Xinzhong Zhang

Prevalence and Associated Factors of Overweight and Obesity in a Chinese Rural Population

Background: Overweight and obesity are now considered as a serious health problem, and a very important risk factor for many diseases.

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 (≥5 years of residency; ≥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.

Factors associated with hypertension awareness, treatment and control in rural Chinese

The factors associated with hypertension awareness, treatment and control were studied in 45 925 rural Chinese aged ≥ 35 years. Of all hypertensives (n=17355), 29.5% were aware of their condition, 20.2% were receiving treatment and only 0.9% had their blood pressure (BP) adequately controlled, and most hypertensives in rural China did not comprehend the fatalness of high BP. Results indicate that more attention is needed in improving the cognitional level of hypertensive fatalness and more effort is also needed in promoting hypertension awareness, treatment and control among all hypertensives in rural China.

The prevalence and heterogeneity of prehypertension: a meta-analysis and meta-regression of published literature worldwide

Objective Prehypertension appears to be a precursor of hypertension and has been recognised as a major risk factor for cardiovascular disease (CVD). Recognition of prehypertension provides important opportunities for preventing hypertension and CVD. We aimed to investigate the world-wide prevalence and heterogeneity of prehypertension. Methods We performed a meta-analysis of cross-sectional studies worldwide that reported the prevalence of prehypertension. We searched for publications between January 1966 and November 2010, using PubMed, Ovid and the Cochrane Library, with the keyword ‘prehypertension’, supplemented by a manual search of references from recent reviews and relevant published original studies. Pooled prevalence of prehypertension was calculated using random-effects models. Heterogeneity was investigated by subgroup analysis and meta-regression. Twenty-two articles met our inclusion criteria, with a total sample of 242 322 individuals. Results The overall pooled prevalence of prehypertension was 38%. Significant heterogeneity across estimates of prevalence was observed (p = 0.000, I2 = 99.9%). The prevalence rose as the sample size increased, and was higher among men than women (41 vs 34%). The non-Asian population was more likely to be prehypertensive than Asian individuals (42 vs 36%). A high prevalence of 47% was observed among the black African population in the non-Asian subgroup. The inception year of the surveys was the only source of heterogeneity we found by meta-regressional analysis (p = 0.06). Conclusion These results indicate that the prevalence of prehypertension was relatively high, particularly among males. Although more attention has been paid to this segment of the population since 2003, additional practical and reasonable steps should be taken to prevent and treat prehypertension.

Gender differences in blood lipids and the risk of ischemic stroke among the hypertensive adults in rural China

BACKGROUND Though large epidemiological studies have not established associations between blood lipids and ischemic stroke, increasing evidences have suggested that lipid-modifying agents may reduce cerebrovascular events. AIMS To determine whether blood lipids are risk factors for ischemic stroke among hypertensive rural adults in China. SETTINGS AND DESIGN A cross-sectional survey was conducted during 2004-2006, which underwent cluster multistage sampling to a hypertensive resident group in the countryside of China. MATERIALS AND METHODS A total of 6,412 individuals (2,805 men, 3,607 women) with age>or=35 years were included. At baseline, lifestyle and other factors were obtained and blood lipids were assessed at a central study laboratory. Ischemic stroke was defined according to the criteria established by the National Survey of Stroke and all cases were further classified into lacunar infarction and other ischemic strokes. STATISTICAL ANALYSIS Univariable and multivariable logistic regression were used. RESULTS In the univariable logistic regression model, LDL cholesterol (LDLc) in men and total cholesterol (TC), LDLc and TC-to-HDL cholesterol (TC: HDLc ratio) in women were risk factors for other ischemic strokes, with OR 1.42 (95% CI, 1.16-1.75), 1.31 (95% CI, 1.11-1.55), 1.47 (95% CI, 1.16-1.88) and 1.67 (95% CI, 1.28-2.14), respectively. After adjusting for independent variables, an increase in non-HDL cholesterol (non-HDLc) was associated with a significant increased risk of other ischemic strokes in women, with adjusted OR 1.45 (95% CI, 1.08-1.93). CONCLUSIONS LDLc was the common risk factor for ischemic stroke in men and women, whereas Non-HDLc, TC and TC: HDLc ratio levels were related to ischemic stroke as risk factors only in women.

Prevalence of metabolic syndrome in han and mongolian rural population with hypertension

The prevalence of metabolic syndrome, as defined by the International Diabetes Federation, was compared in two rural populations with hypertension in China. A total of 6326 subjects aged ≤ 35 years were included: 5043 Han and 1283 Mongolian. Metabolic syndrome was identified in 33.9% (men: 16.1%; women: 47.8%) of the Han and 37.6% (men: 14.7%; women: 55.0%) of the Mongolian populations. In men, prevalence of metabolic syndrome showed no obvious ethnicity differences; however, in women, prevalence was significantly higher in the Mongolian than in the Han population. This study showed high prevalence and ethnic differences in prevalence of metabolic syndrome in these two Chinese hypertensive populations.

Prevalence of and Risk Factors for Isolated Systolic Hypertension in the Rural Adult Population of Liaoning Province, China

The prevalence of and associated risk factors for isolated systolic hypertension, as defined by the Joint National Committee (JNC)-6 classification, were investigated in the rural population of Liaoning Province, China. A total of 45 925 people aged 35 years or older were examined in a cross-sectional study. Overall, the prevalence of isolated systolic hypertension was 10.6% (males 10.1%; females 11.2%). The prevalence of isolated systolic hypertension was positively correlated with age, gender, smoking status, alcohol intake, body mass index, salt intake and Mongolian race. This study showed that isolated systolic hypertension was very common in rural Chinese people and that many risk factors are linked with isolated systolic hypertension.

GW24-e3900 The association between glomerular filtration rate and stroke in hypertensive patients in rural areas of China

Objectives The present study is to explore the association between estimated glomerular filtration rate (eGFR) and stroke in hypertensive patients in rural areas of China. Methods The prospective study was based on 3711 hypertensive patients who were aged at least 35 years, free from cardiovascular diseases, and had serum creatinine at baseline. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation. Results During a median follow-up of 4.9 years, 176 first-ever strokes (98 ischaemic, 75 haemorrhagic, and three were unspecified strokes) occurred. We found no independent association between eGFR and risk of haemorrhagic stroke. In contrast, with decreasing eGFR, the risk of total and ischaemic stroke strongly increased; the sex and age-adjusted hazard ratios for overall and ischaemic stroke were 3.34 [95% confidence interval (CI) 1.61-6.93] and 3.79 (95% CI 1.33-10.81) for patients with eGFR below 60 versus eGFR at least 90 ml/min per 1.73 m, respectively. In addition, patients with an eGFR of 60-90 relative to eGFR at least 90 ml/min per 1.73 m had hazard ratios of 2.31 (95% CI 1.53-3.51) and 3.24 (95% CI 1.76-6.00) for overall and ischaemic stroke after adjustment for sex and age, respectively. Adjustment for other cardiovascular factors only slightly attenuated the associations. Conclusions The patients with decreased eGFR, also included those with eGFR range between 60 and 90 ml/min per 1.73 m, had an independently increased risk of overall and ischaemic stroke in hypertensive patients in rural areas of China.