The Relationship Between Reproductive Factors And Three Hypertension Subtypes In Women Of Child-bearing Age In The Rural Areas Of Shandong

BackgroundHypertension is the most important risk-factor of cardiovascular disease (CVD). The main complications of hypertension harm people’s health in China seriously. Therefore the prevention and control of it should become the preferred public health problem in China. There are three subtypes in hypertension, including isolated systolic hypertension(ISH), isolated diastolic hypertension (IDH). and systolic-diastolic hypertension (SDH). Researches showed that all subtypes of hypertensions can increase the risk of CVD. However, even high-normal blood pressure (BP) level (stages of pre-ISH, pre-IDH and pre-SDH) can lead to risks of CVD and stroke. Women are at high risk of hypertension. Data showed that it was far higher for the prevalence of hypertension in menopause, the proportion of CVD and stroke leaded by hypertension, and the rates of heart attack deaths before age50in women than men in the same period. Previous studies showed that reproductive factors such as age of menarche and reproductive years were all associated with CVD, stroke and diabetes (DM). Nonetheless, there is deficiency in the research of relationship between reproductive factors and hypertension. Moreover, pathogenesis of reproductive factors in hypertension is still not clear. The age of subjects in former researches is after menopause or including perimenopause, so the fluctuation of the level of estrogen and weight, blood glucose and blood lipid. as confounding factors, will affect conclusions. On account of that, it contributes to avoiding confounding bias and accessing to what extent reproductive factors of child-bearing age women can affect the risk of CVD by circumscribing subjects in child-bearing age.ObjectiveTo explore the association between reproductive factors of child-bearing period and hypertension and pre-hypertension of three subtypes, in order to assess the risk of subtypes in child-bearing age women, and to provide the scientific basis to establish the prevention and treatment strategies.Methods:This study is based on the baseline survey of chronic disease cohort study leaded by school of public health in Shandong University, using random cluster sampling method to collect rural residents in17natural villages of three cities (Jvnan, Liangshan and Pingyin) of Shandong including questionnaire survey, physical examination and serologic test, etc. Multiple logistic regression analysis and other statistical methods were used to evaluate the relationships between reproductive factors and three subtypes.Results1. The prevalence of hypertension was16.61%. The prevalence of three subtypes were3.86%in ISH,5.75%in IDH, and7.00%in SDH respectively.2. The analysis of association between demographic characteristics and serum indexes and three subtypes of hypertension Results showed that demographic characteristics including age, occupation types, cultural level, marital status and body mass index (BMI) were significant difference among three subtypes of hypertension. Serum indexes such as fasting plasma glucose (FBG), fasting total serum cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c) were significant difference among three subtypes of hypertension. Single-factor logistic regression analysis showed that all confounders were associated with hypertensive and prehypertensive levels of three subtypes accepted for HDL-c.3. The analysis of association between reproductive factors and three subtypes of hypertension.4. After adjusted demographic characteristics and serum indexes respectively or at the same time, the relationships between single reproductive factors and hypertension were that early/late age at menarche, early age at first full-team pregnancy, gravid ity, parity number of children, number of reproductive years, age at first marriage, and menstrual period may be all associated with three subtypes. Multi-factors logistic regression analysis showed that late age at menarche is a risk factor of pre hypertensive levels of three subtypes and SDH. Number of reproductive years and menstrual period were risk factors of SDH.In the1SH group, after adjusted with demographic characteristics, the risk association between early menarche and pre-ISH, age at first marriage and ISH are significant. Early age at first full-team pregnancy, gravidity, parity and number of children are protective factors for ISH. After adjusted with serum indexes, late menarche. gravidity, parity and number of children, and number of reproductive years may be risk factors of ISH or pre-ISH. Menstrual period and menstrual cycle may be protective factors of ISH and pre-ISH respectively. The result of mutli-factors model including all reproductive factors and confouders showed that late age at menarche was a risk factor of pre-ISH, and OR(95%CI) was1.55(1.07,2.25).In the IDH group, after adjusted with demographic characteristics, late menarche, early age at first full-team pregnancy, gravidity, parity, number of children, number of reproductive years may be risk factors of IDH/pre-IDH. Age at first marriage may be a protective factor for IDH. After adjusted with serum indexes, late menarche. early age at first full-team pregnancy, gravidity, parity, number of children,and number of reproductive years may be risk factors of IDH/pre-IDH. Age at first marriage may be a protective factor of IDH. The result of mutli-factors model including all reproductive factors and confouders showed that late age at menarche was a risk factor of pre-IDH, and OR(95%CI) was1.61(1.10.2.35).In the SDH group, after adjusted with demographic characteristics, number of reproductive years and menstrual cycle may be risk factors of SDH/pre-SDH. Early age at first full-team pregnancy, gravidity. parity and number of children may be protective factors for SDH. After adjusted with serum indexes. late menarche, early age at first full-team pregnancy, gravidity, parity, number of children,and number of reproductive years may be risk factors of SDH or pre-SDH. The result of mutli-factors model including all reproductive factors and confouders showed that late age at menarche, number of reproductive years, and menstrual cycle were risk factors of SDH, and late age at menarche was also assiciated with pre-SDH, and OR(95%CI) were2.69(1.49,4.86),1.70(1.13.2.56).1.21(1.07,1.37) and1.14(1.00,1.30) respectively.Conclusion1. Reproductive factors were associated with the three subtypes of hypertension in rural women of child-bearing age, which suggested that reproductive factors affected the risk of hypertension in rural women of child-bearing age. After adjusted with different confounding factors, the inconsistency of the relationships between reproductive factors and three subtypes of hypertension suggested that reproductive pathogenic mechanisms of three subtypes of hypertension might have heterogeneity.2. Age at menarche was associated with BP and all the three subtypes of hypertension. Late menarche(^18years) was a risk factor of pre-ISH, pre-iDH, SDH, and pre-SDH respectively.3. Number of reproductive years was in risk of three subtypes of hypertension.4. Single-factor analysis shows that among demographic characteristics, age, and BMI were important risk factors of three subtypes of hypertension. Serum indexes (TC and TG) were important risk factors of three subtypes of hypertension. HDL-c was a important protective factor of ISH, IDH, pre-IDH and pre-SDH respectively.