Shasha Yu

Association between sleep duration and hypertension among Chinese children and adolescents.

Short sleep duration was reported to be associated with an increased risk of hypertension among adults. The present study aimed to investigate this association in children and adolescents.

Total and abdominal obesity among rural Chinese women and the association with hypertension.

OBJECTIVE Obesity increases the risk of hypertension and other chronic diseases, which are little known in rural China. This study aimed to investigate the epidemiologic features and the association with hypertension of obesity in rural Chinese women. METHODS A cross-sectional survey was conducted during 2004 through 2006, which used a multistage cluster sampling method to select a representative sample in Liaoning Province, China. In total 23 178 rural participants at least 35 y of age were examined (the percentage of subjects >64 y old was 14.5%). Data on demographic variables (age, sex, and race), smoking status, use of alcohol, physical activity, and education level were obtained by interview. Overweight and obesity were defined according to the World Health Organization classification. Hypertension was defined according to the criteria established by the Seventh Report of the Joint National Committee, and untreated hypertensive subjects were further classified into three subtypes: isolated systolic hypertension, isolated diastolic hypertension, and systolic and diastolic hypertension. Multivariable models and performed Poisson logistic regression analysis were used to determine associations among body mass index (BMI), waist circumference, and variables. RESULTS Overall, the prevalences of overweight and obesity were 24.4% and 2.7%, respectively, as defined by BMI, whereas the prevalences were 48.6% and 4.9% as defined by waist circumference. Poisson regression revealed that high levels of physical activity (defined by BMI, moderate: prevalence ratio [PR] 0.976, 95% confidence interval [CI] 0.965-0.988, high: PR 0.985, 95% CI 0.971-0.999; defined by waist circumference, moderate: PR 0.955, 95% CI 0.944-0.965, high: PR 0.973, 95% CI 0.960-0.985) and current smoking status (defined by BMI, PR 0.950, 95% CI 0.938-0.962; defined by waist circumference, PR 0.966, 95% CI 0.954-0.978) were protective factors and ethnicity was a risk factor (defined by BMI, Mongolian nationality: PR 1.042, 95% CI 1.030-1.054; defined by waist circumference, PR 1.043, 95% CI 1.033-1.054) for overweight or obese participants. There were other risk factors for overweight or obese participants such as high levels of education defined by BMI (PR 1.033, 95% CI 1.010-1.058) and diet score defined by waist circumference (PR 1.004, 95% CI 1.000-1.008). After adjustment, BMI and waist circumference were associated with the greatest likelihood of systolic and diastolic hypertension (for BMI ≥30 kg/m², PR 2.455, 95% CI 1.786-3.374; for waist circumference ≥88 cm, PR 1.517, 95% CI 1.133-2.031). BMI was more related to isolated diastolic hypertension than to isolated systolic hypertension, whereas waist circumference was more related to isolated systolic hypertension than to isolated diastolic hypertension. CONCLUSION Although the prevalence of overweight and obesity as defined by BMI was low, it was relatively high as defined by waist circumference in rural Chinese women. High levels of physical activity and current smoking status had negative relations to overweight or obesity, whereas ethnicity, high levels of education, and diet score showed positive relations. Obese women defined by BMI or waist circumference had an increased risk of hypertension.

Prehypertension Is Not Associated with All-Cause Mortality: A Systematic Review and Meta-Analysis of Prospective Studies

