Survey Of Prehypertension With Impaired Glucose Metabolism In Elderly Peoples In Tianjin

Background:In2003, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) have proposed the term of "prehypertension", referred to the systolic blood pressure of120-139mmHg and/or diastolic blood pressure of80-89mmHg, which is a precursor of clinical hypertension. Prehypertension is the early stage of clinical hypertension and blood pressure related cardiovascular events, with a high prevalence, it has an increased risk of clinical hypertension and increases the risk of cardiovascular events. Hypertension and diabetes are common diseases of the elderly and often co-existing, there are40%to50%of diabetic patients with hypertension, and in recent years, studies have found that hypertension often coexisted with impaired glucose metabolism. Studies have also shown that impaired glucose metabolism already existed in prehypertension population. Euro Heart Study showed that, only FPG will missed about2/3of impaired glucose metabolism patients."China Heart Survey" showed that, the overall prevalence of impaired glucose metabolism in hospitalized patients with coronary heart disease was76.9%, if not have OGTT, and depend only on FPG test,87.4%of IGT and80.5%of diabetes patients will be missed.Objectives:To learn more about prehypertension and impaired glucose metabolism, this study investigated and analyzed the elderly population with undiagnosed hypertension of six districts of the Tianjin city in China.Method:Using natural sampling method, six communities were selected in Tianjin area from Mai2011to Mai2012. All participants40-70year old with undiagnosed hypertension completed a detailed questionnaire and underwent anthropometric measurements. Divided into two group, prehypertension group and normal blood pressure (normotension) group using2010, Chinese guideline of hypertension and treatment diagnosis criteria:No used of antihypertensive medication, systolic blood pressure<120mmHg and diastolic blood pressure<80mmHg diagnosed as normal blood pressure, systolic blood pressure of120～139mmHg and/or diastolic blood pressure80～89mmHg as prehypertension. Used the World Health Organisation standars WHO/IDF2006, to detect Fasting Serum Glucose (FPG) and2-hour Oral Glucose Tolerance Test (OGTT2hPG) level in participants:Diabetes Mellitus was diagnosed as FPG≥7.0mmol/L and/or2h glucose (OGTT2hPG)≥11.1mmol/L; Impaired Fasting Glucose (IFG):6.1mmol/L<FPG<7.0mmol/L and OGTT2hPG<7.8mmol/L; Impaired Glucose Tolerance (IGT):7.8mmol/L<OGTT2hPG<11.1mmol/L and FPG<6.1mmol/L. We used SPSS software version17.0to investigate the relation between prehypertension and other related clinicopathological factors, measurement data were expressed as mean±standard deviation(x±s), One-Way ANOVA variance analysis for multiple comparisons, Chi-squared tests for categorical variables, t-tests for continuous variables were performed in this study. P<0.05was considered statistically significant.Result:In612subjects with prehypertension (205men,407women) mean age (57±6.8) years old,223subjects have impaired glucose metabolism,108have DM,20have IFG,84have IGT and11have IFG+IGT; in431subjects with normotension (69men,362women) mean age (54±6.6) years old,102subjects have impaired glucose metabolism,41have DM,5have IFG,42have IGT and14have IFG+IGT. The detection rate of prehypertension with impaired glucose metabolism was37.61%. The detection rate of impaired glucose metabolism in prehypertension group was higher than in normotensive group(37.61%vs24.76%, P=0.000χ2=18.34); The detection rate of DM in prehypertension group was higher than in normotensive group(18.21%vs9.95%, P=0.000χ2=16.35); the detection rate of IGT in prehypertension group was higher than in normotensive group(14.17%vs10.19%, P<0.05χ2=6.49); and the detection rate of IFG in prehypertension group was higher than in normotensive group(3.37%vs1.21%, P<0.05χ2=6.39). Men had high rate of prehypertension in different ages group than women, among40-44years,45-49years,55-59years,60-64years age group, and the difference was statistically significant (P<0.05). Detection rate of prehypertension increased with increasing ages in women, the difference was statistically significant (P<0.05); Between40-70years old ages group there is no difference between men and women in detection rate of impaired glucose metabolism. Detection rate of impaired glucose metabolism increased with increasing ages in women, the difference was statistically significant (P<0.05); there was no linear relationship in men. SBP, BMI, waist-to-hip ratio, TG, LDL-c and UA level were higher in impaired glucose metabolism with prehypertension group than with normotension group, while HDL-c was lower than normotension group, the difference was statistically significant (P<0.05). In915subjects with no history of DM, impaired glucose metabolism was detected in195and85subjects with easy OGT Test and FPG respectively. Easy OGT Test detection of impaired glucose metabolism rate was21.31%, higher than FPG detection rate9.29%(P<0.05,χ2=111.00). Only used FPG, will be missed diagnosis of impaired glucose metabolism in110patients (56.41%).Conclusion:1. There is a high detection rate of impaired glucose metabolism included DM, IGT, and IFG in prehypertensive than in normotensive.2. Only used FPG will be missed diagnosis of impaired glucose metabolism patients of56.41%, prehypertension population should have easy OGT test.3. When impaired glucose metabolism appeared in prehypertension population, it associated with cardiovascular risk factors such as obesity and hyperlipidemia.4. Detection rate of prehypertension and impaired glucose metabolism increased with increasing age in elderly women population, but men did not have such law.5. Elderly men population had higher detection rate of prehypertension than women, there is no difference in detection rate of impaired glucose metabolic.