Professional Documents
Culture Documents
tmpD41D TMP
tmpD41D TMP
Abstract
Objective To characterize hypertensive patients living in metropolitan cities in China.
Methods This was a cross-sectional survey conducted in Beijing, Shanghai and Guangzhou. The eligibility
criteria included outpatients 35-85 years of age with a systolic blood pressure (SBP) of !140 mmHg or a diastolic blood pressure (DBP) of !90 mmHg or both and/or patients receiving antihypertensive medications.
The patients demographic characteristics, medical history and findings of physical examinations, laboratory
tests and cardiovascular imaging (i.e., ultrasonic cardiogram) were included in the survey. Risk stratification
and the rate of hypertension control were evaluated.
Results A total of 25,336 individuals were surveyed, of which 79.1% were from cardiology clinics and
51.8% were male hypertensives. The average SBP/DBP was 139.318.6/82.312.0 mmHg. The mean age
was 63.611.5 years. The mean BMI was 25.13.8 kg/m2. Among the men, 55.9% had a waist circumference
of >90 cm. Among the women, 50.9% had a waist circumference of >85 cm. The percentages of patients
with diabetes mellitus, heart disease and cerebral vascular disease were 20.3%, 39.2% and 10.4%, respectively. The smoking rate was 17.6%. Overall, 60.9% of the patients were in the very high risk group. While
97.7% of the patients were receiving antihypertensive drug therapy, only 40.2% had controlled SBP/DBP
(i.e., under 140/90 mmHg). The control rate was statistically higher in Beijing and Shanghai than in Guangzhou and among older patients than among younger patients (43% among the patients >75 years of age vs.
28.1% among the patients 35-45 years of age).
Conclusion In Beijing, Shanghai and Guangzhou, most hypertensive patients have various cardiovascular
risk factors and cardiovascular diseases. High blood pressure is not under appropriate control in all cases, especially among young hypertensives and patients living in Guangzhou city. Approaches designed to target
multiple risk factors and concomitant cardiovascular diseases and boost the hypertension control rate are warranted.
Key words: blood pressure, hypertension, cardiovascular disease, risk factors, antihypertensive treatment,
control rate
(Intern Med 52: 1863-1867, 2013)
(DOI: 10.2169/internalmedicine.52.9582)
Introduction
Approximately 26.4% of the adult population worldwide
National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China,
Department of Medicine, University of Virginia, USA, Chinese Physician Association, China, Chinese Hypertension League & Beijing Hypertension Institute, China and Cardiovascular and Neurological Institute, USA
Received for publication December 26, 2012; Accepted for publication April 19, 2013
Correspondence to Dr. Wen Wang, wangwen5588@vip.sina.com
1863
DOI: 10.2169/internalmedicine.52.9582
Target organ
Diabetes mellitus
Concomitant CV diseases
damage
Systolic and diastolic BP level
LVH: ECG;
UCG
Smoking
Postprandial plasma
ischaemic attack
Dyslipidaemia
(200mg/dL)
7&Pmol/L(220mg/dL) or
LDL-&6 mmol/L(140mg/dL) or
heart failure
HDL-& mmol/L(40mg/dL)
Obesity
Abdominal: WC M85cm, WFm)
General: BMI28kg/m2
CV: cardiovascular, LVH: left ventricular hypertrophy, TC: total cholesterol, LDL: low density lipoprotein, HDL: high density
lipoprotein, WC: waist circumference, M: male, F: female, BMI: body mass index, ECG: electrocardiogram, UCG: ultrasonic
cardiogram
Grade 1 HTN
SBP140-159 or DBP 9099
low risk
moderate risk
high risk
Grade 3 HTN
6%380 or '%310
1864
DOI: 10.2169/internalmedicine.52.9582
Shanghai
(n=9,536)
51.7
65.411.3
138.218.0
81.811.1
25.13.5
Guangzhou
(n=3,509)
46.4
62.911.1
145.019.7
83.612.3
24.64.4
Total
(n=25,336)
51.8
63.611.5
139.318.6
82.312.0
25.13.8
Gender (male, %)
Age (years)
SBP (mmHg)
DBP (mmHg)
BMI (kg/m2)
WC (cm)
Male
92.712.4
89.910.3
85.510.3
91.111.5
Female
86.711.7
85.611.1
83.510.3
85.611.3
Classification of WC (%)
Male
FP
78.4
70.7
68.0
74.1
FP
62.0
51.4
45.6
55.9
FemalH80 cm
76.7
70.6
68.6
73.1
FP
55.5
45.2
45.8
50.9
Rate of smoking (%)
20.2
12.8
13.4
17.6
Rate of medical history (%)
Heart disease
39.3
41.0
34.0
39.2
Cerebral vascular disease
9.5
12.8
7.1
10.4
Diabetes mellitus
21.4
19.6
19.3
20.3
19.6*
26.6
19.7
LVH
17.8*
Antihypertensive drugs (%)
97.2
98.4
97.2
97.7
Values are expressed as Mean SD. WC: waist circumference, LVH: left ventricular
hypertrophy. * p <0.005 vs. Guangzhou, p <0.005 vs. Shanghai
Beijing
5.6
22.1
11.3
61.0*
Shanghai
6.3
20.6
9.9
63.2*
Guangzhou
7.7
23.6
14.7
54.0
Total
6.2
21.7
11.2
60.9
Results
In total, 25,336 survey forms were collected, representing
a response rate of 88.9%. A total of 12,291 forms were collected from Beijing, 9,536 forms were collected from
Shanghai and 3,509 forms were collected from Guangzhou.
