| Cardiovascular disease(CVD)is a chronic disease that poses a serious threat to human's health,and hypertension is the leading risk factor for CVDs,especially in China,where more than half of CVDs are associated with hypertension.With high prevalence and low awareness,hypertension is far away from controlled.In this study,we aimed to estimate the epidemiological relationship between hypertension and cardiovascular death,to improve the current prevention and control strategies.Objective:This study aimed to investigate the relationship between hypertension and mortality of CVD in rural male population 40 years older through a 25-year follow-up cohort study,and further analyze the main risk factors and disease burden of cardiovascular death,providing a scientific basis for exploring and perfecting the corresponding strategies for intervention,which is of great significance to further improve the health level of Chinese population.Methods:Methodologies of cohort study and qualitative interview were used for on-site investigation,data processing,and data analysis.The theory and method of disease burden were used to evaluate the burden of CVD death caused by hypertension.According to the theory of etiology,the theory of hermeneutics and the theory of three levels of disease prevention,the countermeasures and suggestions of prevention and control of hypertension were put forward.Tanghe county of Henan province and Fenghuang county of Hunan province were chosen,with relatively stable follow-up population,based on the cohort of the“Prospective Study on Adult Male Behavior and Health Risk Factors in China”jointly conducted by the China Center for Disease Control and Prevention(the Chinese Academy of Preventive Medicine)and Oxford University.22 282 men aged 40 years older were selected as subjects of this study;the follow-up deadline was 31 December 2016,and the follow-up outcome was cardiovascular death.EpiData 3.2 software was used to build database,IBM SPSS24.0 and SAS 9.4 statistical software were used to statistically analyze the data.The?~2test was used to compare the categorical variables;the t-test was used to compare the continuous variables;Cox regression analysis was used to analyze the risk factors.The NVivo11.0 software was used to entry,collate and analyze the qualitative interview data.Results:The average time of follow-up was 19.1±8.7 years.A total of 22 282 participants were recruited.The cumulative number of deaths in the cohort was 10 828,with a death rate of 48.6%,and 4 504(41.6%)deaths were attributed to CVD.Among the deaths of CVD,IHD died in 1 279 cases,accounting for 28.4%,IS died in 1 201cases,accounted for 26.7%,HS died in 1 317 cases(29.2%),and other 707 cases(15.7%).78.0%,89.9%and 79.1%were Han population,peasant,and married.The average age of participates was 53.7±10.3 years.The average BMI value was21.4±2.2 kg/m~2.There were about 73.5%current smoking population,and 69.7%non-drinking population.The average daily salt intake was 12.6±6.4 grams;and the average of 14.4±6.8 g/day in Tanghe population,it was significantly higher than that of 10.3±5.1 g/day in Fenghuang population(t=51.452,P<0.001).There was about43.4%prehypertension,26.9%hypertension and 7.5%isolated systolic hypertension(ISH)in the baseline.Among those with high blood pressure,the proportion of hypertension at level 1,2,and 3 were 18.9%,5.6%,and 2.5%,respectively.The average systolic and diastolic blood pressures were 124.2±19.4 mmHg and 78.7±11.4 mmHg,respectively.The prevalence of hypertension in Tanghe was 33.5%higher than that in Fenghuan population(18.5%)(?