Prevalence, Awareness, Treatment, Control and Risk Factors of Hypertension in the Guangxi Hei Yi Zhuang and Han Populations

Prevalence, awareness, treatment and control of hypertension in Guangxi Zhuang Autonomous Region

Hypertension (HTN) is getting more prevalent in China, but the HTN's status in Guangxi remains unclear. Our study started from 2013 to 2015 and was dedicated to better acknowledging the status of HTN in Guangxi. The study enrolled 17,100 residents aged ≥ 15 years across Guangxi, from 2013 to 2015, using a stratified multistage random sampling method. Parameters including blood pressure (BP), height, and weight were measured by validated devices. HTN was defined as the average systolic BP (SBP) ≥ 140 mm Hg and/or average diastolic BP (DBP) ≥ 90 mm Hg, or any usage of antihypertensive medications within two weeks. The awareness, treatment, and control were defined as a self-reported history of HTN, a self-reported current usage of antihypertensive medications, and a BP lower than 140/90 mm Hg, respectively. The age and sex-standardized prevalence, awareness, treatment, control rates of HTN for the population aged ≥ 15 years in Guangxi were 15.80%, 16.48%, 11.99%, 3.62%, respectively. Prevalence and control rates were the same for men and women (P > 0.05), while women's awareness and treatment rates were higher than those of men (P < 0.05). Zhuang nationality had a higher prevalence than Han (23.50% vs. 20.35%, P < 0.001), while Han had higher awareness, treatment, control rates (37.39% vs. 31.22%, 30.59% vs. 22.37%, 8.99% vs. 4.55%, individually, P < 0.05). HTN was prevalent in Guangxi, while the awareness, treatment, control rates were adverse. Region-specific strategies to intervene in HTN were needed.

Prevalence, awareness, treatment, and control of hypertension in Northern China: a cross-sectional study

Background

Hypertension has always been a worldwide health concern. The purpose of this study was to investigate the prevalence, awareness, treatment, and control rates of hypertension among adult residents of northern China, where people usually have a high-fat, high-salt diet and heavy alcohol consumption.

Methods

Through the Early Screening and Comprehensive Intervention Project for High Risk Groups of Cardiovascular Diseases in the Inner Mongolia of northern China, we collected data of 70,380 residents, from September 2015 to June 2017. We assessed the prevalence, awareness, treatment, and control of hypertension in the total population and sub-populations. Multivariable logistic regression analyses were used to identify the factors associated with the prevalence and control of hypertension.

Results

Among participants, only 13.4% had optimal blood pressure levels. About 55.7% (95% confidence interval (CI) = 55.3–56.1%) of the participants had hypertension. In addition, the awareness, treatment, control and control under-treatment rate of hypertension were 52.8% (95%CI = 52.3–53.3%), 43.3% (95%CI = 42.8–43.8%), 8.6% (95%CI = 8.3–8.9%) and 19.8% (95%CI = 19.2–20.4%), respectively. Multivariable logistic regression showed that older, male, Han, living in rural areas, current drinker, not married, lower educational level, lower annual income, diabetes, obesity, and dyslipidemia were more likely to be suffered from hypertension (P < 0.05). Controlled hypertension was less common in those younger, Mongol, not married, farmer, current drinker, lower educational level, obesity, diabetes, without prior CHD, and without prior CVD (P < 0.05).

Conclusion

Among populations aged 35–75 years in Northern China, more than half have hypertension, fewer than one-tenth have successfully controlled hypertension, and fewer than one-fifth of hypertension patients receiving treatment have controlled hypertension.

Prevalence and risk factors associated with hypertension in the Chinese Qiang population

Our aim is to investigate the prevalence and risk factors associated with hypertension among the Chinese Qiang population. From September 2012 to March 2013, a cross-sectional study was conducted in urban and rural communities of the Qiang population using multistage cluster sampling. A total of 2676 people aged above 20 years were enrolled in the analysis. Standardized mercury sphygmomanometer was used to measure the blood pressure twice after a 10-minute seated rest, and the average blood pressure was obtained. The hypertension prevalence among the population aged above 20 years was 13.9%, and age-standardized prevalence was 12.3%. Male and female prevalence of hypertension, as well as the prevalence in urban and rural areas, all increased with age. There were no significant differences between males and females and between urban and rural residents. Among hypertensive patients, 44.2% were aware of their hypertension, 38.0% were undergoing antihypertensive treatment, but only 10.5% achieved blood pressure control. Multivariate logistic regression analysis showed that the risk factors of hypertension included age, low income, overweight and obesity, family history of hypertension. The prevalence of hypertension in Chinese Qiang adults is significantly lower than the national level. Awareness, treatment, and control rates of hypertension were low in the Qiang population. Thus, hypertension-related health knowledge should be more aggressively delivered to improve public awareness and the capacity of community health services should be strengthened.

Knowledge and Understanding of Hypertension Among Tibetan People in Lhasa, Tibet

BACKGROUND

The aim of this study was to investigate the knowledge and understanding about hypertension among residents in Lhasa, Tibet.

METHODS

A total of 1, 370 native Tibetan people aged ≥18 years old were enrolled in this survey. Individuals were selected using stratified proportional sampling and Lhasa was divided into Urban, Suburban, Agricultural and Pastoral areas. Data pertaining to blood pressure, socio-demographic details, knowledge and perceptions about hypertension were obtained.

RESULTS

The prevalence of hypertension was highest among Urban participants (56.1%) and lowest among Pastoral participants (34.2%). The awareness of hypertension (43.1%) was lowest among Agricultural participants. Less than one third of the respondents knew the normal range of blood pressure. A considerable proportion (49.2%) had no idea of risk factors and consequences of hypertension. With regard to prevention and control, about 30% of the respondents did not know the lifestyle changes for hypertension prevention. Regarding treatment, 30% of participants did not provide an answer. Most of the respondents acquired knowledge of hypertension from healthcare providers. Participants from the Agricultural areas had the lowest knowledge of hypertension. Approximately 75.5% of hypertensive patients ceased antihypertensive medications on their own after improvement of blood pressure.

CONCLUSIONS

The understanding of hypertension was poor among the native Tibetan people in Lhasa. There is a need to improve education and primary health care services to this large hypertensive population.

Environmental exposure in indigenous communities: an international perspective

There are more than 7000 spoken languages in the world today and many others that have already disappeared. The number of languages in relation to the number of countries (192 members of the United Nations) gives some indication of the number of indigenous communities there are in the world. Many of these communities are at various stages of integration into more dominant cultures, but many others struggle to maintain a traditional lifestyle. Many are subsistence communities that depend upon local sources of food and whose way of life is threatened by encroachment of more dominant cultures. There are, of course, different environmental threats in the various communities, but they fall into several categories that are common to many of them. There is often lack of access to medical care and disease-protective actions like immunizations. There is greater vulnerability than in more conventional societies to inclement weather, and this will become more serious with climate change. There is often contamination of local traditional animal and plant foods by chemicals because of long-range transport of contaminants by air or water or because of industries located in geographic areas close to indigenous communities where there is little governmental regulation. Life expectancy in many indigenous communities is much less than in more developed mainstream societies. However, these problems, which are widely viewed as being caused by poverty and lack of education, are balanced by the value to these communities of maintaining a traditional lifestyle that would otherwise simply disappear into the mainstream cultures of the various countries.