The survey forms were collected from cardiology, internal
medicine, hypertension and gerontology clinics (79.1%,
11.0%, 5.0% and 4.9%, respectively).
The general characteristics of the patients are listed in Table 3. The patients were middle-aged and older. While most
of the parameters exhibited only marginal differences among
the three cities, general obesity, as expressed by the body
mass index (BMI), and abdominal obesity, as expressed by
the waist circumference (WC), were highest in Beijing, as
was the smoking rate. However, the rate of left ventricular
hypertrophy (LVH) was greater in Guangzhou (p<0.05 vs.
Beijing and Shanghai).
With respect to risk stratification, 19,852 forms were eligible and 5,484 forms were excluded due to missing lipid
profiles, ECG and ultrasound findings, blood glucose test results, data regarding the smoking status and/or miscalcula-
1865
DOI: 10.2169/internalmedicine.52.9582
Guangzhou
Total
31.6
31.6
40.2
30.8
32.3
39.5
40.8
24.0
35.6
31.6
31.3
31.9
28.1
37.0
40.0
42.2
43.0
tion of the BMI. The results are shown in Table 4. The proportion of hypertensive patients in the very high group of
cardiovascular risk was highest in Shanghai (>Beijing>
Guangzhou, p<0.05).
The hypertensive control rates are shown in Table 5. The
overall control rate in Guangzhou was the lowest among the
cities, and this result remained unchanged following age and
sex adjustment. The control rate increased in association
with age, being 28.1% in the 35- to 45-year-old group versus 43% among the patients over 75 years of age.
Discussion
This study was a large scale survey of cardiovascular risk
stratification and hypertension control rates in hospital-based
clinics in three cities in China. The sample size in the current study was five times greater than that used in our previous study (6); therefore, the data should be more representative and more applicable to hospital-based clinics in large
cities in China. Our new major finding is that hypertensive
patients treated at hospital-based clinics in three big cities
often had multiple cardiovascular risk factors and concomitant cardiovascular diseases, which confirms our previous
findings in a Chinese population. In a cohort of 26,655 hypertensive patients (18-98 years of age) treated at 282 hospitals across the nation (8), 21.1% and 53.3% were classified
as belonging to the high and very high risk groups, with
higher rates of diabetes, obesity and smoking.
The rate of diabetes mellitus was 20.3% in our survey of
hypertensive patients and was 9.7% in the general adult Chinese population (9). As a noncommunicable disease, the incidence of diabetes has increased substantially in China over
the last few decades. The higher rate of diabetes warrants
that the blood glucose level of each individual with hypertension be examined. Among various cardiovascular risk factors, elevated levels of blood pressure and blood glucose are
the greatest risk factors for incident stroke (10).
Obesity is an important CVD risk factor (11) and is significantly related to poor BP control (12). Abdominal obesity is more closely related to CVD than overall obe-
1866
DOI: 10.2169/internalmedicine.52.9582
References
1. Keraney PM, Whelton M, Reynolds K, Muntner P, Whelton PK,
He J. Global burden of hypertension: analysis of world wide data.
Lancet 365: 217-223, 2005.
2. Li LM, Rao KQ, Kong LZ, Yao CH, Xiang HD, Zhai FY, Ma GS,
Yang XG. (Technical Working Group of China National Nutrition
and Health Survey). A description on the Chinese national nutrition and health survey in 2002. Chin J Epidemiol 26: 478-484,
2005.
