Chinese patients is unclear. This study developed a microsimulation model to compare costs and effectiveness of drug treatment and nondrug treatment for the subgroup of stage I hypertensive patients over a lifetime horizon from a government affordability perspective. Event rates of mortality and cardiovascular complications were estimated from 3 cohorts in the Chinese population. Costs and health utilities were obtained from the national statistics report and published literature. The model predicted that drug treatment generated quality-adjusted life-years of 13.52 and associated with expected costs of $6825 in comparison with 13.81 and $7328 produced by nondrug treatment over a lifetime horizon among stage I hypertensive patients aged ≥65 years without cardiovascular disease. At a willingness-to-pay threshold of $8836/quality-adjusted life-year (the GDP per capita in 2017), drug treatment only had a 1.8% probability of being cost-effective compared with nondrug treatment after 10 000 probabilistic simulations. Sensitivity analysis of treatment costs, benefits expected from treatment, health utilities, and discount rates did not change the results. Our results suggested that drug treatment was not cost-effective compared with nondrug treatment for stage I hypertensive patients aged ≥65 years without cardiovascular disease in China.
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Affiliation(s)
- Yan-Feng Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Na Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pei Wang
- Department of Health Economics, School of Public Health, Fudan University, Shanghai, China
| | - Jae Jeong Yang
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, USA
| | - Xing-Yue Song
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiong-Fei Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaomin Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meian He
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Honglan Li
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yu-Tang Gao
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yong-Bing Xiang
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tangchun Wu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Danxia Yu
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, USA
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Saatchi M, Mansournia MA, Khalili D, Daroudi R, Yazdani K. Estimation of Generalized Impact Fraction and Population Attributable Fraction of Hypertension Based on JNC-IV and 2017 ACC/AHA Guidelines for Cardiovascular Diseases Using Parametric G-Formula: Tehran Lipid and Glucose Study (TLGS). Risk Manag Healthc Policy 2020; 13:1015-1028. [PMID: 32848484 PMCID: PMC7431169 DOI: 10.2147/rmhp.s265887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose An area of interest to health policymakers is the effect of interventions aimed at risk factors on decreasing the number of new cardiovascular disease (CVD) cases. The aim of this study was to estimate the generalized impact fraction (GIF) and population attributable fraction (PAF) of hypertension (HTN) for CVD in Tehran. Patients and Methods In this population-based cohort study, 8071 participants aged ≥30 years were followed for a median of 16 years. A survival model was used to estimate the 10- and 18-year risk of CVD. JNC-IV and 2017 ACC/AHA guidelines were used to categorize blood pressure (BP). PAF and GIF were estimated in different scenarios using the parametric G-formula. Results Of 7378 participants included in analyses, 22.7% and 52.3% were classified as hypertensive according to the JNC-IV and 2017 ACC/AHA guidelines, respectively. According to the 2017 ACC/AHA, the 10-year risk of CVD was 5.1% (4.3–6.0%), 8.9% (6.7–12.0%), and 7.1% (6.1–8.4%) for normal BP, elevated BP, and stage 1 HTN, respectively, and 20.8% (18.8–23.0%) for stage 2 of the 2017 ACC/AHA and JNC-IV. The PAF of stage 2 vs stage 1 and vs normal BP for CVD was 17.4% (11.5–21.8%) and 20.4% (14.6–26.4%), respectively. The GIF of 30% reduction in the prevalence of stage 2 HTN to stage 1 and to normal BP for CVD was 5.1% (3.4–6.6%) and 6.1% (4.4–8.0%), respectively. Based on JNC-IV, the PAF and GIF of 30% for CVD were 17.8% (12.7–22.9%) and 5.4% (4.0–6.9%), respectively. Conclusion By reducing the prevalence of HTN by 30%, a remarkable number of new CVD cases would be prevented. In an Iranian population, the comparison of HTN cases with normal BP showed no association between stage 1 HTN and CVD, whereas elevated BP was a significant risk factor for the incidence of CVD.
