| As we all know,hypertension and its complications were harmful to human beings.However,the hypertension prevalence in China was high,while the awareness,treatment,and control rate were relatively low,thus making cardiovascular and cerebrovascular events significantly increasing.The accurate assessment of hypertension prevalence contributed to identifying the population prevalence,making a reasonable disease plan,and allocating medical resources rationally.However,the changes in the diagnostic criteria and different screening and measurement patterns of hypertension might have a certain impact on hypertension prevalence.The current study evaluated hypertension prevalence from different diagnostic criteria,different screening,and blood pressure measurement patterns.At the same time,the study discussed the traditional influencing factors of hypertension.Moreover,new reversible influencing factors of hypertension were explored,which helped reduce hypertension prevalence,take appropriate prevention and treatment measures,improve the prognosis of cardiovascular and cerebrovascular diseases.Part One Updated hypertension prevalence rate based on the 2017ACC/AHA Amercican high blood pressure guidelineObjectives:The American College of Cardiology/American Heart Association(ACC/AHA)updated the hypertension definition from140/90mm Hg to 130/80mm Hg according to the adult hypertension guideline for prevention,detection,evaluation,and management.The purpose of the current study was to investigate the hypertension prevalence with different diagnostic criteria to further evaluate the potential impact of the2017ACC/AHA high blood pressure(HBP)guideline on hypertension prevalence rate.Meanwhile,the study was to find hypertension influencing factors.Methods:The data was collected from the Physical Examination Centre of the Second Hospital of Hebei Medical University from January 2012 to December 2017.Demographic information,including age,sex,height,weight as well as the risk factors of hypertension such as the history of hyperlipidemia,diabetes,cardiovascular disease,cerebrovascular disease,respiratory system disease,smoking,alcohol consumption,and family history of hypertension were collected.The hypertension prevalence,awareness,treatment,and control rate were evaluated according to different guidelines,aiming to explore the potential impact of the 2017ACC/AHA HBP guideline on hypertension prevalence rate.Additionally,hypertension influencing factors were also explored.Results:According to the diagnostic criteria of 140/90mm Hg,hypertension prevalence,awareness,treatment,and control rate were 30.54%,44.33%,32.52%,and 13.04%respectively.However,when the 2017ACC/AHA HBP guideline was used,the population with hypertension increased from 20453 to 34460 and the hypertension prevalence rate increased from 30.54%to 51.45%,awareness rate decreased from 44.33%to 26.31%,treatment rate declined from 32.52%to 19.30%and control rate declined from 13.04%to 2.72%.Additionally,hypertension influencing factors were also explored.The multivariate logistic regression analysis demonstrated that male,elderly,overweight or obesity,history of hyperlipidemia,diabetes,cardiovascular disease,cerebrovascular disease,and family history of hypertension were identified as risk factors,recommended in 2018 ESC/ESH and 2017 ACC/AHA HBP guidelines(P<0.05).However,the most added diagnosed hypertension were young adults without a history of hyperlipidemia,diabetes,cardiovascular disease,and family history of hypertension(P<0.01).Conclusions:The diagnostic criteria of 130/80mm Hg will result in a substantial increase in prevalence rate.Meanwhile,the added diagnosed hypertension populations were mostly young low-risk population,thus making people seriously consider whether the 2017ACC/AHA guideline was applied.Part two The effect of one visit survey on hypertension prevalenceObjectives:At present,the hypertension prevalence was mainly surveyed by one visit,and the average blood pressure measured by one visit survey was considered to be representative of the real blood pressure level.However,the variation of blood pressure might lead to hypertensive prevalence overestimated.Meanwhile,there were few studies on the number and characteristics of overvalued people by one visit survey.On the other hand,the current guidelines recommend 24-hour ambulatory blood pressure monitoring(ABPM)for the diagnosis of hypertension.The purpose was to assess the effect of one visit survey on hypertension prevalence and compare the significance of one visit and daytime multiple visit survey in the diagnosis of hypertension by using daytime ambulatory blood pressure and one visit blood pressure measurement results.Methods:The study conducted an epidemiological survey of 1116people from January 2018 to December 2019.The professional doctors were trained to collect demographic information:basic information(name,age,and sex),hypertension-related histories(hyperlipidemia,diabetes,cardiovascular,cerebrovascular history),and family history of hypertension.Meanwhile,the height,weight,and other physical examination information were recorded and the