Association of the MLXIPL/TBL2 rs17145738 SNP and serum lipid levels in the Guangxi Mulao and Han populations

Background

The rs17145738 single nucleotide polymorphism (SNP) near MLX interacting protein-like/transducin (beta)-like 2 (MLXIPL/TBL2) loci is associated with serum lipid levels, but the results are inconsistent in diverse ethnic/racial groups. The current study was to investigate the association of MLXIPL/TBL2 rs17145738 SNP and several environmental factors with serum lipid profiles in the Guangxi Mulao and Han populations.

Methods

A total of 649 subjects of Mulao nationality and 712 participants of Han nationality aged 16–84 years were randomly selected from our previous stratified randomized samples. Genotyping was performed by polymerase chain reaction and restriction fragment length polymorphism combined with gel electrophoresis, and then confirmed by direct sequencing.

Results

Serum apolipoprotein (Apo) B levels were higher in Mulao than in Han (P < 0.001). There were no significant differences in the genotypic and allelic frequencies of the MLXIPL/TBL2 rs17145738 SNP between the two ethnic groups or between males and females. The T allele carriers had higher triglyceride (TG) and ApoB levels in Mulao, and higher total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels in Han than the T allele non-carriers (P < 0.05 for all). Subgroup analyses showed that the T allele carriers had higher ApoB levels in both Mulao and Han females than the T allele non-carriers, but the T allele carriers had lower ApoB levels in Han males than the T allele non-carriers (P < 0.05, respectively). The T allele carriers in Han had higher TC, high-density lipoprotein cholesterol (HDL-C) levels and ApoA1/ApoB ratio and lower TG levels in males, and higher LDL-C levels and lower ApoA1/ApoB ratio in females than the T allele non-carriers (P < 0.05 for all). Serum TC levels in the combined population of the two ethnic groups and in Han, and HDL-C levels in Han males were correlated with genotypes (P < 0.05 for all). Serum lipid parameters were also correlated with several environmental factors (P < 0.05-0.01).

Conclusions

The association of MLXIPL/TBL2 rs17145738 SNP and serum lipid profiles is different between the Mulao and Han populations. There is a sex-specific association in the both ethnic groups.

Association of the rs7395662 SNP in the MADD-FOLH1 and several environmental factors with serum lipid levels in the Mulao and Han populations

BACKGROUND

The rs7395662 single nucleotide polymorphism (SNP) in the MADD-FOLH1 has been associated with serum lipid traits, but the results are inconsistent in different populations. The present study was undertaken to investigate the association of rs7395662 SNP and several environmental factors with serum lipid levels in the Guangxi Mulao and Han populations.

METHOD

A total of 721 subjects of Mulao and 727 subjects of Han Chinese were randomly selected from our previous stratified randomized samples. Genotyping of the SNP was performed by polymerase chain reaction and restriction fragment length polymorphism combined with gel electrophoresis, and confirmed by direct sequencing.

RESULTS

Serum apolipoprotein (Apo) B levels were higher in Mulao than in Han (P < 0.01). The allelic and genotypic frequencies in Han were different between males and females (P < 0.05 for each), but there was no difference between Mulao and Han or between Mulao males and females. The levels of low-density lipoprotein cholesterol (LDL-C) and ApoB in Mulao females were different among the genotypes (P < 0.05), the G allele carriers had higher LDL-C and ApoB levels than the G allele non-carriers. The levels of total cholesterol (TC), triglyceride (TG), LDL-C and ApoB in Han males and TC, TG and high-density lipoprotein cholesterol (HDL-C) in Han females were different among the genotypes (P < 0.05-0.01), the subjects with GG genotype in Han males had higher TC, TG, and ApoB and lower LDL-C levels than the subjects with AA or AG genotype, and the G allele carriers in Han females had lower TC and HDL-C levels than the G allele non-carriers. The levels of LDL-C and ApoB in Mulao females were correlated with the genotypes (P < 0.05 for each). The levels of HDL-C and ApoAI in Han males and HDL-C in Han females were correlated with genotypes (P < 0.05-0.001). Serum lipid parameters were also correlated with several environmental factors in both ethnic groups (P < 0.05-0.01).

CONCLUSION

The association of rs7395662 SNP and serum lipid levels is different between the Mulao and Han populations, and between males and females in both ethnic groups.

Relationships between high-sensitive C-reactive protein and markers of arterial stiffness in hypertensive patients. Differences by sex

Background

The present study was designed to evaluate the relationship between high-sensitivity C-reactive protein (hs-CRP) and arterial stiffness according to sex in patients with arterial hypertension.

Methods

A case-series study was carried out in 258 hypertensive patients without antecedents of cardiovascular disease or diabetes mellitus. Nephelometry was used to determine hs-CRP. Office or clinical and home blood pressures were measured with a validated OMRON model M10 sphygmomanometer. Ambulatory blood pressure monitoring was performed with the SpaceLabs 90207 system. Pulse wave velocity (PWV) and central and peripheral augmentation index (AIx) were measured with the SphygmoCor system, and a Sonosite Micromax ultrasound unit was used for automatic measurements of carotid intima-media thickness (IMT). Ambulatory arterial stiffness index and home arterial stiffness index were calculated as “1-slope” from the within-person regression analysis of diastolic-on-systolic ambulatory blood pressure.

Results

Central and peripheral AIx were greater in women than in men: 35.31 ± 9.95 vs 26.59 ± 11.45 and 102.06 ± 20.47 vs 85.97 ± 19.13, respectively. IMT was greater in men (0.73 ± 0.13 vs 0.69 ± 0.10). hs-CRP was positively correlated to IMT (r = 0.261), maximum (r = 0.290) and to peripheral AIx (r = 0.166) in men, and to PWV in both men (r = 0.280) and women (r = 0.250). In women, hs-CRP was negatively correlated to central AIx (r = −0.222). For each unit increase in hs-CRP, carotid IMT would increase 0.05 mm in men, and PWV would increase 0.07 m/sec in men and 0.08 m/sec in women, while central AIx would decrease 2.5 units in women. In the multiple linear regression analysis, hs-CRP explained 10.2% and 6.7% of PWV variability in women and men, respectively, 8.4% of carotid IMT variability in men, and 4.9% of central AIx variability in women.

Conclusions

After adjusting for age, other cardiovascular risk factors and the use of antihypertensive and lipid-lowering drugs, hs-CRP was seen to be positively correlated to carotid IMT in men, and negatively correlated to central AIx in women. The association of hs-CRP to arterial stiffness parameters differs between men and women.