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Affiliation(s)
- Mohammad Saatchi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Yazdani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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14
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Deaths from total and premature cardiovascular disease associated with high normal blood pressure and hypertension in rural Chinese men and elderly people. J Hum Hypertens 2020; 35:741-750. [PMID: 32690863 DOI: 10.1038/s41371-020-0379-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 11/12/2022]
Abstract
To investigate the association of blood pressure (BP) categories with total and premature cardiovascular disease (CVD) mortality in rural Chinese. The study included 14,539 adults ≥18 years in rural China. Baseline study visits were conducted in 2007-2008, and follow-up visits in 2013-2014. Data were collected by face-to-face questionnaire interview, and anthropometric and laboratory measurements. A sub-distribution hazards model was used to calculate adjusted sub-distribution hazard ratios (aSHRs) and 95% confidence intervals (CIs). During the 6-year follow-up, 257 total and 209 premature CVD deaths occurred. As compared with normal BP (systolic BP/diastolic BP (SBP/DBP) < 120/80 mmHg), for men and people aged ≥60 years, hypertension (SBP/DBP ≥ 140/90 mmHg) associated with total CVD mortality (aSHR 3.57, 95% CI 2.06-6.17; aSHR 2.15, 1.29-3.56) and premature CVD mortality (aSHR 4.41, 2.37-8.21; aSHR 2.31, 1.27-4.19). Also, as compared with normal BP, for men and people aged ≥60 years with high normal BP (SBP/DBP 120-139/80-89 mmHg), risk of total CVD mortality increased (aSHR 1.85, 1.05-3.28; aSHR 1.78, 1.05-3.04), as was premature CVD mortality (aSHR 1.89, 0.99-3.64; aSHR 1.91, 1.03-3.54). Among men and people aged ≥60 years in rural China, risk of total and premature CVD mortality was increased for those with high normal BP and hypertension. Prevention and treatment strategies for additional CVD risk reduction targeting men and elderly people with hypertension or even high normal BP are needed to reduce CVD mortality risk.
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15
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The Association of Stage 1 Hypertension Defined by the 2017 ACC/AHA Guideline with Stroke and Its Subtypes among Elderly Chinese. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4023787. [PMID: 32149103 PMCID: PMC7035505 DOI: 10.1155/2020/4023787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/17/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
Abstract
Background The 2017 American College of Cardiology and American Heart Association hypertension guideline updated stage 1 hypertension definition as systolic blood pressure range from 130 to 139 mmHg or diastolic blood pressure from 80 to 89 mmHg. However, the association of stage 1 hypertension with stroke and its subtypes among the older population in rural China remains unclear. Methods This population-based cohort study consisted of 7,503 adults aged ≥60 years with complete data and no cardiovascular disease at baseline from rural areas of Fuxin County, Liaoning province, China. Follow-up for the new cases of stroke was conducted from the end of the baseline survey to the end of the third follow-up survey (January 1, 2007-December 31, 2017). Adjusted Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals with the normal blood pressure as a reference, and calculated population attributable risk was based on prevalence and hazard ratios. Results During a median follow-up of 12.5 years, we observed 1,159 first-ever incident stroke (774 ischemic, 360 hemorrhagic, and 25 uncategorized). With the blood pressure <120/<80 mmHg as a reference, stage 1 hypertension showed the adjusted hazard ratios (95% confidence intervals) of 1.45 (1.11-1.90) for all stroke, 1.65 (1.17-2.33) for ischemic stroke, and 1.17 (0.74-1.85) for hemorrhagic stroke, respectively. In this study, the population attributable risk values of stage 1 hypertension were 10.22% (2.64%-18.56%) for all stroke and 14.34% (4.23%-25.41%) for ischemic stroke. Conclusion Among adults aged ≥60 years in rural China, stage 1 hypertension defined by 2017 American College of Cardiology and American Heart Association hypertension guideline was independently associated with the increased risk of all stroke and ischemic stroke, excluding hemorrhagic stroke.
