| [Objective]Taking the individuals with aged 65 years or older for the research object to investigate and understood the health status of this subjects.Then,combined with molecular epidemiology to explore the effects between related genes of vasoconstriction pathways and environmental factors on essential hypertension(EH).Finally,the compound intervention based on previous investigation was put into practice.According to effects of intervention,we could offer a scientific evidence for the management of essential hypertension among the local elderly.[Methods]In part one,with the method of two-stage random sampling,the respondents were extracted from communities' archives whose filing rate is over 95% and were surveyed by one questionnaire so that we can have insight into the health status among the aged.Then,we used the indexes of mean and standard deviation and constituent ratio to descript,and t-test,variance analysis and Chi-square to infer.Second part used the case-control study.With the same sampling frame,we extracted the individuals that conformed to,so that we can discuss the influencing factors of the prevalence of hypertension or hypertension with diabetes mellitus(T2DM).At the same time,we took their DNA to test the genotype of polymorphic loci with LDR.Then,non-condition logistic regression analysis and crossover analysis were used to analyze the interaction between gene and gene,and environmental factors and gene.Otherwise,the invariance analysis and non-condition logistic regression analysis were used to analyze the factors of the control of this disease.In the third part,to investigate the eating habits among the aged 65 years or older in Zherong at the first time to building the dietary pattern which could be appropriate to the southern area.Then,we extracted the subjects the same as the first and second part in Fuzhou to participate in the compound intervention.Most importantly,they should be volunteers.Finally,we used invariance and non-condition logistic regression to analyze the effects.[Results]1.The study manifested that the prevalence rate of hypertension in elderly aged 65 years or older was 61.3%,and standardized one was 61.0%.The latter was higher than the rate(50.3%)in 2011 in the community of Fuzhou.2.The mean of Body Mass Index(BMI)of all subjects was 24.1±3.5 kg/m2.However,there was different proportion between overweight and obesity.The former was 38.4%,and the latter was 10.8%.This index also showed a downward trend with age.Meanwhile,the levels of triglyceride(TG)and total cholesterol(TC)were higher in women than in men(P<0.05).On the other hand,the hypertensive patients' diastolic blood pressure(DBP)was higher in men than in women,while male pulse pressure(PP)was lower than women,and DBP became lower and pulse pressure started to rise with age(P<0.05).Among the aged who have EH and T2 DM both,male DBP was higher than female.It also could be seen that their DBP became lower and PP started to rise with age(P<0.05).3.Overweight(OR=2.552;95%CI,1.261 to 5.164),obesity(OR=6.088;95%CI,1.636 to 22.657),and a family history of EH(OR=3.124;95%CI,1.629 to 5.992)were dangerous factors for the population to have EH.4.The hypertensive patients couldn't be found in association with rs11739136,rs1799983,rs1799722 in the study(P>0.05).Howevere,there was a negative multiplicative interaction between rs1799983 and rs1799722.It also had shown that people who carried CT+TT genotype of rs11739136 and whose BMI was over 24kg/m2 had higher risk to have this disease(OR=3.089;95%CI:1.065 to 13.618);people who carried CT+TT genotype of rs1799722 and whose BMI was over 24kg/m2 made the same effect on having hypertension(OR=3.406;95%CI:1.262 to 9.196).5.Obesity(OR=7.153;95%CI,1.751 to 29.229),a family history of EH(OR=2,998;95%CI,1.332 to6.702)or EH complicated with T2DM(OR=16.679;95%CI,5.910 to 47.065)were the influencing factors for people to have EH and T2 DM both.6.There was significant difference in allele frequency distribution of rs11739136 and rs1799722 in male patients who had EH and T2 DM both(P<0.05).In this group,people who carried TT genotype of rs1799722 might increase risk to get these diseases both;it was the same as CT genotype of rs1799722 carriers.However,it couldn't be found the association of rs11739136,rs1799983 and rs1799722 with hypertension and diabetes in female group or entire subjects(P>0.05).There was not known the interaction between gene and gene.But it had shown that rs11739136 and BMI had positive additional interaction in male group and the entire one.7.Taking regular exercise(OR=0.273;95%CI,0.105 to 0.715),having sweet preference(OR=3.832;95%CI,1.273 to 11.530),and often taking bamboo shoot(OR=0.035;95%CI,0.002 to 0.603),getting grade 3 EH(OR=5.190;95%CI,1.824 to 14.771)and subsequent visiting(OR=0.274;95%CI,0.103 to 0.727)were the influencing factors for bad BP control.Eating bamboo shoot(OR=301;95%CI,0.104 to 0.873)was the protective factor,while poor medication compliance(OR=10.341;95%CI,1.275 to 83.855)and obesity(OR=6.746;95%CI,1.306 to 34.837)were dangerous one for patients to have poor control status.8.After intervention,the subjects who had hypertension in management of SBP,DBP and TG were decreased by 14.7 mm Hg,7.9mm Hg and 0.3mmol/L.While those who had EH and T2 DM both in management of SBP and DBP were decreased by 13.4mm Hg and 6.5mm Hg.Compared with each control group,the SBP and DBP of intervention groups were lower(P<0.05).The TC,TG and BMI were lower than those in control,but it was not statistically significant(P>0.05).[Conclusions] 1.Compared to the other regions of China,the prevalence rate of hypertension among the elderly is at a higher level in Fuzhou.And this trend was rising during these years.2.Overweight,obesity and a family history of hypertension are dangerous factors for the elderly to have hypertension.And obesity,a family history of hypertension or hypertension and T2 DM both could increase the risk for the population aged 65 years and older to have EH and T2 DM both.3.The polymorphism of rs11739136(kcnmb1/E65K)and rs1799722(bdkrb2/-58T/C)may have relation with the susceptibility of hypertension and diabetes both in the elderly(especially in men).Meanwhile,there is an addition interaction between rs11739136(kcnmb1/E65K)and BMI.And the multiplicative interaction between rs1799983(enos/G894T)and rs1799722(bdkrb2/-58T/C)may have impact on having hypertension.4.We draw a conclusion that having sweet preference and getting grade 3 hypertension could increase the risk to have bad BP control;while taking regular exercise and eating bamboo shoot,and returning visit a doctor will protect patients to get better BP.In terms of patients who have hypertension and diabetes both,poor medication compliance and obesity are dangerous factors for them;while eating bamboo shoot is good.According to each individual characteristic,health advisors of community can implement targeted preventive and control measures to reduce complications and improve control rate.5.The intervention which makes up of eating fiber,exercising and taking health lessons is the effective way to control patients' BP. |
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