Hypertension prevalence, awareness, treatment, control, and associated factors in adults in southern China

BACKGROUND

Hypertension is the most important risk factor for cardiovascular diseases. Little information exists on the status of hypertension among southern Chinese. We therefore investigated the hypertension prevalence, awareness, treatment, control, and associated factors in a southern Chinese population with 85 million residents.

METHODS

Stratified multistage cluster sampling with probability proportional to size method was used in this survey. A representative sample of 13,889 residents aged 20 years or above with completed questionnaire and blood pressure (BP) measurement was obtained. BP was measured in accordance with the 1999 World Health Organization/International Society of Hypertension Guidelines. Information related to history of diagnosis and treatment of hypertension was collected through questionnaire.

RESULTS

The prevalence of hypertension in this population was 20.5% (16.5%, 24.4%), which translated to 9.8 million adults suffering from hypertension in Guangdong province. The urban population had higher prevalence of hypertension than the rural population (25.1 vs. 16.1%). The prevalence of awareness, treatment, and control of hypertension in hypertensive patients living in urban regions were 42.8, 37.9, and 13.5%, respectively, which were higher than those in rural regions (the corresponding figures were 17.6, 10.4, and 3.4%, respectively). Nearly 50% urban adults and 80% rural adults did not measure their BP in the last 12 months. Frequency of BP measurement was associated with both awareness and treatment.

CONCLUSIONS

Hypertension was prevalent in southern China. The prevalence of awareness, treatment, and control of hypertension is low. Urgent strategies are needed to improve prevention, detection, and treatment of hypertension in this large Chinese population.

Sex-specific association of rs16996148 SNP in the NCAN/CILP2/PBX4 and serum lipid levels in the Mulao and Han populations

BACKGROUND

The association of rs16996148 single nucleotide polymorphism (SNP) in NCAN/CILP2/PBX4 and serum lipid levels is inconsistent. Furthermore, little is known about the association of rs16996148 SNP and serum lipid levels in the Chinese population. We therefore aimed to detect the association of rs16996148 SNP and several environmental factors with serum lipid levels in the Guangxi Mulao and Han populations.

METHOD

A total of 712 subjects of Mulao nationality and 736 participants of Han nationality were randomly selected from our stratified randomized cluster samples. Genotyping of the rs16996148 SNP was performed by polymerase chain reaction and restriction fragment length polymorphism combined with gel electrophoresis, and then confirmed by direct sequencing.

RESULTS

The levels of apolipoprotein (Apo) B were higher in Mulao than in Han (P < 0.001). The frequencies of G and T alleles were 87.2% and 12.8% in Mulao, and 89.9% and 10.1% in Han (P <0.05); respectively. The frequencies of GG, GT and TT genotypes were 76.0%, 22.5% and 1.5% in Mulao, and 81.2%, 17.4% and 1.4% in Han (P <0.05); respectively. There were no significant differences in the genotypic and allelic frequencies between males and females in both ethnic groups. The levels of HDL-C, ApoAI, and the ratio of ApoAI to ApoB in Mulao were different between the GG and GT/TT genotypes in males but not in females (P < 0.01 for all), the subjects with GT/TT genotypes had higher serum levels of HDL-C, ApoAI, and the ratio of ApoAI to ApoB than the subjects with GG genotype. The levels of TC, TG, LDL-C, ApoAI, and ApoB in Han were different between the GG and GT/TT genotypes in males but not in females (P < 0.05-0.001), the T allele carriers had higher serum levels of TC, TG, LDL-C, ApoAI, and ApoB than the T allele noncarriers. The levels of HDL-C, ApoAI, and the ratio of ApoAI to ApoB in Mulao were correlated with the genotypes in males (P < 0.05-0.01) but not in females. The levels of TC, TG, HDL-C, LDL-C, ApoAI and ApoB in Han were associated with the genotypes in males (P < 0.05-0.001) but not in females. Serum lipid parameters were also correlated with several enviromental factors in both ethnic groups (P < 0.05-0.001).

CONCLUSIONS

The genotypic and allelic frequencies of rs16996148 SNP and the associations of the SNP and serum lipid levels are different in the Mulao and Han populations. Sex (male)-specific association of rs16996148 SNP in the NCAN/CILP2/PBX4 and serum lipid levels is also observed in the both ethnic groups.

Association of apolipoprotein A5 gene polymorphisms and serum lipid levels

BACKGROUND AND AIMS

Apolipoprotein (APO) A5 gene polymorphisms have been associated with increased plasma triglyceride (TG), but the results are inconsistent. The present study was undertaken to detect the APOA5 gene polymorphisms and their associations with lipid profiles in the Guangxi Hei Yi Zhuang and Han populations.

METHODS AND RESULTS

Genotyping of the APOA5 -1131T>C, c.553G>T and c.457G>A was performed in 490 subjects of Hei Yi Zhuang and 540 participants of Han Chinese aged 15-89 years. The -1131C allele frequency was higher in high total cholesterol (TC) than in normal TC subgroups in both the ethnic groups (P<0.05). The c.553T allele frequency was higher in high TG than in normal TG subgroups (P<0.01), in high APOB than in normal APOB subgroups in Hei Yi Zhuang (P<0.05), or in females than in males in Han (P<0.01). The c.457A allele frequency in Han was higher in high TG than in normal TG subgroups, in low APOA1 than in normal APOA1 subgroups, in males than in females, or in normal APOB than in high APOB subgroups (P<0.05-0.01). The levels of TC, low-density lipoprotein cholesterol and APOB in Hei Yi Zhuang were correlated with -1131T>C genotype or allele, and the levels of TG were associated with c.553G>T genotype (P<0.05). The levels of TG, APOA1 and APOB in Han were correlated with c.457G>A genotype or allele, and the levels of TC were associated with -1131T>C allele (P<0.05).

CONCLUSIONS

The differences in the lipid profiles between the two ethnic groups might partly result from different APOA5 gene-environmental interactions.

Association of the GALNT2 gene polymorphisms and several environmental factors with serum lipid levels in the Mulao and Han populations

BACKGROUND

The association of UDP-N-acetyl-alpha-D-galactosamine: polypeptide N-acetylgalactosaminyltransferase 2 gene (GALNT2) single nucleotide polymorphisms (SNPs) and serum lipid profiles in the general population is not well known. The present study was undertaken to detect the association of GALNT2 polymorphisms and several environmental factors with serum lipid levels in the Guangxi Mulao and Han populations.

METHOD

A total of 775 subjects of Mulao nationality and 699 participants of Han nationality were randomly selected from our stratified randomized cluster samples. Genotyping of the GALNT2 rs2144300 and rs4846914 SNPs was performed by polymerase chain reaction and restriction fragment length polymorphism combined with gel electrophoresis, and then confirmed by direct sequencing.