~2=729.312,P<0.001).The associations between blood pressure and cardiovascular death:The cumulative number of deaths in the cohort was 10 828,with a death rate of 48.6%,and 4 504(41.6%)deaths were attributed to CVD.The CVD mortality rate was105.7/10 000 person-year,with 73.3/10 000 person-year in normal blood pressure population.The mortality rate of population with prehypertension,hypertension,and ISH was 91.6/10 000 person-year,173.9/10 000 person-year and 16.55/10 000person-year,respectively.The mortality rate of CVD death in patients with 1,2 and 3level of hypertension were 147.4/10 000 person-year,221.5/10 000 person-year,and308.2/10 000 person-year respectively.With the increase of blood pressure,the mortality of CVD increased gradually.The risks of CVD death were based on the normal blood pressure population,the HRs of prehypertension,hypertension,and ISH were 1.26(95%CI,1.16,1.36),2.51(95%CI,2.32,2.72),and 2.37(95%CI,2.12,2.65),respectively.The HRs of the risks of CVD death in patients with 1,2,and 3level of hypertension were 2.10(95%CI,1.93,2.29),3.30(95%CI,2.94,3.69),4.82(95%CI,4.18,5.55).After adjusted for other factors,compared to population with normal blood pressure,the HRs for the risk of CVD death caused prehypertension,1,2,and 3 level of hypertension were 1.11(95%CI,1.03,1.20),1.36(95%CI,1.24,1.48),1.63(95%CI,1.45,1.84),and 2.13(95%CI,1.84,2.47),respectively.The total mortality rate of IHD was 30.0/10 000 person-year,and with 21.6/10000 person-year in normal blood pressure population.The mortality rate of population with prehypertension,hypertension,and ISH was 25.7/10 000 person-year,49.0/10000 person-year and 47.8/10 000 person-year,respectively,which were all higher than that of the normal blood pressure group(P<0.05).The mortality rate of IHD death in patients with 1,2 and 3 level of hypertension were 45.9/10 000 person-year,56.9/10000 person-year,and 59.1/10 000 person-year respectively.The risks of death contributed to IHD in the cohort were compared with the normal blood pressure group.The HRs(95%CI)of the prehypertension group,hypertension and ISH groups were1.20(1.04,1.39)?2.47(2.14,2.86)?2.42(1.98,2.98);The difference was statistically significant(P<0.05).The HR(95%CI)of IHD death in patients with grade 1,2 and 3hypertensions were 2.27(1.94,2.65),3.00(2.41,3.73)and 3.34(2.44,4.56),respectively.After adjusted for other factors,compared to population with normal blood pressure,the HR(95%CI)for the risk of IHD death caused prehypertension was1.03(0.89,1.20).The difference was nonsignificant(?~2=0.179,P=0.673).The HRs(95%CI)for the risk of IHD death caused by 1 and 2 level of hypertension were 1.31(1.12,1.55),1.28(1.02,1.61);The differences were significant(P<0.05).The HR(95%CI)for the risk of IHD death caused by 3 level of hypertension was 1.30(0.95,1.80).The difference was nonsignificant(?~2=2.635,P=0.105).The total mortality rate of IS was 28.2/10 000 person-year,and with 19.5/10 000person-year in normal blood pressure population.The mortality rate of population with prehypertension,hypertension,and ISH was 23.4/10 000 person-year,48.4/10000 person-year and 41.5/10 000 person-year,respectively,which were all higher than that of the normal blood pressure group(P<0.05).The mortality rate of IS death in patients with 1,2 and 3 level of hypertension were 39.3/10 000 person-year,66.0/10000 person-year,and 91.2/10 000 person-year respectively.The risks of death contributed to IS in the cohort were compared with the normal blood pressure group.The HRs(95%CI)for the risk of IS death caused by prehypertension,hypertension and ISH were 1.21(1.04,1.41),2.65(2.28,3.08)and 2.27(1.83,2.83),respectively.The differences were significant(P<0.05).The HR(95%CI)for the risk of IS death caused by 1,2 and 3 grades of hypertension were 2.12(1.79,2.51),3.74(3.03,4.62)and 5.44(4.18,7.08).After adjusted for other factors,compared to population with normal blood pressure,the HR(95%CI)for the risk of IS death caused by prehypertension was 1.05(0.90,1.23).The difference was nonsignificant(?