Manlu Zhu

Survey on prevalence of hypertension in China: background, aim, method and design.

☆ All authors take responsibility for all aspects of the re of the data presented and their discussed interpretation. ☆☆ Source of funding: This research was supported by th the Twelfth Five-year Plan (No. 2011BAI11B01) from the C Technology; by OMRON Corporation, Kyoto, Japan for the 1300) and body fat and weight measurement device (V-b support from BUCHANG PHARMA, Xian, China, Pfizer (Beijing) Company Limited. ⁎ Corresponding author. Tel.: +86 10 8839 8666; fax: E-mail address: gaorunlin@263.net (R. Gao).

Association of visceral and total body fat with hypertension and prehypertension in a middle-aged Chinese population.

Objective: This article investigates the relative effects of percentage body fat (PBF) and visceral fat index (VFI) on the prevalence of hypertension and prehypertension, and evaluates if excess visceral deposition of body fat increased the risk of hypertension or prehypertension. Methods: A general population-based sample of men (n = 5297) and women (n = 6232), aged 35–64 years, was studied. Based on blood pressure (BP) levels, normotensive, prehypertensive, and hypertensive study participants were identified. Multivariate linear regression models with SBP or DBP as a dependent variable and multivariate ordinal logistic regression models with BP categories as a dependent variable were performed. Results: In the normotensive, prehypertensive, and hypertensive participants, the mean (standard deviation) PBF was 27.83 (6.85), 28.91 (6.65), and 30.2 (6.73), respectively, whereas VFI was 6.97 (3.78), 8.89 (4.35), and 10.75 (5.05), respectively. After adjusting for age, smoking, alcohol consumption, education, regions (north or south), areas (urban or rural), diabetes, and family history, PBF and VFI (in separate models) showed a strong positive association with hypertension or prehypertension (P < 0.0001). However, when both PBF and VFI were adjusted for in the same multivariate model, VFI but not PBF remained positively associated with hypertension and prehypertension for both genders (P < 0.0001). A similar positive association was reported with the VFI/PBF ratio (P < 0.0001). Conclusion: As excess visceral body fat is strongly associated with higher risk of hypertension and prehypertension, measurements of VFI or VFI/PBF ratio, in addition to PBF, will provide a better understanding of adiposity-related risks for hypertension and prehypertension.

Survey of Prevalence, Awareness, Treatment, and Control of Hypertension Among Chinese Governmental and Institutional Employees in Beijing

Few studies have been done on the effects that awareness, treatment, and control have on hypertension among governmental and institutional employees.

Status of Hypertension in China: Results From the China Hypertension Survey, 2012–2015

Background: Although the prevalence of hypertension (HTN) continues to increase in developing countries, including China, recent data are lacking. A nationwide survey was conducted from October 2012 to December 2015 to assess the prevalence of HTN in China. Methods: A stratified multistage random sampling method was used to obtain a nationally representative sample of 451 755 residents ≥18 years of age from 31 provinces in mainland China from October 2012 to December 2015. Blood pressure (BP) was measured after resting for 5 minutes by trained staff using a validated oscillometric BP monitor. HTN was defined as systolic BP (SBP) ≥140 mm Hg/or diastolic BP (DBP) ≥90 mm Hg or use of antihypertensive medication within 2 weeks. Pre-HTN was defined as SBP 120 to 139 mm Hg and DBP 80 to 89 mm Hg without antihypertensive medication. HTN control was defined as SBP <140 mm Hg and DBP<90 mm Hg. In addition, the prevalence of HTN (SBP ≥130 or DBP ≥80 mm Hg) and control rate (SBP <130 and DBP <80 mm Hg) of HTN were also estimated according to the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline. Results: Overall, 23.2% (≈244.5 million) of the Chinese adult population ≥18 years of age had HTN, and another 41.3% (≈435.3 million) had pre-HTN according to the Chinese guideline. There were no significant differences of HTN prevalence between urban and rural residents (23.4% versus 23.1%, P=0.819). Among individuals with HTN, 46.9% were aware of their condition, 40.7% were taking prescribed antihypertensive medications, and 15.3% had controlled HTN. Calcium channel blockers were the most commonly used antihypertensive medication (46.5%) as monotherapy, and 31.7% of treated hypertensive patients used ≥2 medications. The prevalence of HTN based on the 2017 American College of Cardiology/American Heart Association guideline was twice as high as that based on 2010 Chinese guideline (46.4%), whereas the control rate fell to 3.0%. Conclusions: In China, there is a high prevalence of HTN and pre-HTN, and awareness, treatment, and control of HTN were low. Management of medical therapy for HTN needs to improve.