RESULTS

There were no significant differences in the genotypic and allelic frequencies of both SNPs between the two ethnic groups, or between the males and females. The subjects with TT genotype of rs2144300 in Mulao had lower serum triglyceride (TG) levels than the subjects with CC genotype in females (P < 0.01). The participants with CT/TT genotype of rs2144300 in Han had lower TG and apolipoprotein (Apo) B levels, and higher high-density lipoprotein cholesterol (HDL-C), ApoA1 levels and the ratio of ApoA1 to ApoB in males; and higher low-density lipoprotein cholesterol (LDL-C) and ApoB levels in females than the participants with CC genotype (P < 0.05-0.001). The individuals with GA/AA genotype of rs4846914 in Mulao had higher total cholesterol (TC) and LDL-C levels than the individuals with GG genotype in males (P < 0.05 for each). The subjects with AA genotype of rs4846914 in Han had higher LDL-C and ApoB levels, and lower HDL-C levels and the ratio of ApoA1 to ApoB than the subjects with GG genotype (P < 0.05 for each). The levels of TC in Mulao were correlated with the genotypes of rs4846914 in males (P < 0.05). The levels of ApoA1 in Han were correlated with the genotypes of both SNPs, and the levels of HDL-C and ApoB and the ratio of ApoA1 to ApoB were associated with the genotypes of rs2144300 in males (P < 0.05-0.001). The levels of LDL-C in Han were correlated with the genotypes of rs4846914 in females (P < 0.05). Serum lipid parameters were also correlated with several enviromental factors.

CONCLUSIONS

The associations of both GALNT2 rs2144300 and rs4846914 SNPs and serum lipid levels are different in the Mulao and Han populations. These discrepancies might partly result from different GALNT2 gene-enviromental interactions.

Apolipoprotein A1/C3/A5 haplotypes and serum lipid levels

Background

The association of single nucleotide polymorphisms (SNPs) in the apolipoprotein (Apo) A1/C3/A4/A5 gene cluster and serum lipid profiles is inconsistent. The present study was undertaken to detect the association between the ApoA1/C3/A5 gene polymorphisms and their haplotypes with serum lipid levels in the general Chinese population.

Methods

A total of 1030 unrelated subjects (492 males and 538 females) aged 15-89 were randomly selected from our previous stratified randomized cluster samples. Genotyping of the ApoA1 -75 bp G>A, ApoC3 3238C>G, ApoA5 -1131T>C, ApoA5 c.553G>T and ApoA5 c.457G>A was performed by polymerse chain reaction and restriction fragment length polymorphism combined with gel electrophoresis, and then confirmed by direct sequencing. Pair-wise linkage disequilibria and haplotype analysis among the five SNPs were estimated.

Results

The levels of high-density lipoprotein cholesterol (HDL-C) and ApoA1 were lower in males than in femailes (P < 0.05 for each). The allelic and genotypic frequencies of the SNPs were no significant difference between males and females except ApoC3 3238C>G. There were 11 haplotypes with a frequency >1% identified in the cluster in our population. At the global level, the haplotypes comprised of all five SNPs were significantly associated with all seven lipid traits. In particular, haplotype G-G-C-C-A (6%; in the order of ApoA5 c.553G>T, ApoA5 c.457G>A, ApoA5 -1131T>C, ApoC3 3238C>G, and ApoA1 -75bp G>A) and G-A-T-C-G (4%) showed consistent association with total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), ApoA1, ApoB, and the ApoA1/ApoB ratio. In addition, carriers of haplotype G-G-T-C-G (26%) had increased serum concentration of HDL-C and ApoA1, whereas carriers of G-G-C-G-G (15%) had high concentrations of TC, triglyceride (TG) and ApoB. We also found that haplotypes with five SNPs explain much more serum lipid variation than any single SNP alone, especially for TG (4.4% for haplotype vs. 2.4% for -1131T>C max based on R-square) and HDL-C (5.1% for haplotype vs. 0.9% for c.553G>T based on R-square). Serum lipid parameters were also correlated with genotypes and several environment factors.

Conclusions

Several common SNPs and their haplotypes in the ApoA1/C3/A5 gene cluster are closely associated with modifications of serum lipid parameters in the general Chinese population.

Association of high-sensitivity C-reactive protein with carotid artery intima-media thickness in hypertensive older adults

Hypertension is a major traditional risk factor for atherosclerosis. Increased carotid artery intima-media thickness (IMT) is considered to be a noninvasive marker of global atherosclerotic disease. The aim of this study is to assess the association between C-reactive protein (CRP) and carotid artery IMT among hypertensive older adults. A case-control study was done on 90 adults age 60 years and older, of which 60 were hypertensive (30 males and 30 females) and 30 were matched healthy controls. Measurements included conventional cardiovascular risk factors including obesity parameters, blood pressure, lipid profiles, smoking habits, the serum concentrations of high-sensitivity CRP (hs-CRP), and the carotid artery IMT. Hypertensive patients had higher body mass index, Total cholesterol, low-density lipoprotein, and hs-CRP level (P < .001) than the control group. Carotid artery IMT was significantly higher among the hypertensive group (P < .001). hs-CRP and hypertension duration were positively correlated to carotid IMT among the hypertensive group. All of the other factors failed to show a significant relationship with the carotid IMT. These results suggest inflammation, as measured by hs-CRP level, is associated with carotid artery IMT among hypertensive adults rather than other traditional risk factors.

Interactions of the apolipoprotein A5 gene polymorphisms and alcohol consumption on serum lipid levels

BACKGROUND

Little is known about the interactions of apolipoprotein (Apo) A5 gene polymorphisms and alcohol consumption on serum lipid profiles. The present study was undertaken to detect the interactions of ApoA5-1131T>C, c.553G>T and c.457G>A polymorphisms and alcohol consumption on serum lipid levels.

METHODOLOGY/PRINCIPAL FINDINGS

A total of 516 nondrinkers and 514 drinkers were randomly selected from our previous stratified randomized cluster samples. Genotyping was performed by polymerase chain reaction and restriction fragment length polymorphism. The levels of serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), ApoA1 and ApoB were higher in drinkers than in nondrinkers (P<0.05-0.001). The genotypic and allelic frequencies of three loci were not different between the two groups. The interactions between -1131T>C genotypes and alcohol consumption on ApoB levels (P<0.05) and the ApoA1/ApoB ratio (P<0.01), between c.553G>T genotypes and alcohol consumption on low-density lipoprotein cholesterol (LDL-C) levels (P<0.05) and the ApoA1/ApoB ratio (P<0.05), and between c.457G>A genotypes and alcohol consumption on TG levels (P<0.001) were detected by factorial regression analysis after controlling for potential confounders. Four haplotypes (T-G-G, C-G-G, T-A-G and C-G-T) had frequencies ranging from 0.06 to 0.87. Three haplotypes (C-G-G, T-A-G, and C-G-T) were significantly associated with serum lipid parameters. The -1131T>C genotypes were correlated with TG, and c.553G>T and c.457G>A genotypes were associated with HDL-C levels in nondrinkers (P<0.05 for all). For drinkers, the -1131T>C genotypes were correlated with TC, TG, LDL-C, ApoB levels and the ApoA1/ApoB ratio (P<0.01 for all); c.553G>T genotypes were correlated with TC, TG, HDL-C and LDL-C levels (P<0.05-0.01); and c.457G>A genotypes were associated with TG, LDL-C, ApoA1 and ApoB levels (P<0.05-0.01).