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Liu L, Wang B, Liu X, Ren Y, Zhao Y, Liu D, Zhou J, Liu X, Zhang D, Chen X, Cheng C, Liu F, Zhou Q, Li J, Cao J, Chen J, Huang J, Zhang M, Hu D. Sex-Specific Association of Blood Pressure Categories With All-Cause Mortality: The Rural Chinese Cohort Study. Prev Chronic Dis 2020; 17:E09. [PMID: 31999540 PMCID: PMC6993785 DOI: 10.5888/pcd17.190131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction The relationship between blood pressure categories and all-cause mortality has not been fully addressed in cohort studies, especially in the general Chinese population. Our study aimed to assess the sex-specific association of systolic blood pressure (SBP), diastolic blood pressure (DBP), and 2017 United States hypertension guidelines with all-cause mortality in China. Methods We conducted a prospective study of 13,760 rural Chinese adults aged 18 or older (41.1% men). Mean age overall was 49.4, 51.0 for men, and 48.3 for women. We analyzed the blood pressure–mortality relationship by using restricted cubic splines and Cox proportional-hazards regression analysis, estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Results During a mean follow-up of 5.95 years, 710 people died (60.3% men) from any cause. We found a U-shaped SBP–mortality or DBP–mortality relationship for both sexes. Mortality risk was increased for men with SBP 120–139 mm Hg (adjusted HR [aHR], 1.42; 95% CI, 1.10–1.82) or ≥140 mm Hg (aHR, 2.05; 95% CI, 1.54–2.72), and for DBP ≥90 mm Hg (aHR, 1.53; 95% CI, 1.10–2.13) as compared with SBP 100–119 mm Hg or DBP 70–79 mm Hg. Mortality risk also was increased for men with blood pressure status defined according to 2017 US hypertension guidelines as elevated, SBP 120–129 and DBP >80 mm Hg (aHR 1.48; 95% CI,1.11–1.98); stage 1 hypertension, SBP/DBP 130–139/80–89 mm Hg (aHR 1.53; CI, 1.19–1.97); and stage 2 hypertension, SBP/DBP ≥140/90 mm Hg (aHR 1.83; CI, 1.33–2.51). No significant relationship was observed for women. Conclusion Elevated blood pressure and stages 1 and 2 hypertension were positively associated with all-cause mortality for men but not women in rural China.
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Affiliation(s)
- Leilei Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Bingyuan Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.,Department of Preventive Medicine, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Xincan Liu
- Department of Cardiology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Yongcheng Ren
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.,Department of Preventive Medicine, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.,Department of Preventive Medicine, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Dechen Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.,Department of Preventive Medicine, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Junmei Zhou
- Department of Preventive Medicine, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Xuejiao Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dongdong Zhang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xu Chen
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Cheng Cheng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Feiyan Liu
- Department of Preventive Medicine, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Qionggui Zhou
- Department of Preventive Medicine, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Jianxin Li
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jie Cao
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jichun Chen
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jianfeng Huang
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ming Zhang
- Department of Preventive Medicine, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China. E-mail:
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Geng T, Talaei M, Jafar TH, Yuan J, Koh W. Pulse Pressure and the Risk of End-Stage Renal Disease Among Chinese Adults in Singapore: The Singapore Chinese Health Study. J Am Heart Assoc 2019; 8:e013282. [PMID: 31766974 PMCID: PMC6912960 DOI: 10.1161/jaha.119.013282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/23/2019] [Indexed: 12/15/2022]
Abstract
Background Although hypertension is an established risk factor for chronic kidney disease, less is known about the relationship of pulse pressure (PP), a measure of arterial stiffness, with chronic kidney disease. We investigated the association of systolic blood pressure (BP), diastolic BP, PP, and mean arterial pressure with the risk of end-stage renal disease (ESRD) in the prospective population-based Singapore Chinese Health Study. Methods and Results We used data from 30 636 participants who had BP measured at ages 46 to 85 years during follow-up I interviews between 1999 and 2004. Information on lifestyle factors was collected at recruitment from 1993 to 1998, and selected factors were updated at follow-up I. We identified 463 ESRD cases over an average 11.3 years of follow-up I by linkage with the nationwide Singapore Renal Registry. Cox proportional hazards regression models were used to assess the relations between different BP indexes and ESRD risk. Each BP index was positively associated with ESRD when studied individually. However, when PP was included as a covariate, systolic and diastolic BP and mean arterial pressure were no longer associated with ESRD. Conversely, PP remained significantly associated with ESRD risk in a dose-dependent manner (Ptrend<0.001) after adjusting for systolic or diastolic BP. Compared with the lowest group (<45 mm Hg) of PP, the hazard ratio was 5.25 (95% CI, 3.52-7.84) for the highest group (≥85 mm Hg). The association between hypertension and ESRD risk was attenuated and no longer significant after adjusting for PP. Conclusions Our findings provide a basis for targeting reduction of arterial stiffness to decrease ESRD risk.