Objectives Quantitative associations between prehypertension or its two separate blood pressure (BP) ranges and cardiovascular disease (CVD) or all-cause mortality have not been reliably documented. In this study, we performed a comprehensive systematic review and meta-analysis to assess these relationships from prospective cohort studies. Methods We conducted a comprehensive search of PubMed (1966-June 2012) and the Cochrane Library (1988-June 2012) without language restrictions. This was supplemented by review of the references in the included studies and relevant reviews identified in the search. Prospective studies were included if they reported multivariate-adjusted relative risks (RRs) and corresponding 95% confidence intervals (CIs) of CVD or all-cause mortality with respect to prehypertension or its two BP ranges (low range: 120–129/80–84 mmHg; high range: 130–139/85–89 mmHg) at baseline. Pooled RRs were estimated using a random-effects model or a fixed-effects model depending on the between-study heterogeneity. Results Thirteen studies met our inclusion criteria, with 870,678 participants. Prehypertension was not associated with an increased risk of all-cause mortality either in the whole prehypertension group (RR: 1.03; 95% CI: 0.91 to 1.15, P = 0.667) or in its two separate BP ranges (low-range: RR: 0.91; 95% CI: 0.81 to 1.02, P = 0.107; high range: RR: 1.00; 95% CI: 0.95 to 1.06, P = 0.951). Prehypertension was significantly associated with a greater risk of CVD mortality (RR: 1.32; 95% CI: 1.16 to 1.50, P<0.001). When analyzed separately by two BP ranges, only high range prehypertension was related to an increased risk of CVD mortality (low-range: RR: 1.10; 95% CI: 0.92 to 1.30, P = 0.287; high range: RR: 1.26; 95% CI: 1.13 to 1.41, P<0.001). Conclusions From the best available prospective data, prehypertension was not associated with all-cause mortality. More high quality cohort studies stratified by BP range are needed.

Prevalence and awareness of diabetes mellitus among a rural population in China: results from Liaoning Province

To clarify the diabetes prevalence trends among the rural population in northern China.

Visceral Adiposity Index and Lipid Accumulation Product Index: Two Alternate Body Indices to Identify Chronic Kidney Disease among the Rural Population in Northeast China

We aimed to compare the relative strength of the association between anthropometric obesity indices and chronic kidney disease (CKD). Another objective was to examine whether the visceral adiposity index (VAI) and lipid accumulation product index (LAPI) can identify CKD in the rural population of China. There were 5168 males and 6024 females involved in this cross-sectional study, and 237 participants (2.12%) suffered from CKD. Obesity indices included body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), VAI and LAPI. VAI and LAPI were calculated with triglyceride (TG), high-density lipoprotein (HDL), BMI and WC. VAI = [WC/39.68 + (1.88 × BMI)] × (TG /1.03) × (1.31/ HDL) for males; VAI = [WC/36.58 + (1.89 × BMI)] × (TG/0.81) × (1.52/HDL) for females. LAPI = (WC-65) × TG for males, LAPI = (WC-58) × TG for females. CKD was defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min per 1.73 m2. The prevalence of CKD increased across quartiles for WHtR, VAI and LAPI. A multivariate logistic regression analysis of the presence of CKD for the highest quartile vs. the lowest quartile of each anthropometric measure showed that the VAI was the best predictor of CKD in females (OR: 4.21, 95% CI: 2.09–8.47, p < 0.001). VAI showed the highest AUC for CKD (AUC: 0.68, 95% CI: 0.65–0.72) and LAPI came second (AUC: 0.66, 95% CI: 0.61–0.70) in females compared with BMI (both p-values < 0.001). However, compared with the traditional index of the BMI, the anthropometric measures VAI, LAPI, WC, and WHtR had no statistically significant capacity to predict CKD in males. Our results showed that both VAI and LAPI were significantly associated with CKD in the rural population of northeast China. Furthermore, VAI and LAPI were superior to BMI, WC and WHtR for predicting CKD only in females.

Prevalence and risk factors of hypertension among pre- and post-menopausal women: A cross-sectional study in a rural area of northeast China

