Xiqui Wu

Factors Associated With Hypertension Awareness, Treatment, and Control in a Representative Sample of the Chinese Population

Abstract—We studied factors associated with awareness, treatment, and control of hypertension (systolic/diastolic blood pressure measurements ≥140/90 mm Hg, respectively, and/or current drug treatment for hypertension) in a representative sample of the Chinese population (n=15 838). Awareness, treatment, and control were defined by self-report of a hypertension diagnosis, self-report of current antihypertensive medication use, and a systolic and diastolic blood pressure <140/90 mm Hg, respectively. Higher awareness (OR; 95% CI) was noted for persons who were married (1.43; 1.09, 1.88) and had their blood pressure measured in 1 year (47.4; 31.7, 70.4) or 1 to 5 years (11.4; 7.09, 18.2) preceding their study visit; lower awareness was found among men (0.62; 0.52, 0.74) and current smokers (0.79; 0.63, 0.99). Among those aware of their hypertension, treatment was more common (OR; 95% CI) at higher income (1.24 [0.87, 1.75], 1.46 [1.01, 2.12] and 1.58 [1.06, 2.37] for increasing versus the lowest quartile of income) and for participants who had their blood pressure measured during the preceding year (3.87; 1.89, 7.93) and was less common among men (0.76; 0.59, 0.98). Controlled hypertension was more common (OR; 95% CI) among persons whose blood pressure had been measured 1 year (4.93; 1.51, 16.1) and 1 to 5 years (14.8; 3.63, 60.5) prior to their study visit and, among persons aware of their hypertension diagnosis, those who undertook lifestyle modification (1.59; 1.11, 2.27). These data identify potential methods for improving blood pressure control in China through the identification, follow-up, and lifestyle modification of persons with high blood pressure.

Body Mass Index and Risk of Stroke among Chinese Men and Women

The relationship between body mass index (BMI) and stroke incidence and mortality remains controversial, particularly in Asian populations.

Alcohol consumption and risk for stroke among Chinese men

Stroke is a leading cause of death and long‐term disability in China. The objective of this study was to examine the relation between alcohol consumption and risk for stroke among Chinese men.

Trends in overweight and obesity in Chinese adults: between 1991 and 1999-2000.

Objective: The aim of this study was to evaluate trends in BMI and the prevalence of overweight (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) between 1991 and 1999–2000 among Chinese adults.

Incidence and predictors of hypertension over 8 years among Chinese men and women.

Objective To determine the 8-year incidence of hypertension and its risk factors among Chinese adults. Methods A population-based sample of 10 525 Chinese adults aged ≥40 years and free from hypertension at baseline was followed up from 1991 to 1999–2000. Incident hypertension was defined as systolic pressure ≥140 mmHg, diastolic pressure ≥90 mmHg, or current use of antihypertensive medication. Results Over a mean of 8.2 years of follow-up, 28.9% of men and 26.9% of women developed hypertension. Among men, independent predictors of incident hypertension were baseline age [relative risk (RR) per 5 years: 1.10; 95% confidence interval (CI): 1.07, 1.13], living in urban regions versus rural regions (RR: 0.74; 95% CI: 0.64, 0.85), alcohol drinking versus non-drinking (RR: 1.13; 95% CI: 1.02, 1.24), prehypertension versus normotension (RR: 1.70; 95% CI: 1.53, 1.88), heart rate (RR of third versus first tertile: 1.27; 95% CI: 1.13, 1.44), body mass index (RR of third versus first tertile: 1.28; 95% CI: 1.12, 1.46) and low versus high physical activity (RR: 1.27; 95% CI: 1.10, 1.47). Results were similar for women, with current smoking in place of alcohol drinking and opposite results for region. The population-attributable risk of modifiable risk factors was between 25 and 50%. Conclusions These data indicate that the incidence of hypertension is high among these Chinese adults, and suggest that 25–50% of new hypertension cases could be prevented with risk factor modification. Given the excess cardiovascular mortality associated with hypertension, these data call for urgent improvements in hypertension prevention and control programs in China.

Alcohol consumption and risk of coronary heart disease among Chinese men

BACKGROUND Observational studies suggest that moderate alcohol consumption may lower risk of myocardial infarction (MI) and coronary heart disease (CHD); yet, evidence for this comes almost entirely from Western populations. METHODS We conducted a prospective cohort study in 64,597 Chinese men aged > or = 40 years who were free of clinical CHD at baseline examination. Data on frequency and type of alcohol consumed were collected at the baseline examination in 1991 using a standard protocol. Follow-up evaluation was conducted in 1999-2000, with a response rate of 94%. RESULTS Over 494,084 person-years of follow-up, we documented 725 (361 fatal) incident MI and 976 (588 fatal) incident CHD events. After stratification by province to account for multi-stage sampling design and adjustment for age, education, physical activity, cigarette smoking, body mass index, systolic blood pressure, urbanization (urban vs. rural), geographic variation (north vs. south) and history of diabetes, relative risk (95% confidence interval) of MI was 0.93 (0.70-1.24) for participants consuming 1 to 6 drinks/week, 0.66 (0.54-0.82) for those consuming 7 to 34 drinks/week, and 0.58 (0.41-0.81) for those consuming > or = 35 drinks/week (p for linear trend <0.0001) compared to non-drinkers. The corresponding relative risks for CHD events were 0.99 (0.77-1.27), 0.67 (0.56-0.81), and 0.58 (0.44-0.78), respectively (p for linear trend <0.0001). CONCLUSION Alcohol consumption may be related to lower risk of MI and CHD in middle-aged and older Chinese men. However, heavy alcohol consumption may lead to increased mortality from other causes; therefore, the implications of these findings should be interpreted cautiously.

Hypertension and cardiovascular diseases intervention in the capital steel and iron company and Beijing Fangshan community

Two intervention studies are described involving >110 000 subjects in each. The first was in a steel factory where one intervention site had health promotion, aimed at altering diet, and particularly reducing salt and fat intake, modest alcohol drinking and smoking cessation, together with a high‐risk strategy of hypertension control. The second study involved similar population and high‐risk strategies in three of five rural communities. Significant reductions occurred in both intervention and control factory sites in blood pressure, with greater falls in the intervention site, together with a marked additional reduction in salt intake and better control of hypertension. In the rural communities, blood pressure fell in all communities to a more modest degree than in the factory, but with greater blood pressure falls, together with greater smoking cessation and more modest alcohol drinking in the intervention compared with the control communities. Stroke mortality fell by 74.3% and all strokes morbidity by 54.7% in the steel factory as a whole. In the rural communities, the intervention sites showed significantly greater falls in stroke rates than in the control communities. These data show the value and effectiveness of combining a population and high‐risk strategy for controlling blood pressure and cardiovascular diseases in both a rural setting and in the work place in China.