A Retrospective Study Of The Effect Of Hypertension Related Risk Factors On The Progression Of Hypertension

BackgroundA rapid increase in prevalence of hypertension has been suggested in several nationwide surveys and some regional studies across the last three decades.Studies pointed out that hypertension and its complications caused 2.5 million deaths in China in 2013,accounting for 14.2%of total disability adjusted life years.A large number of domestic and foreign research data pointed out that age,resting heart rate,overweight or obesity,dyslipidemia,hyperuricemia,impaired fasting glucose,decreased renal function and other risk factors are involved in the progress of hypertension and they may the independent risk factors of hypertension.Effective control of hypertension,thereby reducing blood pressure in patients with hypertension,can significantly reduce stroke and heart disease events,significantly improve the quality of life of patients and effectively reduce the burden of disease.In recent years,it has been found that adjusting one or more of these risk factors or maintaining a healthy lifestyle can reduce the incidence of hypertension.Therefore,we must emphasize the prevention and reduction of the hypertension-related risk factors of hypertension.In our country,many epidemiological studies have pointed out that overweight or obesity is an independent risk factor of hypertension and hypertension to occur in combination with other risk factors,however,fewer epidemiological studies from southern China about hypertension and most of the related studies on combining multiple risk factors are cross-sectional studies,which do not reveal the time relationship between risk factors and hypertension.This study retrospectively analyzed the impact of hypertension-related risk factors on the progression of hypertension in non-hypertensive subjects.This study is divided into two parts:Chapter ? Impact of different body mass index on the progression to hypertension in non-hypertensive populationObjectives To investigate the impact of different body mass index on the progression to hypertension in non-hypertensive population.Methods Subjects who participated in annual physical examination and completed at least 2 times were selected,and they were divided into low weight group(BMI<18.5),normal weight group(18.5?BMI<24),overweight group(24<BMI<28)and obesity group(BMI>28)according to the baseline BMI.The clinical features and the incidence of hypertension were compared among four groups.According to the different blood pressure at baseline,the subjects were divided into normal blood pressure group and high-normal blood pressure group,multivariate Cox regression was used to analyze the effect of BMI at different blood pressure at baseline on the progression of hypertension.Results(1)23665 non-hypertensive subjects at baseline were enrolled.A total of 2502 subjects developed hypertension after a mean follow-up of 3.6 years.(2)The incidence of hypertension increased from low weight group to obesity group and were 2.80%,6.41%,17.88%,27.84%in low weight group,normal weight group,overweight group and obesity group,respectively.(3)Mutivariate Cox regression analysis showed that the risk of hypertension increased from normal weight group to obesity group after adjusted for other confounding factors.The risk of hypertension in overweight group and obesity group were 1.22 times and 1.35 times higher than normal weight group.This trend of increasing risk of hypertension from normal weight group to obesity group exists both in the normal group and the high normal group.Conclusions The incidence and the risk of hypertension increase with increment of baseline body mass index.Chapter ? Effect of clustering of hypertension related risk factors on the progression of hypertensionObjectives This study aimed to develop a risk score composited of 7 risk factors-age,resting heart rate,overweight or obesity,dyslipidemia,hyperuricemia,impaired fasting glucose,eGFR,and to evaluate the relation between this score and hypertension incidence.Methods:A total of 23,665 people who participated in at least 2 annual physical examinations between 2011 and 2016 were included.Cox proportional hazards model was used to evaluate the relation between accumulative score and the risk of developing hypertension.Results(1)Age?45 years old,resting heart rate>80 beats/minute,overweight or obesity,dyslipidemia,hyperuricemia,impaired fasting glucose regulation and eGFR<90ml/min/1.73m2 are all risk factors of incident hypertension.(2)The risk of hypertension increased progressively with the increase of accumulative score,the multivariable adjusted hazard ratios(95%confidence interval)for incident hypertension comparing participants with 2,3 and>4 points versus 0 point were 1.61(1.29-2.02),2.05(1.67-2.57),and 2.77(2.22-3.46),respectively(P trend<0.001).This association was consistent after stratification by sex.Conclusions:There was a strong,gradient relation between increased accumulative score and higher risk for incident hypertension.