liver,kidney function,blood lipid,blood glucose,and other blood indexes were tested.The blood pressure was measured in the pattern of ABPM and one visit survey respectively.The study evaluated the effect of one visit survey on hypertension prevalence and compare the significance of one visit and daytime multiple visit survey in the diagnosis of hypertension by using daytime ambulatory blood pressure and one visit blood pressure measurement results.At the same time,the study analyzed the characteristics of the overestimated population in one visit survey.Besides,the study explored the predictive value of blood pressure level in one visit survey to true positive hypertension.Results:The mean value of blood pressure in one visit survey was about8 mm Hg higher than that in daytime multiple visit survey.Meanwhile,the hypertension prevalence in one visit and daytime multiple visit survey was29.84%and 14.07%respectively.The hypertension prevalence in the one visit survey was significantly higher than in daytime multiple visit survey.The hypertensive prevalence was likely to be overestimated by one visit survey.The risk factors of overestimated population was female,BMI<24.00 kg/m~2and DBP<100mm Hg(OR=2.42,95%CI:1.33-4.41,P<0.01;OR=2.55,95%CI:1.37-4.77,P<0.01;OR=20.11,95%CI:4.32-93.64,P<0.01).At the same time,the positive predictive value of one visit survey to hypertension was 36.34%.Furthermore,ROC analysis was used to evaluate the predictive value of blood pressure for true positive hypertension.The results showed that,in the male population,the area under the curve of systolic blood pressure was0.65(0.58-0.73),and the best diagnostic threshold was 147.50 mm Hg(sensitivity was 49.43%,specificity was 81.08%).The area under the curve of diastolic blood pressure was 0.80(0.74-0.86)and the best diagnostic threshold was 95.50 mm Hg(sensitivity was 68.97%,specificity was 81.98%).However,in the female population,the systolic and diastolic blood pressure in one visit survey had no significant predictive value for true positive hypertension(P>0.05).Conclusions:The mean value of blood pressure in one visit survey was about 8 mm Hg higher than that in daytime multiple visit survey and the hypertension prevalence was likely to twice as overestimated in one visit survey.Most of the overestimated people were female with DBP<100mmhg and normal BMI.Besides,the positive predictive value of hypertension in one visit survey was low.In the male population with hypertension by one visit survey,the diagnostic threshold should be raised to 148/96mm Hg to better diagnose true positive hypertension.However,in the female population,the blood pressure in one visit survey had no significant predictive value for true positive hypertension.Therefore,it was necessary to further monitor ABPM to determine whether there was hypertension.Part three Simple renal cyst was an independent risk factor for hypertensionObjectives:Hypertension was the main cause of cardiovascular and cerebrovascular diseases,whose complications were seriously harmful to human health.Therefore,finding out reversible hypertension risk factors was important to improve the prognosis of cardiovascular and cerebrovascular diseases.Meantime,the simple renal cyst was common kidney disease.However,the relationship between simple renal cyst and hypertension was not clear at present.The study was aimed to explore the relationship between simple renal cyst and hypertension to find out the reversible risk factors of hypertension,thus making the prevalence decline and further improving the prognosis of cardiovascular and cerebrovascular diseases.Methods:In this study,there were a total of 66883 participants in the Physical Examination Centre of the Second Hospital of Hebei Medical University from January 2012 to December 2017.The professional doctors and nurses were trained to collect information on the physical examination subjects.The information included as follows:demographic information(name,age,sex,height,weight,systolic blood pressure,and diastolic blood pressure,etc.),the related hypertension risk factors(history of hyperlipidemia,diabetes,cardiovascular,cerebrovascular,smoking,drinking,etc.),blood biochemical indexes and whether with hypertension or simple renal cysts.The overall population was separated into hypertension group and non-hypertension group according to the dependent variables of hypertension and the renal cysts group and non-renal cysts group according to the independent variables of simple renal cysts.The relationship between simple renal cysts and hypertension were analyzed with univariate analysis,multivariate regression analysis in different models,subgroup analysis,and propensity matching.Moreover,the populations with renal cysts were divided into the single side and both sides'renal cysts groups,small and large renal cysts groups,unitary and multiple renal cysts groups to further explore the relationship between the subtypes of renal cysts and hypertension respectively.Meanwhile,according to the subtype characteristics of renal cyst,a comprehensive scoring system was established to explore the effect of renal cyst load