Hypertension Status And Its Association With Sleep Status In Middle-aged And Elderly People At High And Low Altitudes

Purposes:(1)To understand the prevalence of hypertension in middle-aged and elderly people,and to explore the direct and indirect pathways and effects of sleep on hypertension,so as to lay the foundation for further mechanism research;(2)To explore the pathway of sleep status on hypertension in high altitude and low altitude areas,and compare the difference of the pathway and effect of sleep status on hypertension in high altitude and low altitude areas,so as to provide reference for prevention strategies of hypertension and control of risk factors in different areas.Materials and Methods:The data of this Study were collected from the database of the China Health and Retirement Longitudinal Study(CHARLS),and the data of the 2015 national Longitudinal study were selected.The study variables mainly come from seven modules:(1)basic information;(2)Family;(3)Health status and function;(4)Medical care and insurance;(5)Work,retirement and pensions;(6)Income,expenditure and assets;(7)Physical examination(blood pressure,respiratory function,grip strength,balance ability,etc.),including the subjects’social demographic characteristics,lifestyle,sleep status,hypertension and other aspects of information.Based on previous research evidence,the hypothesis of this study was put forward,and a structural equation theoretical model was established for the correlation between sleep status and hypertension in middle-aged and elderly people,so as to explore the direct and indirect effects of sleep status on hypertension and the role of sleep status in the correlation between other factors and hypertension.On the basis of the fit degree of the total population structural equation model,the multi-group structural equation model was further used to compare the differences in model structure and path coefficient of the association between sleep status and hypertension in the middle-aged and elderly people with high and low sea,taking altitude as the grouping variable.Results:(1)A total of 12142 subjects were included in this study,including 11470 in the low-altitude group and 672 in the high-altitude group.Slightly more women than men(55.9%vs 44.1%).Age distribution:mainly 65～75 years old,3890 people,accounting for 32.0%;there were 3,624 people aged 75 or above,accounting for 29.8 percent;residential areas are mainly rural,with 8582 people,accounting for 70.7%;the marital status was mainly married,with 10382 people,accounting for 85.5%;the education level was mainly junior high school or below,with 10,692 people,accounting for 88.0%;the annual personal income is mainly concentrated in the range of 10,000～50,000(yuan),with 5,314 people,accounting for 43.8%.The results showed that the distribution of gender,age,residence,marital status,education level and annual personal income of the two groups were comparable(P<0.05).(2)The number of hypertensive patients in this study was 4731,with a prevalence rate of 39.0%.The prevalence of hypertension in the high-altitude group was 43.5%.The prevalence of hypertension in the low-altitude group was 38.7%.The results showed that there was a statistically significant difference in the prevalence rate between the high-altitude group and the low altitude group(~2=6.026,P=0.014).In terms of age distribution,the prevalence of hypertension increased gradually with the increase of age,and the prevalence trend was the same in the high and low altitude groups.In terms of gender distribution,the prevalence of hypertension in females was higher than that in males(43.0%vs 33.8%).The prevalence of hypertension in both men and women in the high-altitude group was higher than that in the low altitude group.The prevalence of hypertension decreased with the increase of sleep time.At the same time,the worse the sleep quality,the higher the prevalence of hypertension in the middle-aged and the elderly,the same trend in the high and low altitude groups;The prevalence of hypertension was lower in middle-aged and older adults who napped compared to non-nappers(49.9%vs31.6%).(3)Factors related to hypertension in high altitude population(P<0.05)included age,sex,smoking,alcohol consumption,vigorous activity,moderate physical activity,walking or walking,sleep duration,sleep quality,napping,BMI,depression.With the decrease of sleep duration,the proportion of hypertension increased gradually.As the quality of sleep decreased,the proportion of hypertension increased,with the highest proportion(73.4%)in those with"very poor"sleep quality.Factors associated with hypertension at low altitude(P<0.05)included sex,age,education,annual personal income(yuan),smoking,alcohol consumption,vigorous activity,moderate physical activity,walking or walking,sleep duration,sleep quality,napping,BMI,depression.The proportion of hypertension among smokers(46.7%)was higher than that among non-smokers(34.7%).With the decrease of sleep duration,the proportion of hypertension increased gradually.The worse the sleep,the higher the proportion of hypertension.(4)The structural equation model constructed in this study reached the fitting index and had good fit(GFI=0.994,AGFI=0.990,CFI=0.983,TLI=0.977,RMSEA=0.023).Sleep status had a negative effect on hypertension(β=-0.221,95%CI=-0.243,-0.199),indicating that the worse the sleep status,the higher the risk of hypertension in the middle-aged and elderly population.The direct effect of sleep status was-0.105,accounting for47.5%of the total effect.The indirect effect of sleep status was-0.116,accounting for52.5%of the total effect.According to the Bootstrap mediation effect test,the indirect effect was mainly mediated by physical activity,BMI and depression,and the mediating effect accounted for 42.24%,38.79%and 18.97%of the total effect.(5)The fitting index of the multi-group structural equation model constructed in this study reached the standard,indicating that the multi-group model constructed in this study was well fitted to the data under the grouping of altitude variables,and the model was acceptable between high and low altitude groups.The critical ratio test result,according to thea=0.05 inspection level,most of the path coefficient between high and low altitude group the difference was statistically significant.In the high-altitude group,the total effect of sleep status on hypertension was higher than that in the low altitude group(β_高=-0.257,β_低=-0.214),and the direct effect of sleep status on hypertension was-0.134,accounting for 52.1%of the total effect.In the low-altitude group,the direct effect of sleep status on hypertension was-0.100,accounting for 46.7%of the total effect.According to the Bootstrap mediation effect test,the indirect pathway of action of sleep status on hypertension was statistically significant in both groups(P<0.05).In the high-altitude group,the total indirect effect of sleep status on hypertension was-0.123,and the intermediate effect mediated by BMI accounted for 48.78%.In the low altitude group,the total indirect effect of sleep status on hypertension was-0.114,and the mediating effect mediated by physical activity accounted for the highest proportion(43.86%).Conclusions:(1)In this study,prevalence was significantly higher in the high-altitude group than in the low altitude group(43.5%vs 38.7%,P=0.014).It is suggested that we should pay more attention to the current situation of hypertension in high altitude area and put forward targeted prevention and control strategies according to the characteristics of hypertension.(2)Sleep status not only directly affects hypertension,but also indirectly affects hypertension through physical activity,BMI and depression;At the same time,sleep status is an important mediating variable in the network of influencing factors ofhypertension,suggesting that there is a complex correlation between sleep status and hypertension and its influencing factors,and attention should be paid to itscomprehensive effect on hypertension.(3)Sleep status had a greater effect on hypertension in people at high altitude compared with those at low altitude(β_高=-0.257,β_低=-0.214);At high altitude,sleep status had an indirect effect on hypertension mainly through BMI,while at low altitude,physical activity was the primary mediator between sleep status and hypertension.It is suggested that at high altitudes,the correlation between sleep status and BMI should be focused on the effect of hypertension,while at low altitudes,sleep status is closely related to physical activity.These results can provide ideas and hypotheses for the subsequent mechanism research.