OBJECTIVES The aim of this study was to assess the prevalence and risk factors of hypertension in pre-menopausal women (Pre-MW) and post-menopausal women (Post-MW) and determine whether years since menopause (YSM) is associated with hypertension. METHODS A cross-sectional study was conducted with 6324 women over 35 years of age (2616 Pre-MW and 3708 Post-MW). Questionnaires, measurements and blood biochemical indexes were collected. RESULTS The overall prevalence of hypertension among women in rural northeast China was 48.8%, and it increased with age. Post-MW had a higher prevalence of hypertension than Pre-MW (62.4% vs. 29.7%, P<0.01). After controlling for confounding variables, overweight (OR=1.97, 95% CI: 1.72-2.25), obesity (OR=2.97, 95% CI: 2.30-3.84), diabetes mellitus (OR=2.13, 95% CI: 1.73-2.62), high triglycerides (OR=1.41, 95% CI: 1.20-1.65), and history of cardiovascular diseases in first-degree relatives (OR=1.60, 95% CI: 1.42-1.81) were associated with hypertension in all participants. However, abdominal obesity (OR=1.29, 95% CI: 1.05-1.58) was associated with higher odds among Post-MW only. Hypertension was associated with being postmenopausal (OR=1.22; 95% CI: 1.03-1.46), and the risk of hypertension reached a peak level in the <5-year group (OR=1.29; 95% CI, 1.07-1.57). CONCLUSIONS Postmenopausal status was an independent risk factor for hypertension. The risk of hypertension was highest in Post-MW with <5 YSM and then decreased. Other risk factors of hypertension were body mass index (BMI), abdominal obesity, a family history of cardiovascular disease among first-degree relatives, a personal history of diabetes, and high TG.

Self‐reported sleep duration is associated with reduced glomerular filtration rate among adults with hypertension: a population‐based study from rural northeast China

Short sleep duration has been found recently to be a predictor of proteinuria. However, population‐based investigations addressing the association between self‐reported sleep duration and glomerular filtration rate (GFR) among hypertensive patients are lacking. We therefore sought to investigate the extent to which self‐reported sleep duration might be associated with reduced GFR in a large hypertensive population in rural northeast China. A total of 5555 hypertensive participants, aged ≥35 years, in rural areas of Liaoning Province, China, were screened between January 2012 and August 2013, using a stratified, cluster multi‐stage sampling scheme. Anthropometric measurements, self‐reported sleep duration, blood biochemical indexes and other health‐related variables were collected by medically trained personnel. Reduced GFR was defined as the estimated GFR (eGFR) < 60 mL min−1 1.73 m2. On average, participants slept for 6.9 ± 1.6 h per night. Mean self‐reported sleep duration decreased with eGFR (P < 0.001). For both genders, a lower prevalence of reduced GFR was observed among participants who slept ≤6 h per night in total. In the multivariable regression model, after adjustments for age, gender, ethnicity, lifestyle factors, clinical correlates, depressive symptoms and general quality of life, participants who slept for 6 h or less per night were associated with a higher risk of reduced GFR [odds ratio (OR: 1.70, 95% confidence interval (CI): 1.05–2.73] compared with the reference group (self‐reported sleep duration >7 and ≤8 h day−1). We concluded that short self‐reported sleep duration (≤6 h per night) was related significantly to an increased risk of reduced GFR in a hypertensive population. This novel risk factor should be taken into consideration during daily management of hypertension to prevent chronic kidney disease.

Metabolic syndrome in hypertensive adults from rural Northeast China: an update

BackgroundThe last study reported the prevalence of Metabolic Syndrome (MetS) in hypertensive residents from rural Northeast China was conducted approximately ten years ago. The purpose of this study was to update the prevalence and epidemiological features of Metabolic syndrome (MetS).MethodsThis survey was conducted from July 2012 to August 2013. In this study, a total of 5866 hypertensive residents from the rural Northeast China were randomly selected and examined. MetS was defined according to the to the International Diabetes Federation (IDF) criteria. Data regarding the demographic and lifestyle characteristics and the blood biochemical indexes of these participants were collected by well-trained personnel.ResultsThe overall prevalence of MetS among hypertensive residents was 43.1%. Women had significantly higher incidence of MetS than men (56.4%vs. 29.2%, P < 0.001). Overall, 51.7%, 39.6%, 29.3% and 55.9% of the hypertensive adults had abdominal obesity, hypertriglyceridemia, low HDL-C, and increased fasting glucose. Multivariate logistic regression, after adjusting for possible confounders, revealed the following factors that increased the risk of MetS: being female, older age, completion of education through high school, obesity, current smoking. Moderate physical activity, a family income between 5000–20000 CNY per year and higher diet score were correlated with lower rates of MetS.ConclusionsThe prevalence of MetS was dramatically high and exhibited a remarkably increasing trend in hypertensive rural Northeast Chinese. Female had higher incidence of MetS while male had more drastically increasing trend.