on hypertension.Results:1.The univariate analysis of the relationship between renal cyst and hypertension revealed that renal cyst was a risk factor for hypertension(P<0.01);2.The multivariate regression analysis was used to explore the relationship between renal cyst and hypertension in the unadjusted model,the minimally adjusted model,and the fully adjusted model respectively.The results showed that renal cyst was a risk factor for hypertension in the three models(OR=2.60,95%CI:2.46-2.76,P<0.01;OR=1.31,95%CI:1.23-1.40,P<0.01;OR=1.32,95%CI:1.23-1.41,P<0.01).3.The results of subgroup analysis showed good consistency in each subgroup stratification(Interaction P>0.05),and the renal cyst was an independent risk factor for hypertension in each stratification.4.The propensity matching was used to balance the baseline and the result showed that renal cyst was still an independent risk factor for hypertension after propensity matching(OR=1.22,95%CI:1.13-1.32,P<0.01).5.The relationship between the subtypes of renal cysts and hypertension was also studied in the renal cysts population,and the results confirmed that both sides'renal cysts,large cysts,and multiple cysts were all risk factors for hypertension(OR=1.37,95%CI:1.14-1.66,P<0.01;OR=1.16,95%CI:1.00-1.34,P<0.05;OR=1.37,95%CI:1.16-1.61,P<0.01).Meanwhile,according to the characteristics of renal cyst subtypes,a comprehensive scoring system was established to explore the effect of renal cyst load on hypertension.The results between the scores and hypertension showed that the hypertension risk increased with the increase of renal cyst load.Conclusions:The simple renal cyst was an independent risk factor for hypertension.Moreover,there was a positive correlation between renal cyst load and hypertension.The hypertension risk increased gradually with the increase of cysts size,number,and location.These findings may provide a theoretical basis for finding and rectifying the reversible cause of hypertension.Part four The relationship between monocyte to HDL-C cholesterol ratio and hypertensionObjectives:Hypertension,as the main risk factor of cardiovascular and cerebrovascular diseases,was a serious threat to human health.Early identification of the hypertension risk factors was important to improve the prognosis of cardiovascular and cerebrovascular diseases.However,there were no many serum markers for evaluating the severity of hypertension at present.The study aimed to explore the association of monocyte to high-density lipoprotein cholesterol ratio(MHR)with hypertension to evaluate the value of MHR in the diagnosis and treatment of hypertension.Methods:All data was selected from the Physical Examination Centre of the Second Hospital of Hebei Medical University(N=7565).All participants were measured with blood pressure and blood biochemical index tests.Data included demographic information(name,age,sex,height,weight,systolic blood pressure,and diastolic blood pressure,etc.),clinical related information(history of hyperlipidemia,diabetes,cardiovascular,cerebrovascular disease,smoking,alcohol consumption,and hypertension family history)and MHR.Hypertension was the dependent variable and MHR was the independent variable.According to quartiles cut-off points,the MHR were divided into four groups:MHR<4.72,4.72?MHR<6.36,6.37?MHR<8.68,MHR?8.69.The relationship between MHR and hypertension was explored in different ways.Results:1.The univariate analysis of the relationship between MHR and hyperte-nsion demonstrated that MHR was a risk factor for hypertension(P<0.01);2.The multivariate regression analysis was used to explore the relationship between MHR and hypertension in the unadjusted model,the minimally adjusted model,and the fully adjusted model respectively.In all models,MHR was presented as categorical variables,continuous variables,and standardized continuous variables.MHR,as categorical variables,proved to be a risk factor for hypertension in the unadjusted model,the minimally adjusted model,and the fully adjusted model(OR=2.25,95%CI:1.96-2.58,P<0.01;OR=1.88,95%CI:1.60-2.20,P<0.01;OR=1.27,95%CI:1.06-1.52,P<0.01).MHR,as continuous variables and standardized continuous variables,was also identified as a risk factor for hypertension in all models(P<0.05).3.Smooth function analysis of generalized additive model showed that MHR and hypertension showed a continuous linear positive correlation(P<0.05).And the linear positive relationship continues throughout all MHR data without threshold and saturation effect(P=0.565).4.The subgroup analysis showed that MHR was an independent risk factor of hypertension in each stratification and the positive correlation between MHR and hypertension showed good consistency in each subgroup stratification(Interaction P>0.05).Conclusions:MHR was likely to predict the risk of hypertension independently.And there was a continuous linear positive correlation between MHR and hypertension,which continues through all data of MHR.These findings might provide an easily available and inexpensive index for early prediction and diagnosis of hypertension. |
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