CONCLUSIONS

The differences in some serum lipid parameters between the drinkers and nondrinkers might partly result from different interactions of the ApoA5 gene polymorphisms and alcohol consumption.

Interactions of the apolipoprotein C-III 3238C>G polymorphism and alcohol consumption on serum triglyceride levels

Background

Both apolipoprotein (Apo) C-III gene polymorphism and alcohol consumption have been associated with increased serum triglyceride (TG) levels, but their interactions on serum TG levels are not well known. The present study was undertaken to detect the interactions of the ApoC-III 3238C>G (rs5128) polymorphism and alcohol consumption on serum TG levels.

Methods

A total of 516 unrelated nondrinkers and 514 drinkers aged 15-89 were randomly selected from our previous stratified randomized cluster samples. Genotyping of the ApoC-III 3238C>G was performed by polymerase chain reaction and restriction fragment length polymorphism combined with gel electrophoresis, and then confirmed by direct sequencing. Interactions of the ApoC-III 3238C>G genotype and alcohol consumption was assessed by using a cross-product term between genotypes and the aforementioned factor.

Results

Serum total cholesterol (TC), TG, high-density lipoprotein cholesterol (HDL-C), ApoA-I and ApoB levels were higher in drinkers than in nondrinkers (P < 0.05-0.001). There was no significant difference in the genotypic and allelic frequencies between the two groups. Serum TG levels in nondrinkers were higher in CG genotype than in CC genotype (P < 0.01). Serum TC, TG, low-density lipoprotein cholesterol (LDL-C) and ApoB levels in drinkers were higher in GG genotype than in CC or CG genotype (P < 0.01 for all). Serum HDL-C levels in drinkers were higher in CG genotype than in CC genotype (P < 0.01). Serum TC, TG, HDL-C and ApoA-I levels in CC genotype, TC, HDL-C, ApoA-I levels and the ratio of ApoA-I to ApoB in CG genotype, and TC, TG, LDL-C, ApoA-I and ApoB levels in GG genotype were higher in drinkers than in nondrinkers (P < 0.05-0.01). But the ratio of ApoA-I to ApoB in GG genotype was lower in drinkers than in nondrinkers (P < 0.01). Multivariate logistic regression analysis showed that the levels of TC, TG and ApoB were correlated with genotype in nondrinkers (P < 0.05 for all). The levels of TC, LDL-C and ApoB were associated with genotype in drinkers (P < 0.01 for all). Serum lipid parameters were also correlated with age, sex, alcohol consumption, cigarette smoking, blood pressure, body weight, and body mass index in both groups.

Conclusions

This study suggests that the ApoC-III 3238CG heterozygotes benefited more from alcohol consumption than CC and GG homozygotes in increasing serum levels of HDL-C, ApoA-I, and the ratio of ApoA-I to ApoB, and lowering serum levels of TC and TG.

Regular Khat (Catha edulis) chewing is associated with elevated diastolic blood pressure among adults in Butajira, Ethiopia: a comparative study

BACKGROUND

Fresh leaves and buds of the Khat plant (Catha edulis) contain Cathinone, an amphetamine like alkaloid responsible for its pharmacological action. Chewing of Khat has been associated with a transient rise in blood pressure and heart rate in experimental studies. Few studies examined the effect of regular or frequent Khat chewing on blood pressure at the population level. This study was conducted to examine the association of regular Khat chewing with blood pressure among adults.

METHODS

We compared systolic and diastolic blood pressure of adults 35-65 years of age who reported regular chewing of Khat during the preceding five years to those who never chewed Khat during the same period. Study participants were recruited from purposively selected urban and rural villages of Butajira District in Ethiopia. The comparative groups, chewers (334) and non-chewers (330), were identified from among the general population through a house-to-house visit using a screening questionnaire. They were frequency-matched for sex and age within a five-year range. Data were collected through structured interviews and physical measurements including blood pressure, weight and height.

RESULTS

The prevalence of hypertension was significantly higher among Khat chewers (13.4%) than non-chewers (10.7%), odds ratio (OR) = 1.66 (95% confidence interval (CI) 1.05, 3.13). A considerably high proportion of chewers (29.9%) than non-chewers (20.6%) had sub-optimal diastolic blood pressure (> 80 mmHg). The mean (sd) diastolic blood pressure was significantly higher among Khat chewers [75.0 (11.6)] than non-chewers [72.9 (11.7)], P < 0.05. Similarly, Khat chewers had significantly higher mean (sd) heart rate [76.3 (11.5)] than non-chewers [73.9 (12.6)], P < 0.05. There was no significant difference in mean systolic blood pressure between the two groups.

CONCLUSION

Regular chewing of Khat is associated with elevated mean diastolic blood pressure, which is consistent with the peripheral vasoconstrictor effect of Cathinone. Regular Khat chewing may have sustained effects on the cardiovascular system that can contribute to elevated blood pressure at the population level.

Prevalence, awareness, treatment, and control of hypertension in rural China: results from Shandong Province

OBJECTIVES

Hypertension is an important public health problem in rural China with a rapidly increasing prevalence noted in recent years. This study estimates the prevalence, awareness, treatment and control of hypertension in a rural population in Shandong Province, China.

METHODS

A cross-sectional study was conducted in rural Shandong Province, China, in April 2007 using multistage cluster sampling. A total of 16 364 rural residents aged 25 years and more were interviewed and examined. Two blood pressure (BP) measurements were obtained using a standardized mercury sphygmomanometer after a 5-min seated rest. Information on history of hypertension was obtained using a standard questionnaire. Hypertension was defined as mean systolic BP (SBP) at least 140 mmHg and/or diastolic BP (DBP) at least 90 mmHg, and/or self-reported current use of antihypertensive medication.

RESULTS

Overall, 43.8% of the population had hypertension. Among hypertensive patients, only 26.2% were aware of their hypertension, 22.2% were currently undergoing antihypertensive treatment, and 3.9% achieved BP control (<140/90 mmHg). Lack of knowledge about hypertension and the importance of BP control were associated with poor compliance with nonpharmacological and pharmacological treatments.

CONCLUSIONS

In the study population, the prevalence of hypertension is high, but levels of awareness, treatment and control are unacceptably low. There is an urgent need for comprehensive integrated strategies to improve prevention, detection and treatment of hypertension in rural areas in Shandong Province, China.