Prevalence of microalbuminuria among middle-aged population of China: a multiple center cardiovascular epidemiological study.

We assessed the prevalence of microalbuminuria (MAU) and the relationships with other cardiovascular (CV) risk factors among a middle-aged Chinese population. Data from 10 313 participants were included in our cross-sectional survey. Microalbuminuria was defined as the urine albumin to creatinine ratio of 30:300 mg/g from a single-spot morning urine sample. Microalbuminuria was found to be common in males and females (15.04% vs 10.09%) aged 35 to 64 years in this Chinese general population, especially in those with obesity, hypertension, and diabetes. Multivariate analysis found that body mass index, triglyceride, high-sensitivity C-reactive protein, alcohol consumption, hypertension, and diabetes were independently associated with MAU. Microalbuminuria may be a useful indicator for risk of CV disease in general populations.

Relationship Between Alcohol Consumption and Serum Lipid Profiles Among Middle-Aged Population in China: A Multiple-Center Cardiovascular Epidemiological Study.

We assessed the relationship between alcohol consumption and serum lipids in a middle-aged Chinese population. The overall prevalence of drinking among 10 154 participants was 34.07% in males and 3.61% in females. Heavy alcohol drinkers (≥ 30 g/d) tended to be older, smokers, hypertensive, do heavy physical activity, and have a lower body mass index. Levels of high-density lipoprotein cholesterol (HDL-C), apolipoprotein (apo) A1, low-density lipoprotein cholesterol–HDL-C ratio, and apo B–apo A1 ratio rose with increase in alcohol intake in males. An increase of 0.27 mmol/L in triglycerides and a decrease of 2.10 mg/dL in lipoprotein(a), Lp(a), were observed in male alcohol drinkers who consumed ≥30 g alcohol/d compared with abstainers after controlling for all confounders. Levels of total cholesterol, HDL-C, and apo A1 increased with increase in alcohol intake in both genders and Lp(a) decreased with the increase in alcohol intake in males.

Central systolic blood pressure is associated with ethnicity and cardiovascular disease risk factors in Chinese middle-aged population

Background Central systolic blood pressure (CSBP) is a useful prognostic aid in the reduction and prevention of cardiovascular diseases. However, data regarding the distribution of CSBP in China are not available. The study aimed at assessing the distribution of CSBP and examining its relationship with potential cardiovascular risk factors in the Chinese middle-aged population. Design A cross-sectional study. Methods A cross-sectional survey on cardiovascular risk factors across China was conducted in 2009–2010. CSBP levels were estimated using the non-invasive BPro device with A-Pulse central aortic systolic pressure software. The study population included 9113 individuals (mean age 49.84 years; 53.37% women). Results The CSBP levels (mean (standard deviation)) were 119.46 (17.51) mmHg in men and 119.81 (19.29) mmHg in women. CSBP levels were higher in rural than urban and lower in the southern than the northern populations (both P < 0.05). The Han ethnic group had higher CSBP levels than the Tibetans (P < 0.05) but similar to those in the Mongolian, Uyghur, Kazak and Akha groups. Irrespective of gender, the mean CSBP level was higher in individuals with diabetes and hypertension than in those without these disorders (P < 0.05). CSBP was positively associated with cardiovascular risk factors such as age, female gender, body mass index, systolic and diastolic blood pressure, and negatively associated with heart rate. Conclusions CSBP estimated using the BPro device correlates with various cardiovascular risk factors. Our results may help establish future reference values in the Chinese middle-aged population.