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Affiliation(s)
- Ting‐Ting Geng
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | - Mohammad Talaei
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingapore
| | - Tazeen Hasan Jafar
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingapore
- Department of Renal MedicineSingapore General HospitalSingapore
| | - Jian‐Min Yuan
- Division of Cancer Control and Population SciencesUniversity of Pittsburgh Cancer InstitutePittsburghPA
- Department of EpidemiologyUniversity of Pittsburgh Graduate School of Public HealthPittsburghPA
| | - Woon‐Puay Koh
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingapore
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18
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2017 ACC/AHA Blood Pressure Classification and Cardiovascular Disease in 15 Million Adults of Age 20-94 Years. J Clin Med 2019; 8:jcm8111832. [PMID: 31683957 PMCID: PMC6912685 DOI: 10.3390/jcm8111832] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/08/2019] [Accepted: 10/28/2019] [Indexed: 01/22/2023] Open
Abstract
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) high blood pressure (BP) guideline lowered the cut-off for hypertension, but its age-specific association with cardiovascular disease (CVD) remains inconclusive in different populations. We evaluated the association between high BP according to the 2017 ACC/AHA guideline and CVD risks in Koreans aged 20-94 years. In a nationwide health screening cohort, we included 15,508,537 persons aged 20-94 years without prior CVD. BP was categorized into normal, elevated, stage 1 hypertension, or stage 2 hypertension. The primary outcome was a composite CVD hospitalization (myocardial infarction, stroke, and/or heart failure). Over 10 years of follow-up, CVD incidence rates per 100,000 person-years were 105.4, 168.3, 215.9, and 641.2 for normal, elevated BP, stage 1, and stage 2 hypertension, respectively. The age-specific hazard ratios of stage 1 hypertension compared to normal BP were 1.41 (1.34-1.48) at ages 20-34, 1.54 (1.51-1.57) at ages 35-49, 1.38 (1.35-1.40) at ages 50-64, 1.21 (1.19-1.24) at ages 65-79, and 1.11 (1.03-1.19) at ages 80-94 years. With the lowered BP cut-off, 130/80 mmHg, population attributable fraction for CVD was 32.2%. In conclusion, stage 1 hypertension was significantly associated with a higher CVD risk across entire adulthood. The new definition of hypertension may have a substantial population impact on primary CVD prevention.
