The Impact Of High-normal Blood Pressure On The Incidence Of Chronic Kidney Disease And The Relationship Between Masked Hypertension And Job Strain

PART1Prevalence of high-normal blood pressure and associated risk factors among the occupational population in ChangshaObjective:As the pace of life of China speeds up, most of China’s elite workforce lead unhealthy lives, obesity and high-blood pressure occur at an earlier age. So it is important to estimate the prevalence of high-normal blood pressure and identify risk factors in the populations.Methods:Using a stratified cluster sampling method, a representative sample of5,204white collar workers aged20～60years in Changsha was selected between September2011and November2011. Anthropometry, blood pressure, and blood sample were measured with standard instruments and methodology for all the study subjects. Multiple logistic regression methods were used to identify risk factors for high-blood pressure.Results:The prevalence of high-blood pressure and hypertension was33.17%and22.44%, respectively, in all participants. It was higher in males (46.63%) than females (14.84%) for high-blood pressure. Multiple logistic regression showed that middle age (adjusted odds ratio [OR]=1.37,95%confidence interval [CI]:1.01-1.86), male sex (OR=13.40,95%CI:10.93-16.44), central obesity (OR=2.51,95%CI:2.15-2.93), and eating fried food (OR=1.22,95%CI:1.00-1.48) were risk factors for high-blood pressure.Conclusion:High-blood pressure is common among relatively young and apparently healthy white collar workers in urban China, and cardiovascular risk factors cluster during high-blood pressure. It is an important public health challenge that adopts appropriate interventions to prehypertensive occupational groups in different degrees effectively. PART2High-normal blood pressure, hyperuricemia, and risk of chronic kidney disease among the occupational population in ChangshaObjective:To investigate the relationship between high-normal blood pressure and chronic kidney disease (CKD) in a middle-aged occupational population in Changsha. Furthermore, is to evaluate whether high-normal blood pressure is related to the incidence of CKD during the six-year follow-up.Methods:①Using a cluster sampling method, a cross-sectional survey of representative sample of11274white collar workers was carried out in Changsha between March2011and May2011. Chronic kidney disease was defined as eGFR less than60mL/min per1-73m2or the presence of proteinuria. Anthropometry, blood pressure, blood sample and urine sample were measured with standard instruments and methodology for all the study subjects. Multiple logistic regression methods were used to identify risk factors for CKD.②A prospective cohort study was carried out in1703white collar workers without pre-existing CKD in Changsha in2006at baseline. The cohort population was followed for an average of54months by annual examinations. Kaplan-Meier estimates were calculated for CKD. The association of blood pressure, serum uric acid and CKD incidence was examined using a Cox regression model adjusted for relevant factors.Results:①The prevalence of CKD among those with high-normal blood pressure and undiagnosed hypertension were6.93%and11.45%, respectively, compared with18.85%with diagnosed hypertension and3.82%with normal blood pressure, and10.67%in men, and1.77%in women, with a significant difference between genders at each strata of blood pressure.②In men, but not in women, whose blood pressure was high-normal blood pressure, the CKD risk was significantly greater (0R=1.30,95%CI:1.03～1.63) than those with optimal blood pressure.③Hyperuricemia was significantly associated with an increased risk of CKD in men, but not in women (OR=1.79,95%CI:1.48～2.16), and there was an additive effect of hyperuricemia and high-normal blood pressure on CKD risk in men compared with men with optimal blood pressure.④There were3664high-normal blood pressure subjects during the first visit and110subjects developed hypertension during the second visit (30.77%) and multiple logistic regression analysis showed that gender(male), blood pressure at baseline, metabolic syndrome were the risk factors of blood pressure progression.⑤During the follow-up of cohort,194incidences of CKD were recorded. Kaplan-Meier curves showed there was a significant difference in the cumulative incidence of CKD between the different blood pressure categories (log-rank test, P<0.001).⑥The independent risk factors of CKD were age, eGFR, systolic blood pressure,and diastolic blood pressure according to the COX proportional hazard analysis.Conclusion:High-normal blood pressure, as well as hypertension, is significantly associated with CKD among occupational population in Changsha. High-normal blood pressure, particularly in conjunction with hyperuricemia, was found to be an independent risk factor of CKD in men. The results indicate that active control of the blood pressure of high-normal blood pressure individuals is needed to prevent deterioration of kidney function. PART3Characteristics of masked hypertension in normotensive and white collar workers with high-blood pressure and the association between masked hypertension and job strainObjective:To identify demographic, lifestyle, clinical and psychological characteristics of masked hypertension in occupational population in Changsha. Furthermore, is to evaluate whether job strain is associated with the prevalence of masked hypertension.Methods:Study population was drawn from the participants of four public institutions in Changsha between April2011and March2012. There were375white collar workers with normotensive or high-blood pressure underwent office and ambulatory blood pressure measurements, risk factors and target organ damage were evaluated as well. The Chinese version of Karasek’s Job Content Questionnaire (C-JCQ) was used to measure job strain. Masked hypertension was defined as normal office blood pressure (<140/90mm Hg) with elevated ambulatory blood pressure (≥135/85mmHg)Results:①The prevalence of masked hypertension among those with normotensive and high-normal blood pressure were4.6%and22.6%, respectively.②The carotid intima-media thickness and left ventricular mass index tended to increase from true normotensive through masked hypertension with normal office blood pressure to masked hypertension with high-normal office blood pressure.③In men, but not in women, being in the active group (high psychological demands and high decision latitude) was associated with MH (OR:2.04;95%CI:1.17～3.58)Conclusion:The prevalence of masked hypertension was high in the high-normal office blood pressure compared with those normotensives. The cardiovascular risk profile of masked hypertension was increased as well. Masked hypertension is associated with job strain in men and workers in "active" job situations may be more vulnerable to have hypertension. PART4Effect of follow-up management based on PDCA circulation in occupational population with high-blood pressureObjective:To evaluate the effect of follow-up management based on PDCA circulation in promoting lifestyle modification among occupational population with high-blood pressure.Methods:A parallel study base on a cluster-paired randomized trial was carried out in5585staff from36enterprises and public institutions of Changsha between April2010and March2012. The experimental group received the PDCA-based lifestyle intervention while the control group received the conventional follow-up conducted by doctors and nurse of the health management center.Results:After two-year intervention, the mean systolic blood pressure and diastolic blood pressure of the intervention group incrementally decreased by1.76mmHg and6.13mm Hg, respectively. Meanwhile, the progression is postponed from high-blood pressure to hypertension, which the rate of prognosis decreased by nearly10%. The intervention group had better behavior prevalence than the control group including quitting smoking and more frequent aerobic exercise (P<0.05).Most of the biochemical indexes in the experimental group were significantly better than those of control group as well (P<0.05)Conclusion:The follow-up management based on PDCA circulation is an interactive and flexible model, which resulted in improvement of the participants’blood pressure control and lifestyle.