Epidemiological Study On Prehypertension And Target Organ Damage

Background: Hypertension,which can cause damage to the heart,kidney,blood vessels,and other important target organs,is the most common cardiovascular disease.There are significant differences in the definition of prehypertension in different hypertension guidelines,and there are also great differences in the recommendation of intervention for prehypertension.At present,it is not clear whether target organ damage will occur in prehypertension.Objective: This study aims to study the prevalence,clinical characteristics,and target organ damage of prehypertension in a general Chinese population.Methods: Residents ≥ 18 years old in a community in Dali were invited to participate in this study from September to November 2018,and all participants signed informed consent.Participants were excluded if they could not complete pulse wave velocity detection or echocardiography examination.A total of 721 participants were included for the final statistical analysis.A standardized questionnaire was used to collect information about age,smoking,drinking,medication,past medical history,and the participants’ family history.All participants measured height,weight,hip circumference,waist circumference,etc.,and calculated body mass index(BMI).Mercury sphygmomanometer was used to measure the sitting blood pressure five times on the non-dominant arm,and the average value was used for statistical analysis.The participants’ fasting venous blood was collected to detect blood glucose,glycosylated hemoglobin,liver function,renal function,lipid profile,and other indexes.The morning spot urine of the participants was collected to detect the ratio of microalbuminuria to creatinine(UACR).Brachial-ankle pulse wave velocity(ba PWV)and carotid-femoral pulse wave velocity(cf PWV)were measured by the VP-2000 system Sphygmo Cor XCEL system respectively.The central arterial pressure was converted by an algorithm combined with peripheral artery waveform.Left ventricular ejection fraction(LVEF)and left ventricular mass index(LVMI)were measured by echocardiography.Prehypertension was defined by the 2018 Chinese hypertension guidelines(defined as a systolic blood pressure 120-139 mm Hg and/or diastolic blood pressure 80-89 mm Hg)and the 2017AHA/ACC guidelines(prehypertension defined as a systolic blood pressure 120-129 mm Hg and diastolic blood pressure <80mm Hg).The SAS 9.3 was used for data management and statistical analysis.Results:1.The 721 participants included 470 women(65.2%).According to the 2018 Chinese hypertension guidelines,the prevalence of prehypertension was 32%,and the prevalence of hypertension was 24%,of which 80.9% received antihypertensive treatment.According to the 2017 AHA/ACC guidelines,the prevalence of prehypertension was 7%,and the prevalence of hypertension was 48.8%,of which39.8% received antihypertensive treatment.Whether defined by the 2018 Chinese hypertension guidelines or the 2017AHA/ACC guidelines,the prevalence of smoking,drinking,and diabetes in patients with prehypertension were significantly higher than in participants with normal blood pressure(P<0.05).2.Whether defined by the 2018 Chinese Hypertension guidelines or the2017AHA/ACC guidelines,compared with those with normal blood pressure,age,BMI,central and brachial artery blood pressure(systolic blood pressure,diastolic blood pressure,pulse pressure),UACR,ba PWV,cf PWV,LVMI and serum biochemical indexes such as total cholesterol,low-density lipoprotein cholesterol,fasting blood glucose and glycosylated hemoglobin were significantly increased,while glomerular filtration rate was significantly decreased in prehypertensive patients.However,there was no significant difference in pulse rate,LVEF,triglyceride,and high-density lipoprotein cholesterol between prehypertensive patients and normal blood pressure participants(P>0.05).3.After adjusting the covariates of age,sex,BMI,fasting blood glucose,pulse rate,smoking,and drinking,the cf PWV and ba PWV of prehypertensive patients defined according to the 2018 Chinese Hypertension guidelines were significantly higher than those with normal blood pressure;while cf PWV and ba PWV of hypertensive patients were also significantly higher(P<0.0001).The LVMI and UACR in prehypertensive patients were only slightly higher than those in patients with normal blood pressure,and the difference was not statistically significant(P > 0.05).4.After adjusting the covariables including age,sex,BMI,fasting blood glucose,pulse rate,smoking and drinking,cf PWV and ba PWV of prehypertensive patients defined according to the 2017 AHA/ACC guidelines were higher than those of normal blood pressure.However,only the difference of ba PWV was statistically significant(P<0.05).The LVMI and UACR in patients with prehypertension were only slightly increased,and the difference was not statistically significant(P>0.05).5.Whether using cf PWV or ba PWV to define arterial stiffness,the prevalence of arterial stiffness in patients with prehypertension was significantly higher than in participants with normal blood pressure(P<0.0001).Conclusions: In the present Chinese population,patients with prehypertension already have varying degrees of arterial stiffness.More attention should be paid to the management of prehypertensive patients.