| BackgroundHypertension is the most common cardiovascular disease, its complications is one of the major causes of human death. There are about 972 million adults around the world with hypertension, this figure will increase to 1.56 billion by 2025. The incidence of hypertension has been under control in developed countries, but China is still in the rapid increase, which is due to unhealthy lifestyle and dietary habits, as well as the aging of the population and so on. Hypertension has become a major public health problem and the rural population account for a considerable proportion for the increasing number of hypertension. In order to learn the distribution, risk factors, and the control status of hypertension in the rural population, the epidemiological investigations were carried out from July to August in 2007 and 2008 in a rural population in Henan.Subjects and methodsParticipants aged 18 and above were selected randomly by cluster sampling technique. A total of 20194 representative subjects were selected and completed the survey. Data were collected by questionnaire interview including demographic characteristics (age, sex, educational level, marital status, per capita income etc.), behavial risk factors (smoking, drinking and diet) and disease history, family history; anthropometric measurements (height, weight, waist and hip circumferences, and blood pressure), and laboratory measurements [fasting plasma glucose, total cholesterol (TC), triglyeride (TG), and high density lipoprotein cholesterol (HDL-C) ]. Cross-sectional and case-control study designs were used to analyze the prevalence, awareness, treatment, control, classification of blood pressure level and risk factors of hypertension. Receiver operating characteristric (ROC) curve was used to compare central and overall obesity measurements as correlates for identifyting hypertension, and find out the appropriate cut-off point.Results1. Prevalence of hypertension: The crude prevalence of hypertension was 30.77% (27.51% for males and 32.88% for females, respectively) in this survey. The age-adjusted rate was 20.81% (18.21% for males and 22.73% for females, respectively) by the population data of 2000 in China. The prevelence rate in women was significantly higher than that in men (x~2=65.25, P<0.05). The prevalence of hypertension increased with age (P<0.05). The prevelence of hypertension for single population was significantly higher than the rate of married population(37.88% vs 29.86%) (x~2=61.21, P<0.05), In addition, the population with low education and low-income were with higher prevalence of hypertension (P<0.05). Among the study population, the individuals with normal blood pressure, pre-hypertension, grade 1 hypertension, grade 2 hypertension, grade 3 hypertension and isolated systolic hypertension accounted for 41.41%, 33.80%, 15.69%, 6.52% and 2.58% respectively. The propotion for stage 1, 2, and 3 hypertension were 63.30%, 26.29% and 10.41% among hypertensive patients, respectively.2. Awareness, treatment, and control of hypertension: Among hypertensive patients, 64.99% were aware of their high blood pressure, 62.16% were taking antihypertensive medication, and 19.43% achieved their blood pressure under control. There were no significant difference for the average systolic blood pressure level and pulse pressure level between treated and untreated patients with hypertension. The average diastolic blood pressure level for patients treated was 1.41 mmHg lower than the correspanding value for those untreated (t=-5.01, P<0.05).3. Risk factors of hypertension: After adjusted for age, gender, education level, marital status, average yearly individual income, logistic regression analysis shows that family history of hypertension (OR=2.29, 95%CI: 2.10-2.49), diabetes mellitus (OR= 1.31, 95%CI:1.14-1.51), dyslipidemia (OR= 1.20, 95%CI:1.11-1.30), over-weight and obesity (OR=2.56, 95%CI: 2.35-2.78) were significantly positi- vely associated with hypertension, whereas, smoking (OR=0.90, 95%CI: 0.82-0.99) and physical activity (OR=0.87, 95%CI: 0.83-0.91) were nagatively associated with the development of hypertension.4. The predicting abilities of different obesity measurements for hypertension: ROC analysis reveals significant differences between areas under ROC curve (AUCs) for waist-to-height ratio (WHtR) (0.69, 95%CI: 0.69-0.70) and body mass index (BMI) (0.66, 95%CI: 0.65-0.66) and waist circumference (WC) (0.67, 95%CI: 0.66-0.68) (all P<0.05), and the area under ROC curve (AUCs) for WHtR was biggist. Appropriate cut-off points of BMI were 23.8 for male and 25.0 for female (OR=2.51, 95%CI: 2.36-2.67); Appropriate cut-off points of WC for male and female were 83.9cm and 82.1cm respectively (OR=2.90, 95%CI: 2.73-3.09); Appropriate cut-off points of WHtR for male and female were 0.51 and 0.54 (OR=3.16, 95%CI: 2.97-3.36).Conclusions1. There is a relatively high prevalence of hypertension in this area, and the awareness, treatment, and control rates are very low, which suggests that the prevention and control of hypertensin are urgently needed for the residents in rural areas.2. There is stringent need for the hypertension screening program in high risk population. It is also need to strengthen the management of the patients so that to improve the treatment and control status.3. The value of predicting hypertension in WHtR is better then in BMI and WC. Central rather than overall obesity is related more closely to hypertension. Central obesity should be emphasiszed in the population. |
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