Central rather than brachial pressures are stronger predictors of cardiovascular outcomes: A longitudinal prospective study in a Chinese population.

The purpose of this study was to assess the association of blood pressure (BP) measurements with the risk of cardiovascular disease (CVD) and examine whether central systolic BP (CSBP) predicts CVD better than brachial BP measurements (SBP and pulse pressure [PP]). Based on a cross-sectional study conducted in 2009-2010 with follow-up in 2016-2017 among 35- to 64-year-old subjects in China, we evaluated the performance of non-invasively predicted CSBP over brachial BP measurements on the first CVD events. Each BP measurement, individually and jointly with another BP measurement, was entered into the multivariate Cox proportional-hazards models, to examine the predictability of central and brachial BP measurements. Mean age of participants (n = 8710) was 50.1 years at baseline. After a median follow-up of 6.36 years, 187 CVD events occurred. CSBP was a stronger predictor for CVD than brachial BP measurements (CSBP, 1-standard deviation increment HR = 1.49, 95%CI: 1.31-1.70). With CSBP and SBP entering into models jointly, the HR for CSBP and SBP was 1.28 (1.04-1.58) and 1.22 (0.98-1.50), respectively. With CSBP and PP entering into models jointly, the HR for CSBP and PP was 1.51 (1.28-1.78) and 0.98 (0.83-1.15), respectively. For subgroup analysis, the association of CSBP with CVD was stronger than brachial BP measurements in women, those with hypertension and obesity. In the middle-aged Chinese population, noninvasively estimated CSBP may offer advantages over brachial BP measurements to predict CVD events, especially for participants with higher risk. These findings suggest prospective assessment of CSBP as a prevention and treatment target in further trials.

Interankle Systolic Blood Pressure Difference Is a Marker of Prevalent Stroke in Chinese Adults: A Cross-Sectional Study.

This cross-sectional study carried out from November 2014 to December 2014 aimed to determine whether the interankle systolic blood pressure (SBP) difference is an independent marker of prevalent stroke. Simultaneous four-limb blood pressure measurements (oscillometric devices) and calculated SBP difference between the lower limbs were collected from 1485 participants aged 35 years and older. Questionnaires about traditional stroke risk factors were completed. Interankle SBP difference ≥7 mm Hg was independently associated with a history of stroke after adjusting for traditional stroke risk factors (odds ratio, 1.64; 95% confidence interval, 1.53-3.59; P=.0123). Net reclassification improvement analysis showed that adding the interankle SBP difference to traditional risk factors improved the predictive ability for stroke risk by 18.5% (P<.001). In conclusion, an interankle SBP difference ≥7 mm Hg could be an independent marker of stroke history in Chinese adults. It could offer an extra benefit in identifying individuals with risk of stroke beyond conventional clinical features.

The Association of Four-Limb Blood Pressure with History of Stroke in Chinese Adults: A Cross-Sectional Study.

OBJECTIVE: We investigated the association of ankle-brachial blood pressure index (ABI), interarm blood pressure (BP) difference and interankle BP difference, obtained by simultaneous four-limb BP measurement, with history of stroke in a Chinese adult population. METHODS: This cross-sectional study included 1485 participants aged ≥35 years in the framework of the China Hypertension Survey. We performed simultaneous four-limb BP measurement using oscillometric devices with the participants in the supine position and calculated ABI and interarm/interankle BP differences between the 4 limbs. Logistic regression analysis was used to estimate the association of these BP parameters and other factors with a history of stroke. RESULTS: In univariate analyses, participants with ABI <0.9, interarm BP difference ≥15 mmHg, and interankle BP difference ≥10 mmHg had a higher prevalence of stroke than those without (p < 0.0001, p = 0.0152, p = 0.002, respectively). Multiple logistic regression analyses suggested, ABI <0.9 was independently associated with a history of stroke after adjustment for interarm BP difference ≥15 mmHg, interankle BP difference ≥10 mmHg, and traditional risk factors for stroke (p = 0.001). An interankle BP difference ≥10 mmHg was associated with prior stroke after the two variables of hypertension and ABI were removed from the logistic regression model (p = 0.0142). Net reclassification improvement analysis showed that inclusion of interankle BP difference ≥10 mmHg to the independent risk factors (age, family history of stroke, hypertension, and ABI) improved net reclassification by 11.92%. CONCLUSION: ABI <0.9 is an independent risk factor for stroke prevalence in Chinese adults and it just detected a small propotion of paticipants. The addition of interankle BP difference ≥10 mmHg to the independent risk factors for stroke may improve the prediction of stroke.

[A 50-year study on the epidemiology of hypertension in Heilongjiang Province of China].