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19
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Xie Y, Gao J, Guo R, Zheng J, Wang Y, Dai Y, Sun Z, Xing L, Zhang X, Sun YX, Zheng L. Stage 1 hypertension defined by the 2017 ACC/AHA guideline predicts future cardiovascular events in elderly Chinese individuals. J Clin Hypertens (Greenwich) 2019; 21:1637-1644. [PMID: 31556480 PMCID: PMC6900035 DOI: 10.1111/jch.13706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/06/2019] [Accepted: 07/16/2019] [Indexed: 12/02/2022]
Abstract
The 2017 American College of Cardiology and American Heart Association (ACC/AHA) hypertension guideline updated stage 1 hypertension defined as systolic blood pressure (SBP) of 130‐139 mm Hg or diastolic blood pressure (DBP) of 80‐89 mm Hg. However, the impact of 1 hypertension that affects future cardiovascular risk remains unclear among older adults in rural China. The prospective cohort study included 7503 adults aged ≥60 years with complete data and no cardiovascular disease (CVD) at baseline. Follow‐up for the new adverse events was conducted from the end of the baseline survey to the end of the third follow‐up survey (2007.01‐2017.12). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for blood pressure (BP) classifications and adverse events with normal BP as reference (< 120/80 mm Hg). During the 57 290 person‐years follow‐up period, 2261 all‐cause mortality, 1271 CVD mortality, 1159 stroke, and 347 myocardial infarctions (MI) occurred. Patients with stage 1 hypertension versus normal BP had HRs (95% CI) of 1.068 (0.904‐1.261) for all‐cause mortality, 1.304 (1.015‐1.675) for CVD mortality, 1.449 (1.107‐1.899) for stroke, and 1.735 (1.051‐2.863) for MI, respectively. In conclusion, among adults aged ≥60 years, stage 1 hypertension revealed an increased hazard of CVD mortality, stroke, and MI, which is complementary evidence for the application of 2017 ACC/AHA hypertension guidelines in an older Chinese population. Therefore, BP control in patients with stage 1 hypertension may be beneficial to reduce the hazard of CVD in elderly Chinese individuals.
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Affiliation(s)
- Yanxia Xie
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jinyue Gao
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, China
| | - Rongrong Guo
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jia Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yali Wang
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Dai
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liying Xing
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Xingang Zhang
- Department of Cardiology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ying Xian Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, China
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20
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Liu N, Yang JJ, Meng R, Pan XF, Zhang X, He M, Li H, Gao YT, Xiang YB, Shu XO, Zheng W, Wu T, Yu D, Pan A. Associations of blood pressure categories defined by 2017 ACC/AHA guidelines with mortality in China: Pooled results from three prospective cohorts. Eur J Prev Cardiol 2019; 27:345-354. [PMID: 31288541 DOI: 10.1177/2047487319862066] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The recent American College of Cardiology/American Heart Association guidelines for high blood pressure lowered the hypertension criteria from systolic/diastolic blood pressure (SBP/DBP) of 140/90 mmHg or greater to 130/80 mmHg or greater, while the potential impact of the change on Chinese adults remains unclear. DESIGN A pooled prospective cohort analysis. METHODS Included were 154,407 Chinese adults from three prospective cohorts, which measured blood pressure at baseline and follow-up visits, and tracked death events by linkages to medical insurance system or vital statistics registries. Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS During a total follow-up of 1,718,089 person-years, 14,692 deaths were documented including 5086 cardiovascular deaths (1277 ischaemic heart disease and 2509 cerebrovascular disease deaths). Compared to normal blood pressure (SBP/DBP < 120/80 mmHg), newly defined stage 1 hypertension (SBP/DBP 130-139/80-89 mmHg) was associated with increased cardiovascular mortality (HR 1.40, 95% CI 1.16-1.69; HR 1.36, 95% CI 1.12-1.65 for ischaemic heart disease mortality; HR 1.53, 95% CI 1.18-2.00 for cerebrovascular mortality), but not with all-cause mortality (HR 1.04, 95% CI 0.89-1.21). Stage 2 hypertension (SBP/DBP ≥ 140/90 mmHg) showed significant associations with cardiovascular disease and all-cause mortality, while elevated blood pressure (SBP 120-129 mmHg and DBP < 80 mmHg) showed null associations. The associations were stronger in adults younger than 65 years and adults without pre-existing cardiovascular disease compared with their counterparts (P for heterogeneity < 0.05). CONCLUSIONS The newly defined stage 1 hypertension is associated with an increased risk of cardiovascular disease mortality in the Chinese population, particularly among younger adults and those without a history of cardiovascular disease.
