| Hypertension is a systemic disease characterized by higher arterial hypertension, which always associated with the functional or organic changes of heart, blood vessels, brain and kidneys. The standard blood pressure recommended by World Health Organization (WTO) is:the normal systolic blood pressure in adult should be less than or equal to 140mmHg (18.6kPa), while the diastolic blood pressure should be less than or equal to 90mmHg (12kPa). Blood pressure measurements must be repeated to diagnose hypertension. The average diastolic blood pressure should at 90mmHg (12.0kPa) or more at least twice to make the diagnosis of hypertension. Hypertension, as a kind of cardiovascular diseases, is the most popular, and it is also a major public health problem in the worldwide. As is shown in the Nutrition and Health Survey Results of Chinese Residents in 2004, the prevalence of hypertension of people aged 18 or above was 18.8%, and the estimated number of patients was more than 160 million according to this survey. The prevalence and the number of patients of hypertension increased by 31% and 70 million respectively compared to 1991. In 1998, the death of residents in rural areas was mostly caused by cerebrovascular disease. More than one million people died of cerebrovascular disease every year. About five to six million patients survived, of which more than 75% were disabled, which brought a heavy burden to individuals, families and the society. While hypertension is a major risk factor for brain death. Meanwhile, high blood pressure is also the fuse of kinds of diseases, which increases the risk of coronary heart disease, heart failure and kidney disease. As part of the patients had no obvious clinical symptoms, hypertension, also known as human "invisible killer." Therefore, to raise the awareness of hypertension is extremely important to prevention and treatment of this disease. The factors for hypertension can be divided into genetic factors and environmental factors. Several studies have shown that age, high-salt diet, smoking, diabetes, family history of hypertension, body mass index may be associated with hypertension. We can reduce the incidence of hypertension through proper diet, quit smoking, control the blood-glucose and lower body mass index.The special geographical location, unique environmental factors as well as the inappropriate diet and lifestyle may create a unique epidemic characteristics of hypertension in islands. Yuhuan County, which located in the southeast coast of Zhejiang Province, is one of the 14 island counties in our country. The risk factors of hypertension in island regions still lack systematic research, so we choose Yuhuan County to carry out the study of risk factors for hypertension. Our study mainly focuses on the epidemic characteristics, the influence factors and the evaluation on the comprehensive intervention and management of hypertension in adults aged 35 years old or above in Yuhuan. On the basis of above studies, we also carried out a nested case-control study aims at the risk factors of hypertension. This research contains four parts as following:1. Epidemic characteristics of hypertension among residents aged 35 or above in Yuhuan County communityTo explore the prevalence and the control of hypertension in adults in Yuhuan, China. A cross-sectional study was carried out as a baseline study of Yuhuan Health Population Cohort study in all communities in Yuhuan County, Zhejiang Province, China. The results showed that among 125479 eligible subjects, the averages of systolic blood pressure and diastolic blood pressure were 130.7 ±19.4 mmHg and 76.0±10.4 mmHg, respectively, and there were higher average levels of systolic and diastolic blood pressure in male than in female significantly. The prevalence of hypertension was 29.1%(the age-standardized one was 25.9%). There was a statistical difference in gender on the prevalence, and before the age of 50, men had higher prevalences than women significantly and after that, it was reversed in gender differences. The prevalence varied over different age groups and increased as age statistically with the regardless of gender. The findings of this study suggested that the awareness proportion, the treatment proportion, the control proportion, and the control proportion of treated hypertensive of hypertension was 85.4%,60.2%, 24.4%, and 26.6%, respectively. The research suggested that hypertension was prevalent in adults aged 35 years old or above living in Yuhuan County, and further efforts are needed to improve reatment and control of hypertension in such population.2. A community-based survey on hypertensive influence factors among residents in Yuhuan CountyTo explore the prevalence and possible influence factors of hypertension among adults in Yuhuan, China. A cross-sectional study was carried out as a baseline study of Yuhuan Health Population Cohort in all 11 communities in Yuhuan County, Zhejiang Province, China. A total of 125479 subjects aged 35 years old or above participated in this study. The research suggested that the possible risk factors of hypertension were elder, non-farmer and alcohol drinking among the population from Yuhuan communities, and the protective factors were female and lower degree of education. The research suggested that the possible factors of hypertension were gender, age, occupation and alcohol drinking.3. The evaluation on the comprehensive intervention and management of hypertension in adults aged 35 years old or above in Yuhuan communitiesWe carried out a cross-sectional study as a baseline study of Yuhuan Health Population Cohort in all communities in Yuhuan County. Among 125479 participants aged 35 years old or above,37201 subjects were diagnosed as hypertensive with the comprehensive intervention and management on hypertension. The results showed that among 37201 hypertensive patients,36996 were eligible for this study. After the intervention, the averages of both their systolic blood pressure and pulse pressure were slightly higher than those before the intervention, while the averages of both their diastolic blood pressure and BMI were similar to those before the intervention. The treatment proportion and control proportion of hypertension were statistically increased by 6.2% and 1.3%, respectively. The proportion of smoking and drinking alcohol were respectively decreased by 1.4% and 2.5%, respectively. The results demonstrated comprehensive intervention and management on hypertension improved the hypertensive conditions of patients during a short period in communities of Yuhuan County.4. A nested case-control study on the risk factors of hypertension in adults aged 35 years old or above in YuhuanOn the basis of Yuhuan Health Population Cohort study in all communities in Yuhuan County, Zhejiang Province, we followed all the people who were not diagnosed as hypertension in above study. The method of blood pressure measurement was standardized. During this follow-up, we chose patients diagnosed recently as the group of case, while selected controls according to the same sex, age±5 years old and the same or similar residence matched 1:1 with the case from people who were not suffering from hypertension randomly. Univariate analysis showed that diabetes (OR=2.414, P=0.001), and overweight or obesity (OR=1.390, P= 0.021) were risk factors for hypertension; multivariate conditional Logistic regression showed that drinking (OR=1.429, P=0.042), diabetes(OR=2.462, P=0.009), and overweight or obesity (OR=1.346, P=0.045) were risk factors for hypertension, smoking (OR=0.558, P<0.001) may be a protective factor for hypertension; waist circumference, height and BMI may be associated with hypertension. The results suggested that alcohol consumption, diabetes, and overweight or obesity may be risk factors for hypertension among island residents, further research and monitor should be carried out to reduce the prevalence of hypertension. |
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