Distribution of High-Sensitivity C-Reactive Protein and Its Relationship with Other Cardiovascular Risk Factors in the Middle-Aged Chinese Population

Background: An increased concentration of high-sensitivity C-reactive protein (hs-CRP) indicates risk for cardiovascular disease (CVD). Because the available data is limited, a cross-sectional survey was conducted in 2009–2010 to describe hs-CRP distribution and its relationship with established CVD risk factors. Methods: A population-based sample of adults aged 35 to 64 years (n = 14,046) was taken from 12 research populations across China. Demographic and clinical characteristics were recorded, and hs-CRP measured. Pearson’s and Kendall’s tau-b correlation coefficient, and multiple regression analyses were used to test the relationship between hs-CRP and other CVD risk factors. Results: For 8389 (4412 females) eligible participants, hs-CRP was 1.89 ± 4.37 mg/L (median (25th, 75th): 0.80 (0.40, 1.80)), and increased with age, BP, glucose, and BMI (p < 0.05), males had significantly higher hs-CRP than females (2.07 (4.89) vs. 1.73 (3.83), p < 0.001). About 24.3% had the hs-CRP concentrations more than the top quartile (25.8% in males, 22.9% in females), 12.3% (13.3% in males, 11.5% in females) >3 mg/L. There was a significant positive correlation of quartiles of hs-CRP concentrations with age, SBP, DBP, glucose level, BMI, LDL-C/HDL-C ratio, and LDL-C/total cholesterol ratio (p < 0.001). The elevated hs-CRP (>1.80 mg/L) related positively with age, LDL-C, BP, glucose, BMI, and living north and negatively with HDL-C/TC, LDL-C/TC, TC independently (p < 0.05). For subjects with coexisting hypertension, diabetes, high cholesterol, and obesity, about 63.0% were in the top quartile of hs-CRP concentrations. Conclusions: Hs-CRP was associated with most of the known CVD risk factors. Measurement of hs-CRP may provide a more comprehensive view of the patient’s overall risk profile in the Chinese population.

Cost-effectiveness of nitrendipine and hydrochlorothiazide or metoprolol to treat hypertension in rural community health centers in China.

Objective: To compared blood pressure (BP) lowing effects of nitrendipine and hydrochlorothiazide (NH) and nitrendipine plus metoprolol (NM), and estimated the economic effect of these therapies on hypertension. Design and Method: This is a randomized, open-label, prospective clinical trial, outpatients (N = 793) 18–70 years-of-age with stage 2 or severe hypertension (systolic BP ≥ 160 mmHg and/or diastolic BP ≥ 100 mmHg) were recruited from 4 rural community health centers in Beijing and Jilin. Eligible patients were randomized to receive NH or NM. Hypertension treatment costs were calculated using the maximum retail price designated by the Chinas national Development and Reform Commission and general estimation whereas effectiveness was measured as a reduction in systolic and diastolic BP at the end of a 24-week study period. An intent-to-treat analysis was used for comparing treatment groups. Results: Overall 623 patients were eligible for the study and after a 24-week follow up, systolic and diastolic BP were 131.2/82.2 mmHg for the NH group and 131.4/82.9 mmHg for the NM group and these were not significantly different (P = 0.7974 systolic and P = 0.1166 diastolic). NH cost less and was more effective and the cost/effect (C/E) ratio (US

Body mass index and hypertension among Chinese governmental and institutional employees in Beijing.

/mmHg) was 1.4 for systolic BP and 1.9 for diastolic BP for the NH group and 1.9 and 3.8 for the NM groups systolic and diastolic values, respectively. The incremental cost per mmHg for systolic and diastolic values was −8.4 and −28.7 and the incremental cost per patient for achieving target BP was 5.1. Conclusions: Treating hypertension with NH was more cost-effective than NM and these data will allow more reasonable and efficient allocation of limited resources in low-income countries.