| [Objective]To investigate and analyze prevalence of hypertension and influencing factors in individuals with aged 65 years or older in Fuzhou community and to build a hypertension hazard prediction model which suits the local public. The study of the correlation between related genes of vasoconstriction pathways and the prevalence and control of essential hypertension is further researched with the basic data, so that to analyze the “gene-gene” and the “environment-gene” interaction of essential hypertension. Researching influencing factors of BP control in the aged who have hypertension, we can offer a scientific evidence for the prevention and control of essential hypertension among the local elderly. [Method]1. The research was divided into two parts. Existing circumstances research was the first part. With the method of two-stage random sampling, the respondents were surveyed by one questionnaire and certain scales so that we can analyze the prevalence of hypertension. Second part was case-control study. We used non-condition logistic regression analysis, crossover analysis and classification tree model to analyze factors of disease and their interaction. The model was built by C5.0 decision tree algorithm for hazard predicting.2. According to population proportion in community, in each group, we randomly took 109 samples’ DNA which was extracted from karyocyte of peripheral blood to test the genotype of polymorphic loci with LDR. We used non-condition logistic regression analysis and crossover analysis to analyze the relevance of genetic polymorphism and the disease, and the interaction of “environment-gene” and “gene-gene”.3. Based on blood pressure control, in case part, we divided into two groups, well control and poor one. Then non-conditional logistic regression analyses, crossover analysis and classification tree model were applied to analyze factors of blood pressure control and their interaction. [Results]1. The study manifested that the prevalence rate of hypertension in elderly aged 65 years or older was 63.6%(95%CI, 61.5%-65.7%), and standardized one was 63.4% in the community of Fuzhou.2. There was different rate between overweight and obesity. The former took up 40.7%, the latter was 11.5% which abdominal obesity reached 65.7% in the elderly population of the community. And total cholesterol abnormality accounted for 53.8%. In terms of the aged who had hypertension, male diastolic blood pressure was higher than female, while male pulse pressure and systolic were lower than female(P<0.05). Increased with age, diastolic pressure became lower and pulsing started to rise(P<0.05).3. Obesity(OR=3.47; 95%CI, 1.70 to 7.06), abdominal obesity(OR=1.84;95% CI,1.20 to 2.83), monthly income over 3000 Yuan(OR=2.36; 95% CI,1.14 to 4.90), smoking(OR=2.61;95% CI,1.35 to 5.04), drinking(OR=1.94; 95% CI,1.06 to 3.55), lacking of exercise(OR=16.76; 95%CI,10.40 to 27.03), salty preference(OR=3.06; 95%CI,2.02 to 4.63), type A personality(OR=2.20; 95% CI,1.54 to 3.14), and a family history of hypertension(OR=3.75; 95%CI, 2.60 to 5.41) were dangerous factors for elderly population to have hypertension, and among which the family history of hypertension and the abdominal obesity, family history of essential hypertension and salty preference, and abdominal obesity and type A personality had additive interaction on essential hypertension, but multiplicative interaction had not been found yet.4. A hypertension hazard prediction model for the elderly in Fuzhou community was built by C5.0 decision tree algorithm. In the training data, the coincidence between predicted category and actual one was 80.0%, and sensitivity was 75.8%, and specificity was 83.8%; in the testing data, there were 74.0%, 71.8%, and 78.3% in sequence.5. Male group who had this condition would be increased hazard by carrying the T allele or type CT of kcnmb1/E65K; but the relation between kcnmb1/E65 K and female had not been found yet, and either does the relation between enos/G894 T, bdkrb2/-58T/C and hypertension. In dominant inheritance, diastolic pressure of patient who carried CT+TT genotype of kcnmb1/E65 K gene was lower than CC genotype; the pulse pressure diastolic pressure of patient who carried CT+TT genotype of kcnmb1/E65 K gene was higher than CC genotype. The protective factor of BP control in population who had hypertension may be CT+TT genotype of bdkrb2/-58T/C gene(OR =0.30; 95%CI,0.110-0.830).6. In terms of susceptibility of essential hypertension, the effect of kcnmb1/E65 K, enos/G894 T and bdkrb2/-58T/C towards independent and the koinonia between genes, 7the multiplicative interaction, and the additive interaction had not been discovered yet. There was negative multiplicative interaction between bdkrb2/-58T/C gene and abdominal obesity, but the additive interaction of which did not exist. Multiplicative interaction or additive interaction had not been discovered in kcnmb1/E65 K and enos/G894 T gene and abdominal obesity. Multiplicative interaction or additive interaction could not be found between kcnmb1/E65 K, enos/G894 T and bdkrb2/-58T/C gene and type A behavior. Multiplicative interaction or additive interaction had not been discovered in kcnmb1/E65 K, enos/G894 T gene and bdkrb2/-58T/C gene and exercising.7. The group that controlled BP poorly had higher prevalence rate of the total complication, cardiac complication, and cerebrovascular complication than the group that controlled BP well(P<0.05). The total points of the living quality of the former group and the score of its each category were both lower than the latter group(P<0.05).8. Poor BP control was dangerously influenced by salty preference(OR=1.89; 95%CI,1.02 to 3.49), the course lasting over 15 years(OR=2.51; 95%CI,1.55 to 4.06), grade 3 hypertension(OR=3.19; 95%CI,1.75 to 5.79), lacking of monitoring BP(OR=2.22; 95%CI,1.06 to 4.64), refusing medicine(OR=16.39; 95%CI,3.52 to 76.28), and poor medication compliance(OR=4.10; 95%CI,2.10 to 8.00). Among these, the condition of BP monitoring and medication compliance had multiplicative interaction towards BP control, but additive interaction did not exist. Multiplicative interaction or additive interaction could not be found between condition grade and its duration. [Conclusion]1. The prevalence rate of hypertension among the elderly aged 65 years or older is 63.6% in Fuzhou community. Obesity, abdominal obesity, monthly income over 3000 Yuan, smoking, drinking, lacking of exercise, salty preference, type A personality, and a family history of hypertension are dangerous factors for elderly people to have hypertension. The interactions which exist between factors cannot be ignored. Abdominal obesity, salty preference could increase the risk for elderly people with a family history of hypertension to have hypertension, and abdominal obesity could also increase the risk for the aged with type A personality to have hypertension. Attention should be paid to the BP monitoring of high-risk population, and personalized intervention should be done.2. The hypertension hazard prediction model for the elderly in community of Fuzhou built by C5.0 decision tree algorithm has coincidence, sensitivity, and specificity that were all over 70 percent. The model has a well predictive effect and can be used in preliminary screening of the local high-risk population of hypertension.3. The Polymorphism of kcnmb1/E65 K gene may have relation with the susceptibility of essential hypertension in the male elderly; which of bdkrb2/-58T/C may have relation with the blood pressure control condition of essential hypertension group. The aged who carries adverse genotype or allele should regulate the daily behavior more, especially improve abdominal obesity, and pay attention early to prevention and control of hypertension.4. In the aged with essential hypertension, the poor control of blood pressure has close relation with cardiac complication and cerebrovascular complication. People who poorly control their blood pressure have lower living quality than those controls well. We draw a conclusion that poor BP control is influenced by the course lasting over 15 yrs, grade 3 hypertension, lacking of monitoring BP, salty preference, refusing medicine, and poor medication adherence. Lacking of monitoring BP with refusing medicine and poor medication adherence could increase the risk of patients to control BP poorly. Thus, standardized management of hypertension patients should be enhance, especially the management of monitoring BP and medication adherence. Then personalized therapy for individuals and comprehensive prevention and control for the group should be put forward, so that complications could be reduced, and living quality of patients could be actively improved. |
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