OBJECTIVE: To assess the epidemiological characteristics of hypertension and its attributing factors in Heilongjiang province and establish a comprehensive basis for the prevention and control of hypertension in this region. METHODS: Using the stratified chunk method, a survey lasting 50 years was conducted on a sample of 299 677 (including 158 782 males and 140 895 females) patients, aged 15 and above, residing in both rural and urban areas of Heilongjiang province from 1958 to 2007. Both blood pressure measurement and analysis on attributing factors of hypertension were carried out in 1958, 1979, 1991, 1999 and 2007. RESULTS: The prevalence of hypertension was significantly higher in Heilongjiang than in other provinces. It elevated annually, reaching a 3-fold increase in 50 years with an accelerating pace (17.06% to 25.69%) in the recent 8 years. Among the people examined, the prevalence of hypertension increased with aging. Furthermore, the prevalence of hypertension varied among different professions. Office workers had the highest prevalence (41.67%). Compared with; female population, male participants had a much higher prevalence before the age of 55 (P<0.0001). Body mass index, gender, hypertriglyceridemia, age, low-high density lipoprotein cholesterol and family history were identified as major risk factors for the development of hypertension in Heilongjiang province. However, the awareness (48.90%), treatment (25.33%) and control (4.32%) rates of hypertension in this region were relatively low. CONCLUSION: The results of the present study identified Heilongjiang province as a high-risk region for hypertension. It also suggests the necessity to plan and implement actions for the effective prevention and treatment of hypertension in this region.

[Prevalence, awareness, treatment, and risk factors of hypertension in Harbin, Heilongjiang Province].

OBJECTIVE: To investigate the prevalence, rates of awareness, treatment, and control, and risk factors of hypertension among the residents in Harbin, Heilongjiang Province. METHODS: 5523 residents, 2325 males and 3198 females, aged 15 and over, underwent questionnaire survey to understand their general conditions, history of present disease, awareness of disease, treatment, working condition, etc, and measurement of blood pressure (BP), height, body mass, and serum glucose and triglyceride. RESULTS: The no-standardized prevalence of hypertension was 31.30% in general (1674/5348), 38.52% in the males (829/2152), and 26.44% in the females (845/3196). The corresponding standardized prevalence rates of hypertension were 24.91%, 37.72%, and 20.75% respectively. The rates of awareness, treatment, and control of hypertension were 57.41%, 32.74%, and 5.85% respectively. Multiple logistic regression analysis revealed that employment condition, family history of hypertension, alcohol consumption, body mass index, level of triglyceride and serum glucose were risk factors of hypertension. CONCLUSION: Hypertension is highly prevalent is highly prevalent and the rates of awareness, treatment, and control of hypertension are still rather low in Harbin.

[Prevalence and risk factors of prehypertensive status in people from the rural area of Lanxi county, Heilongjiang province].

OBJECTIVE: To access the prevalence of prehypertensive stage and its associated risk factors in rural inhabitants from Lanxi county in Heilongjiang province. METHODS: Through cluster multistage and random sampling methods, local people aged > or = 15 years old in Lanxi county were selected. A survey on blood pressure and associated risk factors was carried out. Overnight fasting blood specimen of people aged > or = 35 years old was collected. Chi-square test, t-test and logistic regression analyses were then performed. RESULTS: 5272 residents were surveyed including 2539 male and 2733 female subjects. The overall prevalence of prehypertension was 36.34%. The prevalence of prehypertension appeared to be higher in males (39.50%) than in females (33.41%) (chi2 = 58.9887, P < 0.0001). The prevalence of prehypertension decreased with increasing age in men > or = 25 years old (chi2 = 96.0698, P < 0.0001), and in women > or = 35 years old (chi2 = 11.5784, P = 0.0208). Data from multivariable logistic regression showed that being male, aged (> or = 55 years old), with waist circumference as > or = 85 cm for men and > or = 80 cm for women, BMI > or = 25.0 kg/m2 and fasting plasma glucose > or = 7.0 mmol/L were risk factors of prehypertension while high-density lipoprotein cholesterol < 0.9 mmol/L was shown as a protective factor (OR = 0.740, P = 0.0036). Dose-response relationships were seen between prehypertension and age, BMI and FPG. CONCLUSION: Prehypertension was popular in the rural area, with high prevalence seen in teenagers. Programs on prehypertension prevention should start from teenagers. Risk factors of prehypertension increased when people became age 55 or older. There was a need to monitor BP more often and to control BP through non-drug methods.

Hypertensive epidemiology in Heilongjiang Province in China.

OBJECTIVE: To assess the epidemiology features of hypertension in Heilongjiang Province, China. METHODS: From 1959 to 1999, 289,157 people in total, ages > or = 15-year old (male 154,091, female 135,066) were investigated four times by a stratified chunk method in rural and urban areas in Heilongjiang Province. After a staff training program, this survey on blood pressure and risk factors was carried out under a worldwide uniform protocol with standardized method and interrelated quality control regulation. Among these samples, 1615 people (male 824, female 791) received blood-lipid analysis. RESULTS: The hypertensive incidence of Heilongjiang was much higher than the average level in China (P < 0.01) and it has gotten higher from 1959 to 1999, especially in the last ten years. It increased more in males than in females (P < 0.01). It was also higher with age. The mean age of hypertensive onset became ten years younger recently. It is different in different areas and professions. Age, BMI (body mass index), drinking alcohol, gender, history of maternal hypertension, high salt diet and professional status were the main risk factors for hypertension in Heilongjiang Province in China. CONCLUSION: The prophylaxis and treatment of hypertension should be enhanced in this area.