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Affiliation(s)
- Na Liu
- Department of Nutrition and Food Hygiene, Huazhong University of Science and Technology, China.,Department of Health Care, The First Affiliated Hospital with Nanjing Medical University, China
| | - Jae Jeong Yang
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, USA
| | - Ruiwei Meng
- Department of Epidemiology and Biostatistics, Huazhong University of Science and Technology, China
| | - Xiong-Fei Pan
- Department of Epidemiology and Biostatistics, Huazhong University of Science and Technology, China
| | - Xiaomin Zhang
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, China.,Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (Incubating), Huazhong University of Science and Technology, China
| | - Meian He
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, China.,Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (Incubating), Huazhong University of Science and Technology, China
| | - Honglan Li
- State Key Laboratory of Oncogene and Related Genes and Department of Epidemiology, Shanghai Jiaotong University School of Medicine, China
| | - Yu-Tang Gao
- State Key Laboratory of Oncogene and Related Genes and Department of Epidemiology, Shanghai Jiaotong University School of Medicine, China
| | - Yong-Bing Xiang
- State Key Laboratory of Oncogene and Related Genes and Department of Epidemiology, Shanghai Jiaotong University School of Medicine, China
| | - Xiao-Ou Shu
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, USA
| | - Wei Zheng
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, USA
| | - Tangchun Wu
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, China.,Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (Incubating), Huazhong University of Science and Technology, China
| | - Danxia Yu
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, USA
| | - An Pan
- Department of Epidemiology and Biostatistics, Huazhong University of Science and Technology, China.,Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (Incubating), Huazhong University of Science and Technology, China
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21
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Yano Y. Cardiovascular events associated with stage 1 hypertension in Asian populations: is this a more critical issue in younger adults? Hypertens Res 2019; 42:1644-1646. [PMID: 31273340 DOI: 10.1038/s41440-019-0286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA.
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22
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Tadic M, Cuspidi C. Should blood pressure ≥130/80 mm Hg be considered as a cardiovascular disease? J Clin Hypertens (Greenwich) 2019; 21:1020-1023. [PMID: 31215136 DOI: 10.1111/jch.13607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/26/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
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23
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Stage 1 hypertension defined by the 2017 ACC/AHA Hypertension Guidelines and Risk of Cardiovascular Events: a Cohort Study from Northern China. Hypertens Res 2019; 42:1606-1615. [DOI: 10.1038/s41440-019-0268-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/12/2019] [Accepted: 04/17/2019] [Indexed: 12/17/2022]
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24
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Wang JB, Huang QC, Hu SC, Zheng PW, Shen P, Li D, Lu HC, Gao X, Lin HB, Chen K. Baseline and longitudinal change in blood pressure and mortality in a Chinese cohort. J Epidemiol Community Health 2018; 72:1083-1090. [DOI: 10.1136/jech-2018-211050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/03/2018] [Accepted: 07/14/2018] [Indexed: 12/16/2022]
Abstract
BackgroundA J-curve association has been demonstrated for blood pressure (BP) and all-cause mortality, but data on longitudinal change of BP and mortality in Chinese population are limited.MethodsWe performed a retrospective cohort study to examine the association between BP (at baseline and longitudinal change) and risk of mortality in Yinzhou District, Ningbo, China, based on the Yinzhou Health Information System. At baseline, a total of 181 352 subjects aged over 18 years with at least one BP examination record were recruited through the Yinzhou Health Information System. The final analysis was restricted to 168 061 participants after exclusion of outliers of BP.ResultsA U-shaped association was observed for BP at baseline and risk of total and cardiovascular mortality. When compared with normotensive participants, patients with hypotension (HRs=1.51, 95% CI 1.21 to 1.88) and stage 3 hypertension (1.28, 95% CI 1.09 to 1.50) had an increased risk of all-cause mortality. Relative to stable BP of normotension, having a rise in BP from normotension to hypertension or from prehypertension to hypertension both conferred an increased risk of total and cardiovascular mortality (total: 1.39 (95% 1.10 to 1.75) and 1.40 (95% 1.15 to 1.69); cardiovascular: 2.22 (95% CI 1.35 to 3.65) and 1.89 (95% CI 1.20 to 2.96), respectively).ConclusionsOur findings emphasise that hypotension and stage 3 hypertension were associated with an increased risk of all-cause mortality. Longitudinal change from normotensive or prehypertensive levels to 140/90 mm Hg or higher could increase the risk of total and cardiovascular mortality.
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