~2=0.408,P=0.523).The HR(95%CI)caused by 1,2 and 3 grades of hypertension were 1.29(1.09,1.54),1.73(1.38,2.15),2.21(1.68,2.91).The differences were significant(P<0.05).The total mortality rate of HS was 30.9/10 000 person-year,and with 20.9/10 000person-year in normal blood pressure population.The mortality rate of population with prehypertension,hypertension,and ISH was 28.3/10 000 person-year,48.7/10000 person-year and 42.5/10 000 person-year,respectively,which were all higher than that of the normal blood pressure group(P<0.05).The mortality rate of HS death in patients with 1,2 and 3 level of hypertension were 40.9/10 000 person-year,58.4/10 000 person-year,and 98.9/10 000 person-year respectively,showing a gradual increase.The risks of death contributed to HS in the cohort were compared with the normal blood pressure group.The HRs(95%CI)for the risk of HS death caused by prehypertension,hypertension and ISH were 1.36(1.17,1.57),2.43(2.10,2.82)and2.13(1.72,2.64)respectively.The differences were significant(P<0.05).The HRs(95%CI)for the risk of IS death caused by 1,2 and 3 grades of hypertension were2.02(1.72,2.38),2.99(2.40,3.72),5.26(4.09,6.78).After adjusted for other factors,compared to population with normal blood pressure,the HR(95%CI)for the risk of HS death caused by prehypertension,1,2 and 3 level of hypertension were 1.27(1.10,1.47),1.60(1.35,1.90),1.94(1.55,2.43)and 3.03(2.33,3.94)respectively.The differences were significant(P<0.05).The deaths of IHD,IS,and HS in the cohort were attributed to hypertension.Among them,hypertension caused a cumulative 596.8 deaths from IHD,accounting for 46.7%of the total deaths,735.1 deaths from IS,accounting for 55.8%of the total deaths,and 748.8 deaths from HS,accounting for 62.4%of the total deaths.The effects of blood pressure on IHD,IS,and HS deaths varied with age.The death rate of IHD,IS and HS increased from 45 years old,reached its peak at 60-64 years old respectively,and began to decline gradually after 65 years old,with a significant downward trend at 75 years old.The YLL of early death in IHD,IS and HS caused by hypertension in the cohort was 12 852.9 years,16 383.4 years,and 14 441.9 years,respectively.The life loss of IHD and IS in the group 60-64 years old was the highest,accounting for 17.6%and 21.6%of the YLL,respectively.The loss of life of HS in the group of 65-69 years old was the largest,accounting for 22.1%of the total YLL of this disease.Smoking,drinking,and BMI have a certain effect on CVD death.The CVD mortality rate of those who never smoked was 99.5 per 10 000 person-year,but among current smokers,the mortality rate of CVD death was 105.8 per 10 000person-years;The difference was no significant(?~2=3.52,P=0.06).The death rate of CVD among those who ever smoked was 177.4/10 000 person-year,it was significantly higher than that of non-smokers(?~2=51.286,P<0.001).Compared with non-smokers,the risk of CVD death in former smokers was 1.88 times higher than that in non-smokers,and HR was 1.88(95%CI,1.58,2.24).The difference was statistically significant(?~2=51.286,P<0.001).The risk of current smokers is 1.07times that of non-smokers,and HR is 1.07(95%CI,0.997,1.15),but the difference is not statistically significant(?~2=3.520,P=0.061).After adjusted for other factors,compared with non-smokers,the former smokers had the greatest risk of dying from CVD,HR was 1.31(95%CI,1.10,1.56).Second,the current HR of smokers was 1.08(95%CI,1.00,1.16),and the difference was significant(P<0.05).The mortality rate of CVD for non-drinking people was 106.6/10 000 person-year,and the rate of drinkers was 103.4/10 000 person–year.There was no significant difference(?~2=0.637,P=0.425).Taking the non-drinking population as a reference,the risk of CVD death in drinking population was basically the same as that in non-drinking population(?~2=0.637,P=0.425),HR was 0.97(95%CI:0.91,1.04);after adjusting other factors,compared with non-drinking population,the risk of death from CVD was increased by5.6%in the drinking population,with an HR of 1.06(95%CI,0.99,1.13).There was no significant(?~2=2.611,P=0.106);The HR of HS-related death risk was 1.17(95%CI,1.04,1.32)in the drinking population,there was significant difference(?~2=6.543,P=0.011).The mortality rate of CVD was 134.8/10 000 person-year in the underweight population with BMI<18.5 kg/m~2.The rate of people with normal weight(18.5 kg/m~2?BMI<24 kg/m~2)was 103.1/10 000 person-year,which was significantly lower than that of the underweight(?