Prehypertension in Rural Northeastern China: Results From the Northeast China Rural Cardiovascular Health Study

This study aimed to determine the present status of prehypertension in rural China. It was conducted between January and August 2013, using a multistage clustering method to select a representative sample of individuals (≥35 years old), resulting in a study population of 11,576 adults. Prehypertension was defined as a systolic blood pressure (BP) in the range of 120 mm Hg to 139 mm Hg and/or a diastolic BP between 80 mm Hg and 89 mm Hg according to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). The results showed that the mean±standard deviation systolic and diastolic BP values for the entire population were 141.8±23.5 mm Hg and 82.1±11.8 mm Hg, respectively. Among the whole population, 35.1% of men and 32.5% of women were prehypertensive. Multiple logistic regression analysis showed that high body mass index, advanced age, alcohol consumption, diabetes, high triglyceride and low‐density lipoprotein cholesterol levels, and elevated diet score were risk factors for prehypertension. This study indicates that there is a high prevalence of prehypertension in rural China and confirms the importance of healthy lifestyles—including the control of obesity, diabetes, and dyslipidemia—to decrease the incidence of prehypertension.

Hyperuricemia is independently associated with left ventricular hypertrophy in post-menopausal women but not in pre-menopausal women in rural Northeast China.

Abstract The aim of this article is to estimate the relationship between hyperuricemia and left ventricular hypertrophy (LVH) and to investigate whether menopause was associated with the relationship between hyperuricemia and LVH. This survey was conducted from July 2012 to August 2013. A total of 6029 women (3508, 58.2% were post-menopause) from the rural Northeast China were randomly selected and examined. LVH was defined using the 2007 Guidelines for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Age, body mass index, glucose, estimated glomerular filtration rate and lipid level were significantly correlated with serum uric acid level. LVH showed a gradual increase in accordance with the serum uric acid level in entire study population (<4.0 mg/dL, 11.4%; 4 to <5 mg/dL, 14.9%; 5 to <6 mg/dL, 18.9%; ≥6 mg/dL, 27.4%; p < 0.001). Multivariate analysis revealed that hyperuricemia was a significantly independent risk factor for LVH in post-menopausal women [OR (95% CI): 1.367 (1.026, 1.821)], but not in pre-menopausal women [OR (95% CI): 1.290 (0.669, 2.486)]. These findings suggested that hyperuricemia can be used as a risk marker of LVH in a female population and, in particular, as an independent risk factor in post-menopausal women but not in pre-menopausal women. Chinese abstract 这篇文章的目的是评估高尿酸血症与左心室肥厚（LVH）之间的关系，并研究绝经与高尿酸血症及左心室肥厚的关系是否相关。这项调查是从2012年7月到2013年8月期间进行的。从中国东北农村随机选择和检查了6029名妇女（3508名为绝经后女性，占58.2%）。LVH定义采用欧洲高血压协会（ESH）和欧洲心脏病学会（ESC）2007年制定的高血压管理指南。年龄、体重指数、血糖、估计的肾小球滤过率及血脂水平与血尿酸水平显著相关。在整个人群中，左心室肥厚的发生率随血尿酸水平的升高逐渐上升（＜4.0mg/dl，11.4%；4到＜5mg/dl，14.9%；5到＜6mg/dl，18.9%；≥6mg/dl，27.4%；P＜0.001）。多元分析显示：高尿酸血症是绝经后妇女左心室肥厚的独立危险因素[OR（95% CI）：1.367（1.026，1.821）]，但不是绝经前妇女左心室肥厚的独立危险因素[OR（95% CI）：1.290（0.669，2.486）]。这些结果表明：高尿酸血症可以作为女性左心室肥厚的一个危险因素，尤其是对于绝经后妇女来说，可以作为一个独立的风险因素，但对绝经前妇女不适用。