3. National center for cardiovascular diseases. Ministry of Health.
Annual Report on Cardiovascular Diseases in 2005 in China. Encyclopedia of China Publishing House, 2006.
4. Kannel WB. Risk stratification in hypertension: new insight from
the Framingham Study. Am J Hypertens 13: S3-S10, 2000.
5. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies Collaboration. Age-specific relevance of usual blood
pressure to vascular mortality: a meta-analysis of individual data
for one million adults in 61 prospective studies. Lancet 360: 19031913, 2002.
6. Li W, Liu L, Puente JG, et al. Hypertension and health-related
quality of life: an epidemiological study in patients attending hospital clinics in China. J Hypertens 23: 1667-1676, 2005.
7. Writing group of 2005 Chinese guideline for the management of
hypertension. Chinese guideline for the management of hypertension. Peoples Medical Publishing House, 2006: 47.
8. Qi WH, Pan CY, Lin SY. A Survey of factors influencing prognosis and control rate for patients with hypertension in mainland
China. Chinese J Cardiology 35: 457-460, 2007 in Chinese, Abstract in English.
9. Chinese Diabetes Society. 2010 China Guideline for Type 2 Diabetes. Peking University Medical Press, 2010: 1.
10. Rodriguez-Colon SM, Mo J, Duan Y, et al. Metabolic syndrome
clusters and the risk of incident stroke: The Atherosclerosis Risk
in Communities (ARIC) Study. Stroke 40: 200-205, 2009.
11. Zhou BF, Wu YF, Zhao LC. Relationship of central obesity to cardiovascular risk factors and their clustering in middle aged Chinese population. Chin J Cardiol 29: 70-73, 2001.
12. Cushma WC, Ford CE, Einhorn PT, et al. for the ALLHAT Collaborative Research Group. Blood pressure control by drug group
in the Antihypertensive and Lipid-Lowering Treatment to Prevent
Heart Attack Trial (ALLHAT). J Clin Hypertens 10: 751-760,
2008.
13. Hsieh SD, Yoshinaga H. Waist/height ratio as a simple and useful
predictor of coronary heart disease risk factors in women. Intern
Med 4: 1147-1152, 1995.
14. Hsieh SD, Yoshinaga H. Abdominal fat distribution and coronary
heart disease risk factors in men-waist/height ratio as a simple and
useful predictor. Int J Obes 19: 585-590, 1995.
15. Wu GH, Chen JM. The effect of abdominal obesity to blood pressure, blood glucose and lipid. Prevention and Control of CVD 7:
203-220, 2007 (in Chinese).
16. Writing group of 2010 Chinese guideline for the management of
hypertension. Chinese guideline for the management of hypertension. Chin J Hypertens 19: 701-744, 2011.
17. Iso H, Date C, Yamamoto A, et al; JACC Study Group. Smoking
cessation and mortality from cardiovascular disease among Japanese men and women: the JACC study. Am J Epidemiol 161: 170179, 2005.
18. Wolf PA, DAgostino RB, Kannel WB, Bonita R, Belanger AJ.
Cigarette smoking as a risk factor for stroke. the Framingham
Study. JAMA 259: 1025, 1988.
19. Donnan GA, McNeil JJ, Adena MA, Doyle AE, OMalley HM,
Neill GC. Smoking as a risk factor for cerebral ischemia. Lancet
16: 643-647, 1989.
20. Ma G, Kong L. Survey on the Status of Nutrition and Health of
Chinese People in 2002: Behavior and Lifestyle. Peoples Health
Press, Beijing, 2006: 7.
21. Yang GH, MA JM, Liu N, Zhou LN. Smoking and passive smoking in Chinese 2002. Chin J Epidemiol 26: 77-83, 2005.
22. Tao X, Wei L, Po H. Active and passive cigarette smoking in
eleven provinces and cities of China. Chinese J Prevention and
Control of CVD 18: 229-230, 2010.
23. Mancia G, De Backer G, Dominiczak A. 2007 Guidelines for the
management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of European Society of Cardiology (ESC).
Eur Heart J 28: 1462-1536, 2007.
24. Williams B, Poulter NR, Brown MJ, et al. British Hypertension
Society guidelines for hypertension management 2004 (BHS-IV):
Summary. Br Med J 328: 634-640, 2004.
25. Ma WJ, Tang JL, Zhang YH, et al. Hypertension prevalence,
awareness, treatment, control, and associated factors in adults in
southern China. Am J Hypertens 25: 590-596, 2012.
1867