摘要
高血压是最常见的心血管疾病,其并发症是造成人类死亡的主要原因之一。估计目前全世界成人中高血压患者大概9.72亿,到2025年这一数字将增加到15.6亿。在发达国家高血压发病率得到控制以后,我国仍在较快地增加,这是不良生活方式增加、膳食结构改变、以及入口老龄化等所致。根据WHO调查每年大约有1700万人死于高血压,与正常人群相比,高血压患者中中风发生率增加2.6～2.8倍,充血性心力衰竭发生率增加3～4倍。高血压已经成为中国一个主要的公共卫生问题,在庞大的高血压人群中,农村人群占有相当大的比例。本研究分别于2007年、2008年的7月～8月对河南省新安县农村地区18岁及以上常住居民进行相关的流行病学调查,了解该地区人群高血压的流行现状及相关危险因素,并评估哪个肥胖测量指标能更有效地预测高血压的发生,为农村地区高血压的防治提供科学依据。
对象与方法
于2007年7月～2008年8月在河南省新安县选择两个在地理、经济社会发展水平方面具有代表性的乡镇(磁涧镇和铁门镇)作为研究现场,以自然村为基本抽样单位,采用整群抽样的方法,抽取18岁及以上的汉常住居民20194人进行调查。研究内容包括问卷调查:人口统计学指标(年龄、性别、文化程度、婚姻状况、人均收入等),生活习惯(吸烟、饮酒及膳食情况)以及疾病史、家族史情况;体格检查:测量血压、身高、体重、腰围;实验室检查:检测空腹血糖、血清总胆固醇、甘油三酯、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇。采用现况研究和病例对照研究方法,对该地区成年人群高血压的患病率、知晓率、治疗及控制情况,血压水平分级情况及高血压的危险因素进行研究,并应用受试者工作特征曲线(receiver operating characteristic curve,ROC curve)探讨不同肥胖测量指标预测高血压风险的能力。
结果
1.高血压的患病率:高血压患病率为30.77%(其中男性27.51%,女性32.88%),以2000年全国第五次人口普查资料20岁以上人群作为标准人口,得到的标化患病率为20.81%(其中男性18.21%,女性22.73%),女性高于男性,差异有统计学意义(χ~2=65.25,P＜0.05)。高血压患病率随年龄的增加而升高,趋势性检验具有统计学意义(χ~2=48.56,P＜0.05)。单身人群高血压患病率(37.88%)高于已婚人群(29.86%)(χ~2=61.21,P＜0.05),另外,低学历和低收入人群中高血压患病率较高(P＜0.05)。调查人群中,正常血压、正常高值、1、2、3级高血压的比例分别为41.41%、33.80%、15.69%、6.52%、2.40%。高血压患者中,现测血压1级,2级,3级的构成比分别为63.30%、26.29%和10.41%。
2.高血压患者的知晓、治疗和控制情况:总体上,64.99%的高血压患者知道患有高血压,有62.14%的患者服用降压药,19.43%的患者血压得到控制。接受治疗的高血压患者与未治疗患者之间的平均收缩压水平和平均脉压水平均无统计学差异(P＞0.05),平均舒张压水平比未治疗患者低1.41mmHg(t=-5.01.P＜0.05)。
3.高血压的危险因素:在调整了年龄、性别、文化程度、婚姻状况、人均收入因素后,高血压家族史(OR=2.29,95%CI:2.10-2.49),糖尿病(OR=1.31,95%CI:1.14-1.51),血脂异常(OR=1.20,95%CI:1.11-1.30)与超重和肥胖(OR=2.56,95%CI:2.35-2.78)是高血压的危险因素;而吸烟(OR=0.90,95%CI:0.82-0.99)与体力活动(OR=0.87,95%CI:0.83-0.91)是高血压的负相关因素。
4.不同肥胖测量指标预测高血压风险能力的比较:腰围(waist circumference,WC)、体重指数(body mass index,BMI)和腰围/身高比值(waist to height ratio,WHtR)预测高血压风险的ROC曲线下面积分别为0.66(95%CI:0.65-0.66)、0.67(95%CI:0.66-0.68)和0.69(95%CI:0.69-0.70),其中WHtR的ROC曲线下面积最大(P＜0.05)。该人群BMI的适宜切点男、女分别为23.8和25.0(OR=2.51,95%CI:2.36-2.67);WC男、女分别为83.9cm和82.1cm(OR=2.90,95%CI:2.73-3.09);WHtR男、女分别为0.51和0.54(OR=3.16,95%CI:2.97-3.36)。对于高血压的患病风险,三个指标中,以WHtR≥0.51/0.54的诊断敏感性和特异性最为均衡,疾病风险的比值比(OR)最大。
结论
1.该农村人群高血压患病率较高,但是知晓率、治疗率和控制率却很低,高血压防治工作急需加强。
2.亟需在高危人群中开展高血压的筛检计划,并加强病人的管理,改善病人的治疗和控制现状。
3.BMI、WC和WHtR三个指标中,预测高血压的价值以WHtR最好。与全身性肥胖相比,中心性肥胖与高血压的关系更为密切,在重视BMI的同时,不能忽略中心性肥胖的危害。
Background
Hypertension 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 methods
Participants 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.
Results
1. 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).
Conclusions
1. 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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