| [Background] Hypertension is a kind of common and chronic cardiovascular diseases (CVD) which is harmful to people's health. Its long-term development can cause damages of heart, brain, kidney and so on. Many countries pay more attention to high incidence, disability and mortality of hypertension. In addition, the relationships between high-normal blood pressure and hypertension or cardio-cerebral vascular diseases are intimate, so strengthening the epidemiological study of high-normal blood pressure is very important theoretically and actually. With the development of society and economy in China, great changes have taken place in population structure, economic status, behavior and life styles, prandium mode and many other aspects in rural areas, which results in significant raise of prevalence of hypertension in rural areas. Although the levels of economy have been raised in many developing rural areas, health awareness couldn't increase. The difference of prevalence of hypertension between city and rural areas decreases gradually. Hypertension has become one of main diseases that affect peasant health. China is a large agriculture country with 0.9 billion peasants, and the study of prevalence of hypertension and it's influenced factors in rural areas is one of main tasks to carry out the plan of primary health care and health for all. Descriptive epidemiology study was used to identify epidemiological distribution characteristics of high-normal blood pressure and hypertension and their influence factors for residents in midwestern rural areas in Shandong province of China, consequently providing scientific evidence for prevention and control of hypertension.[Objectives] The major purposes of this study are to explore the levels of blood pressure, epidemiological distribution of high-normal blood pressure and hypertension and their related influenced factors, consequently providing scientific evidence for the determination of high risk population and surveillance population and making strategies for prevention and control of high-normal blood pressure and hypertension that will be really fit for the research areas. The specific objectives of this study are as following:·To identify the levels of blood pressure for adults in midwestern rural areas of Shandong province;·To estimate the epidemic status of hypertension and high-normal blood pressure among rural residents in midwestern areas of Shandong province;·To analyze main risk factors of hypertension and provide scientific evidence for health policy and intervention measures for the research areas.·To analyze main risk factors of high-normal blood pressure and compare with risk factors of hypertension, consequently exploring a new mode for population surveillance and prevention of hypertension.[Methods] This study is a descriptive epidemiological study. Multi-stage stratified randomized sampling was used in this study. According to development levels of society, economy and geographic setting, Shanghe, Lingxian, Ningyang and Laicheng at county level were sampled in western rural areas of Shandong province; Shouguang, Guangrao, Yiyuan and Cangshan at county level were sampled in middle rural areas of Shandong province. To follow random sampling principle, two towns were randomly sampled in each county samples, and two villages were randomly sampled in each town samples. Systematic sampling was used according to the roster of head of a household in each village samples. All residents aged over 25 year-old in households sampled were investigation objects. All kinds of information were collected by interview, physical examination and laboratory detection in sampled residents.Multi-stage stratified randomized sampling was used in this study, which resulted in bolus structure for samples and unequale probability samples at each stage. So weighting statistic was used in this study.Analysis of variance or t-test was used for comparison of mean of systolic blood pressure (SBP) or diastolic blood pressure (DBP) among different groups. Countryside population data of the fifth population census was used for standardizing rates. Chi-square test was used for comparison of prevalence of high-normal blood pressure or hypertension among different groups. Chi-square trend test was used for trend analysis of prevalence. Single-factor and multi-factors Logistic regression analysis were used to explore risk factors of high-normal blood pressure and hypertension.[Results]1. The mean of SBP and DBP was 135mmHg and 84mmHg respectively in the target population. Both means of SBP and DBP were higher in men than that in women. Both means of SBP and DBP increased progressively with age for men and women. Compared with healthy population, the blood pressure was higher for the population of overweight, obesity, abdomen obesity or diabetes mellitus. Both means of SBP and DBP increased progressively with the growth of body mass index (BMI), waist or blood glucose.2. The standardized prevalence rate of hypertension were 37.8%, 40.8% in men and 34.8% in women. The prevalence rate of hypertension increased with age for men and women. The prevalence rate of hypertension for grade 1, 2 and 3 were 24.4%, 11.9% and 5.8% respectively. The prevalence rate of isolated systolic hypertension (ISH) was 14.4%. The prevalence rate of hypertension for different grades increased progressively with the growth of age.3. The standardized prevalence rate of high-normal blood pressure were 37.8%, 42.2% in men and 36.3% in women (P<0.01). The prevalence rate of high-normal blood pressure decreased with the growth of age above 35 year-old group. The population that both SBP and DBP were in the extent of high-normal blood pressure took the highest proportion in whole population of high-normal blood pressure, followed by the population that only SBP was in the extent of high-normal blood pressure, and the lowest one was the population that only DBP was in the extent of high-normal blood pressure.4. Multinomial Logistic regression analysis indicates that age, more quantity of drinking in everyday, BMI and waist were the common risk factors of high-normal blood pressure and hypertension. Family history of hypertension, diabetes mellitus (DM) and larger proportion of carbohydrate energized were also risk factors of hypertension. Female was one common protective factor of high-normal blood pressure and hypertension. In addition, more vegetable intake and more fruit intake in everyday were also protective factors of hypertension.5. The prevalence rate of coronary heart disease, DM, overweight and obesity increased with the growth of grade of hypertension. The prevalence rate of stroke and chronic obstructive pulmonary disease in hypertension group were higher than that in normal blood pressure group and high-normal blood pressure group. The main complication of self-report hypertension cases was stroke, followed by hypertensive heart disease, coronary heart disease, hypertensive nephropathy, and so on.[Conclusions]1. The mean of SBP and DBP was higher than the nationwide level, and it is the same with the prevalence rate of high-normal blood pressure. Timely and effective prevention measures played an important role in preventing healthy and sub-healthy people from becoming hypertension.2. The prevalence rate of hypertension was higher than the nationwide level for adults in midwestern rural areas of Shandong province. The prevalence rate of stroke and chronic obstructive pulmonary disease in hypertension group were higher, and hypertension has become the main public heath problem in the investigation areas. Obesity, DM and unhealthy behavior and life styles were the main risk factors of high-normal blood pressure and hypertension.[Suggestions]1. The health administrative authorities should take hypertension prevention and control strategies and measures for developing rural areas, including strengthening propaganda of hypertension prevention and control, advocating healthy behavior and life styles, establishing surveillance system of hypertension, DM and obesity, determinating different surveillance frequencies according to health levels and strengthening administration of hypertension patient to prevent cardio-cerebral vascular diseases and other complications.2. The health administrative authorities and medical service should pay more attention to high-normal blood pressure, and determinate surveillance frequency according to level of blood pressure and concomitance risk factors of cardio-cerebral vascular diseases, and strengthen propaganda that is mainly composed of change of behavior and life styles.
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