~2=35.304,P<0.001).Overweight or obese people(BMI?24 kg/m~2)had a CVD mortality rate of 107.8/10 000 person-year.It was lower than that of underweight people(?~2=13.902,P<0.001).With BMI<18.5kg/m~2 as the control group,18.5?BMI<24 kg/m~2 had the lowest risk of CVD death,HR was 0.73(95%CI,0.66,0.81),the difference was statistically significant(P<0.05);followed by BMI?24 kg/m~2 population,the HR was 0.77(95%CI,0.67,0.89).In-depth analysis showed that the death curve of BMI and CVD presented U-shaped trend.After adjusting for other factors,taking BMI<18 as a reference,people with a BMI between 18 and 24 had the lowest risk of cardiovascular death,and the risk of BMI?26 kg/m~2 increased by 17.4%.However,statistical analysis showed no significant difference(P>0.05).Qualitative interview found that Tanghe and Fenghuang basically established the organization framework for prevention and control of three-level chronic diseases in counties,townships and villages.The prevention and control of hypertension was included in the routine work of basic public health service projects,and a number of chronic disease prevention and control measures were implemented.Ordinarily resident of the new rural cooperative insurance coverage rate is high,farmers get certain benefits;Counties and villages took the initiative to prevent and control hypertension.The county health bureau included the prevention and control of hypertension into the year-end assessment system,township hospitals established a mechanism for doctors to receive and monitor blood pressure,and village doctors regularly followed up patients to carry out the prevention and control of hypertension publicity.The two counties basically established the hypertension disease management follow-up system.The difficulties and problems in the prevention and control of hypertension in rural areas:First,insufficient investment in work,lack of effective prevention and control planning and target tasks;second,insufficient human resources,grassroots staff are not very motivated,especially The village doctors have a large workload,poor welfare,and severe,aging trend;third,the villagers'living habits are difficult to change,and the compliance of hypertension medication is less than 10%;fourth,the health education method is single,the effect is not in place;fifth,the villagers have strong mobility and follow-up And management caused difficulties.To achieve the long-term goal of hypertension prevention and control,it is necessary to implement comprehensive prevention and control strategies with governance for health.The countermeasures and suggestions for hypertension prevention and control in China are proposed in this paper from the perspective of the joint effects of government support,medical and health care,scientific research institutions,NGO,families and individuals,which provides a theoretical basis for policy makers to improve the prevention and control strategies of hypertension.Conclusions:(1)Hypertension is the main risk factor for cardiovascular death.With the increase of blood pressure,the risk of cardiovascular death is gradually increased.(2)In the control of hypertension,the mortality of IHD,IS,and HS in the cohort decreased by 47%,56%,and 62%,respectively.(3)Smoking and drinking increase the risk of cardiovascular death,the effect of alcohol consumption on hemorrhagic stroke was obvious.(4)Population aged between 45 and 70 in rural areas have the highest cardiovascular disease burden,and they are the ones who focus on prevention and control.(5)At present,the prevention and control of hypertension in rural areas is faced with many problems,such as insufficient funds and manpower,poor welfare and enthusiasm of village doctors,high prevalence of hypertension,low medication compliance,and large mobility of rural population.Therefore,the prevention and control of hypertension still has a long way to go. |
PDF Full Text Request