Alcohol and hypertension: gender differences in dose-response relationships determined through systematic review and meta-analysis

AIMS

To analyze the dose-response relationship between average daily alcohol consumption and the risk of hypertension via systematic review and meta-analysis.

DESIGN

A computer-assisted search was completed for 10 databases, followed by hand searches of relevant articles. Only studies with longitudinal design, quantitative measurement of alcohol consumption and biological measurement of outcome were included. Dose-response relationships were assessed by determining the best-fitting model via first- and second-degree fractional polynomials. Various tests for heterogeneity and publication bias were conducted.

FINDINGS

A total of 12 cohort studies were identified from the literature from the United States, Japan and Korea. A linear dose-response relationship with a relative risk of 1.57 at 50 g pure alcohol per day and 2.47 at 100 g per day was seen for men. Among women, the meta-analysis indicated a more modest protective effect than reported previously: a significant protective effect was reported for consumption at or below about 5 g per day, after which a linear dose-response relationship was found with a relative risk of 1.81 at 50 g per day and of 2.81 at an average daily consumption of 100 g pure alcohol per day. Among men, Asian populations had higher risks than non-Asian populations.

CONCLUSIONS

The risk for hypertension increases linearly with alcohol consumption, so limiting alcohol intake should be advised for both men and women.

Use of remotely sensed data to evaluate the relationship between living environment and blood pressure

BACKGROUND

Urbanization has been correlated with hypertension (HTN) in developing countries undergoing rapid economic and environmental transitions.

OBJECTIVES

We examined the relationships among living environment (urban, suburban, and rural), day/night land surface temperatures (LST), and blood pressure in selected regions from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Also, the linking of data on blood pressure from REGARDS with National Aeronautics and Space Administration (NASA) science data is relevant to NASA's strategic goals and missions, particularly as a primary focus of the agency's Applied Sciences Program.

METHODS

REGARDS is a national cohort of 30,228 people from the 48 contiguous United States with self-reported and measured blood pressure levels. Four metropolitan regions (Philadelphia, PA; Atlanta, GA; Minneapolis, MN; and Chicago, IL) with varying geographic and health characteristics were selected for study. Satellite remotely sensed data were used to characterize the LST and land cover/land use (LCLU) environment for each area. We developed a method for characterizing participants as living in urban, suburban, or rural living environments, using the LCLU data. These data were compiled on a 1-km grid for each region and linked with the REGARDS data via an algorithm using geocoding information.

RESULTS

REGARDS participants in urban areas have higher systolic and diastolic blood pressure than do those in suburban or rural areas, and also a higher incidence of HTN. In univariate models, living environment is associated with HTN, but after adjustment for known HTN risk factors, the relationship was no longer present.

CONCLUSION

Further study regarding the relationship between HTN and living environment should focus on additional environmental characteristics, such as air pollution. The living environment classification method using remotely sensed data has the potential to facilitate additional research linking environmental variables to public health concerns.

Polymorphism of the sterol regulatory element-binding protein-2 gene and its association with serum lipid levels in the Guangxi Hei Yi Zhuang and Han populations

BACKGROUND

Information about the association of sterol regulatory element-binding protein-2 (SREBP-2) gene polymorphism at the 1784G>C locus and serum lipid parameters is limited and contradictory. The present study was undertaken to compare the difference in the SREBP-2 gene polymorphism and its association with serum lipid levels between the Guangxi Hei Yi Zhuang and Han populations.

METHODS

Genotyping of the SREBP-2 gene in 768 subjects of Hei Yi Zhuang and 798 participants of Han Chinese aged 15 to 89 was performed by polymerase chain reaction and restriction fragment length polymorphism.

RESULTS

The frequency of G allele was 88.9% in Hei Yi Zhuang and 84.7% in Han (P < 0.001). The frequencies of GG, GC, and CC genotypes were 78.9%, 20.1%, and 1.0% in Hei Yi Zhuang, and 70.4%, 28.6%, and 1.0% in Han (P < 0.001), respectively. The frequencies of G allele and GG genotype in Han, but not in Hei Yi Zhuang, were higher in males than in females, or in high total cholesterol (TC >5.18 mmol/L) subgroup than in normal TC subgroup (P < 0.01 for all). In high TC subgroup, TC, triglycerides, low-density lipoprotein cholesterol, and apolipoprotein B levels in Han were lower in GG genotype than in GC/CC genotype (P < 0.05-0.01).

CONCLUSIONS

There were significant differences in the genotypic and allelic frequencies of the SREBP-2 gene polymorphism at the 1784G>C locus between the Hei Yi Zhuang and Han populations. The individuals carrying the G allele have more favorable lipid profiles than those carrying the C allele in Han but not in Hei Yi Zhuang.

Comparison of hypertension and its risk factors between the Guangxi Bai Ku Yao and Han populations

OBJECTIVE

Little is known about the prevalence of hypertension in Bai Ku Yao, an isolated subgroup of the Yao minority in China. The aim of this study was to compare the difference in the prevalence of hypertension and its risk factors between the Guangxi Bai Ku Yao and Han populations.

METHODS

A cross-sectional study of hypertension in 1170 subjects of Bai Ku Yao and 1173 participants of Han Chinese aged 15-89 was conducted by a stratified randomized cluster sampling. Information on diet and lifestyle was collected with standardized questionnaires. Blood pressure, serum lipids and several anthropometric parameters were obtained in all subjects.

RESULTS

Systolic, diastolic and pulse pressure levels and hypertension prevalence (10.85% vs 16.45%, p<0.001) were lower in Bai Ku Yao than in Han. Hypertension was positively correlated with male, age, physical activity, body mass index, waist circumference, total energy, total fat and sodium intakes, and negatively associated with education level and total dietary fibre intake in both ethnic groups (p<0.05-0.001). Hypertension was also positively associated with alcohol consumption in Han. The rates of awareness, treatment and control were lower in Bai Ku Yao than in Han (p<0.05 for all).

CONCLUSIONS

The difference in the hypertension prevalence between the two ethnic groups might result from different diet, lifestyle, physical activity level, sodium intake and genetic factors.

Interactions between alcohol intake and the polymorphism of rs708272 on serum high-density lipoprotein cholesterol levels in the Guangxi Hei Yi Zhuang population

Both alcohol consumption and the polymorphism of the cholesteryl ester transfer protein (CETP) TaqIB gene (rs708272) influence plasma high-density lipoprotein cholesterol (HDL-C) levels. However, their interactions on serum HDL-C levels is not well known. The present study was undertaken to detect the interactions between alcohol consumption and the rs708272 polymorphism on serum lipid levels in the Guangxi Hei Yi Zhuang population. Genotyping of the rs708272 in 342 nondrinkers and 416 drinkers aged 15-70 years was performed by polymerase chain reaction and restriction fragment length polymorphism. Interactions between rs708272 genotype and alcohol consumption was assessed using a cross-product term between genotypes and the aforementioned factor. Statistical significance was evaluated with analysis of co-variance. The frequency of B1 allele was 65.8% in nondrinkers and 64.7% in drinkers (P>.05), respectively. The frequencies of B1B1, B1B2, and B2B2 genotypes were 45.0%, 41.5%, and 13.5% in nondrinkers, and 41.3%, 46.6%, and 12.0% in drinkers (P>.05), respectively. The levels of HDL-C and apolipoprotein (Apo) AI in nondrinkers were higher in B2B2 genotype than in B1B1 genotype (P<.05 for each), whereas triglyceride (TG) levels in drinkers were higher in B1B1 genotype than in B1B2 genotype (P<.05). The levels of TG, HDL-C, Apo AI in B1B1 genotype, and HDL-C and Apo AI in B1B2 genotype were higher in drinkers than in nondrinkers (P<.05-.01), whereas the levels of low-density lipoprotein cholesterol (LDL-C) and Apo B in B2B2 genotype, and the levels of LDL-C in B1B1 genotype were lower in drinkers than in nondrinkers (P<.05-.01). The levels of HDL-C were positively correlated with female sex and genotype in nondrinkers (P<.001 for each), and were positively associated with age and alcohol consumption in drinkers (P<.005 and<.01, respectively). This study suggests that the B1 carriers benefited more from alcohol consumption than the B2 carriers in increasing serum HDL-C and Apo AI levels, and lowering LDL-C levels.

Sex differences in environmental and genetic factors for hypertension

BACKGROUND

Sex differences are observed in many aspects of mammalian cardiovascular function and pathology. Hypertension is more common in men than in women of the same age. Although the effects of gonadal hormones on blood pressure are considered contributing factors, the reasons for sex differences in hypertension are still not fully understood. The present study was undertaken to compare the differences in several environmental and genetic factors between men and women in the Hei Yi Zhuang, an isolated subgroup of the Zhuang minority in China.

METHODS

Information on demography, diet, and lifestyle was collected in 835 women and 834 men aged 15 to 84 years. Genotyping of angiotensin-converting enzyme, adrenergic receptor beta(3), aldehyde dehydrogenase 2, calpastatin, connexin 37, hepatic lipase, lipoprotein lipase, peroxisome proliferator-activated receptor gamma, thyrotropin-releasing hormone receptor, and von Willebrand factor also was performed in these subjects.

RESULTS

The levels of systolic and diastolic blood pressure, and the prevalence, awareness, and treatment of hypertension were lower in women than in men (P < .05). Hypertension was positively associated with age, physical activity, alcohol consumption, body mass index, waist circumference, hyperlipidemia, total energy, total fat, sodium intake, and sodium/potassium ratio, and negatively associated with education level, total dietary fiber, potassium intake, angiotensin-converting enzyme, aldehyde dehydrogenase 2, and hepatic lipase genotypes in men (P < .05). Hypertension was positively associated with age, hyperlipidemia, total energy, total fat, sodium intake, sodium/potassium ratio, calpastatin, and von Willebrand factor genotypes, and negatively associated with education level, total dietary fiber, potassium, calcium intake, lipoprotein lipase, and thyrotropin-releasing hormone receptor genotypes in women (P < .05).

CONCLUSION

Sex differences in the prevalence of hypertension in the Hei Yi Zhuang population may be mainly attributed to the differences in dietary habits, lifestyle choices, sodium and potassium intakes, physical activity level, and some genetic polymorphisms.

Hyperlipidaemia and its risk factors in the Guangxi Bai Ku Yao and Han populations

OBJECTIVE

To compare the differences in hyperlipidaemia prevalence and its risk factors between the Guangxi Bai Ku Yao and Han populations.

DESIGN

Cross-sectional study of hyperlipidaemia.

SETTING

Both populations were from Lihu and Baxu villages in Nandan County, Guangxi Zhuang Autonomous Region, People's Republic of China.

SUBJECTS

A total of 1170 healthy subjects of Bai Ku Yao and 1173 participants of Han Chinese aged 15-89 years were surveyed by a stratified randomized cluster sampling. Information on demographic, dietary and lifestyle characteristics was collected by standard questionnaires. Blood pressure, height, weight, waist circumference, serum lipids and apolipoproteins were measured, and BMI (kg/m2) was calculated as weight divided by the square of height.

RESULTS

The prevalence rates of hypercholesterolaemia, hypertriacylglycerolaemia and hyperlipidaemia in Bai Ku Yao and Han were 12.4 % v. 26.2 % (P < 0.001), 15.0 % v. 14.8 % (P > 0.05) and 24.4 % v. 33.9 % (P < 0.001), respectively. Hyperlipidaemia was positively correlated with BMI, waist circumference, total energy and total fat intakes, and negatively associated with physical activity and total dietary fibre intake in Bai Ku Yao (P < 0.05 to 0.001). Hyperlipidaemia was positively associated with age, alcohol consumption, BMI, waist circumference, total energy and total fat intakes, and inversely correlated with physical activity and total dietary fibre intake in Han (P < 0.05 to 0.001).

CONCLUSIONS

The prevalence of hypercholesterolaemia and hyperlipidaemia was significantly lower in the Bai Ku Yao than in the Han population, which might result from different dietary habits, lifestyle choices and physical activity level, as well as genetic factors between the two ethnic groups.

Hepatic lipase gene -514C/T polymorphism in the Guangxi Hei Yi Zhuang and Han populations

Hei Yi Zhuang is an isolated subgroup of the Zhuang minority in China. This study was designed to compare the difference in the hepatic lipase gene (LIPC) -514C/T polymorphism and its association with lipid profiles between the Guangxi Hei Yi Zhuang and Han populations. Genotyping of the LIPC -514C/T was performed in 873 subjects of Hei Yi Zhuang and 867 participants of Han Chinese. The frequency of -514T allele was 43.47% in Hei Yi Zhuang, and 36.10% in Han (P < 0.001). The frequencies of CC, CT and TT genotypes were 30.01, 53.04 and 16.95% in Hei Yi Zhuang, and 40.95, 45.91 and 13.14% in Han (P < 0.001); respectively. Serum high-density lipoprotein cholesterol (HDL-C) and apolipoprotein B levels in both ethnic groups were higher in LIPC -514T carriers than in C carriers. In addition, serum triglyceride levels in Han were higher in TT genotype individuals than in CC genotype subjects (P < 0.05). Serum HDL-C levels were positively correlated with age, alcohol consumption and LIPC -514C/T genotypes, and negatively associated with hypertension and cigarette smoking in Hei Yi Zhuang (P < 0.05-0.01), whereas HDL-C levels were positively correlated with age, alcohol consumption and LIPC -514C/T genotypes, and negatively associated with body mass index and cigarette smoking in Han (P < 0.05-0.001). The differences in serum HDL-C levels between the two ethnic groups might partially attribute to the differences in the LIPC -514C/T polymorphism.

Apolipoprotein E gene polymorphism and serum lipid levels in the Guangxi Hei Yi Zhuang and Han populations

Hei Yi Zhuang is an isolated subgroup of the Zhuang minority in China. Little is known about the distribution of apolipoprotein (apo) E genetic variations and its role in lipid metabolism in this population. The present study was undertaken to compare the effect of apoE gene polymorphism on serum lipid levels between the Guangxi Hei Yi Zhuang and Han populations. A total of 873 subjects of Hei Yi Zhuang and 867 participants of Han Chinese were surveyed by a stratified randomized cluster sampling. Genotyping of apoE was performed using polymerase chain reaction and restriction fragment length polymorphism. The frequencies of 2, 3, and 4 alleles were 15.23%, 79.84%, and 4.93% in Hei Yi Zhuang, and 9.23%, 81.43%, and 9.34% in Han (P < 0.001); respectively. The frequencies of 2/ 2, 2/ 3, 2/ 4, 3/ 3, 3/ 4, and 4/ 4 genotypes were 4.70%, 17.86%, 3.21%, 68.16%, 5.50%, and 0.57% in Hei Yi Zhuang, and 2.54%, 9.23%, 4.15%, 70.70%, 12.23%, and 1.15% in Han (P < 0.001); respectively. Total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and apoB levels were lower in Hei Yi Zhuang than in Han (P < 0.01-0.001), but high-density lipoprotein cholesterol (HDL-C) levels and the ratio of apoA-I to apoB were higher in Hei Yi Zhuang than in Han (P < 0.001 for each). There were significant differences in TC, HDL-C, LDL-C, and apoB levels among the six genotypes in both ethnic groups (P < 0.01-0.001). Hyperlipidemia was positively correlated with age, body mass index, hypertension, alcohol consumption, and apoE allele in both populations (P < 0.05-0.001). TC, LDL-C, and apoB levels were positively correlated, and HDL-C levels were negatively associated with apoE genotypes in both ethnic groups (P < 0.001 for all). The differences in the lipid profiles between Hei Yi Zhuang and Han Chinese might partly attribute to the differences in apoE genotypic and allelic frequencies.

Prevalence, awareness, treatment, and control of hypertension in rural adults from Liaoning Province, northeast China

Liaoning Province is located in northeast China, which has distinct weather conditions, geographic characteristics and lifestyles compared with other regions of the country; the lifestyle differences are especially pronounced in the rural parts of this region, where there is a dearth of financial and other resources. However, information on the prevalence, awareness, treatment, and control of hypertension in these impoverished areas is very scarce. We therefore performed multistage cluster random sampling of a group of 29,970 adult residents (>or=5 years of residency; >or=35 years of age) of the rural portions of Liaoning Province from 2005 to 2006. The sampling included a survey on blood pressure and associated risk factors. The overall prevalence of hypertension in the community was 36.2%, and 73.0% of hypertensives were unaware of their condition. Among the total group of hypertensives, only 19.8% were taking prescribed medication to lower their BP, and 0.9% had controlled hypertension. Of all subjects, 46.4% did not think that high blood pressure would endanger their lives. As to the reasons given by hypertensives who were aware of their hypertension for not taking antihypertensive medication, 47.4% reported that they lacked knowledge about the mortality of hypertension. The average salt intake in hypertensives was 16.6+/-9.9 g/day, and the percentages of smoking (44.3%), drinking (31.7%) and salt intake>6 g/day (86.8%) in hypertensives were high. Logistic regression analysis indicated that the relative risks (95% confidence interval [CI]) of overweight, obesity, smoking, drinking, increased salt intake and family history of hypertension for hypertension were 1.95 (range, 1.82-2.08), 2.92 (2.40-3.55), 1.19 (1.12-1.27), 1.16 (1.08-1.25), 1.26 (1.20-1.33) and 2.85 (2.66-3.05), respectively. A higher education level was found to be a protective factor. In conclusion, the prevalence of hypertension in adults living in the rural parts of Liaoning Province was high, and the rates of awareness, treatment, and control were unacceptably low, which may have been due to unique geographical characteristics, unwholesome lifestyles, greater sodium intake, lower education levels, and genetic risk factors.

Diet, lifestyle, and blood pressure of the middle-aged and elderly in the Guangxi Bai Ku Yao and Han populations

BACKGROUND

Bai Ku Yao is an isolated subgroup of the Yao minority in China. Little is known about the association of diet and lifestyle with the prevalence of hypertension in this population.

METHODS

A total of 485 subjects of Bai Ku Yao and 501 participants of Han Chinese aged 40-89 were surveyed using stratified randomized cluster sampling. Information on diet and lifestyle was collected by using standard questionnaires. Blood pressure (BP) and serum lipid levels were measured.

RESULTS

Physical activity levels, carbohydrate, vegetal protein, and dietary fiber intake were higher in Bai Ku Yao than in Han, whereas educational level, height, weight, body mass index (BMI), waist circumference, and total energy, fat, protein, dietary cholesterol, and salt intake were higher in Han than in Bai Ku Yao. Systolic, diastolic, and pulse pressure (PP) levels and the prevalence of hypertension (21.9% vs. 28.9%, P < 0.05)were lower in Bai Ku Yao than in Han. Hypertension was positively correlated with age, physical activity,BMI, and waist circumference, as well as with total energy, fat, and salt intake, and negatively associated with educational levels and dietary fiber intake in both ethnic groups (P < 0.05 for all). Hypertension was also positively correlated with triglycerides (TGs) in Bai Ku Yao and alcohol consumption in Han (P < 0.05 for each).

CONCLUSIONS

The differences in BP levels and the prevalence of hypertension among the middle-aged and elderly between Bai Ku Yao and Han might result from different dietary patterns, lifestyle choices, physical activity levels, sodium intake, and even genetic factors.

Comparison of demography, diet, lifestyle, and serum lipid levels between the Guangxi Bai Ku Yao and Han populations

Bai Ku Yao is an isolated subgroup of the Yao minority in China. Little is known about dyslipidemia in this population. The aim of this study was to compare the effects of demography, diet, and lifestyle on serum lipid levels between the Bai Ku Yao and Han populations. A total of 1,170 subjects of Bai Ku Yao and 1,173 subjects of Han Chinese aged 15-89 years were surveyed by a stratified randomized cluster sampling. The levels of total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A-I (apoA-I), and apoB were significantly lower in Bai Ku Yao than in Han. Physical activity level and total dietary fiber intake were higher, whereas body mass index (BMI), waist circumference, total energy intake, and total fat intake were lower in Bai Ku Yao than in Han. Hyperlipidemia was positively correlated with BMI, waist circumference, and total energy and total fat intakes and negatively associated with physical activity level and total dietary fiber intake in both populations, but it was positively associated with age and alcohol consumption only in Han. The differences in the lipid profiles between the two ethnic groups were associated with different dietary habits, lifestyle choices, and levels of physical activities.