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Tyrosine kinase inhibitors (TKIs) have been recognized as crucial agents for treating various tumors, and one of their key targets is the intracellular site of the vascular endothelial growth factor receptor (VEGFR). While TKIs have demonstrated their effectiveness in solid tumor patients and increased life expectancy, they can also lead to adverse cardiovascular effects including hypertension, thromboembolism, cardiac ischemia, and left ventricular dysfunction. Among the TKIs, sorafenib was the first approved agent and it exerts anti-tumor effects on hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC) by inhibiting angiogenesis and tumor cell proliferation through targeting VEGFR and RAF. Unfortunately, the adverse cardiovascular effects caused by sorafenib not only affect solid tumor patients but also limit its application in curing other diseases. This review explores the mechanisms underlying sorafenib-induced cardiovascular adverse effects, including endothelial dysfunction, mitochondrial dysfunction, endoplasmic reticulum stress, dysregulated autophagy, and ferroptosis. It also discusses potential treatment strategies, such as antioxidants and renin-angiotensin system inhibitors, and highlights the association between sorafenib-induced hypertension and treatment efficacy in cancer patients. Furthermore, emerging research suggests a link between sorafenib-induced glycolysis, drug resistance, and cardiovascular toxicity, necessitating further investigation. Overall, understanding these mechanisms is crucial for optimizing sorafenib therapy and minimizing cardiovascular risks in cancer patients., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Li et al.)

Background: Hypertension has become increasingly prevalent in Chinese children and adolescents in recent decades, which affects growth and development of children, leads to cognitive decline and multiple target organ damage. Here, we assessed the impact of different body mass index (BMI) trajectories on the occurrence of hypertension in children and adolescents using a cohort study in Northeast China., Materials and Methods: Children and adolescents aged 5-18 years was extracted for physical examination in Fuxin City, Liaoning Province, China during the 2009-2015 period. A latent category growth mixed model (LCGMM) was used to classify BMI changes and analyze the effect of different BMI trajectories on the risk of occurrence of hypertension in these participants within 5 years., Results: All participates were divided into five BMI trajectories by LCGMM method: slow increasing group ( n  = 2616, 30.8%), overweight and obesity (OW/OB) group ( n  = 1141, 13.4%), normal decreasing group ( n  = 232, 2.7%), stable normal group ( n  = 4383, 51.6%), and fast-increasing group ( n  = 120, 1.4%). Compared with the stable normal group, the slow increasing group [adjusted odds ratio (AOR): 1.610, 95% confidence interval (CI): 1.304-1.989], the OW/OB group (AOR: 3.172, 95% CI: 2.500-4.023) and the fast-increasing group (AOR: 2.708, 95% CI: 1.445-5.074) all increased the risk of developing hypertension in children and adolescents., Conclusion: The potential of developing hypertension varies among groups of children aged 5-18 with different BMI trajectories. Children and adolescents in the normal BMI range (the slow growth group) still need to be aware of the change in BMI trajectory to stop or slow down the progression of BP abnormalities.

Background and Aim: Any single discrete blood pressure (BP) measurement is not enough to estimate adverse cardiovascular events. We aim to comprehensively investigate the association between BP indicators and stroke., Methods: An observational cohort study was conducted among 2888 Shanghai community-aged residents from 2014 to 2018, and a nested case-control study was designed to identify the association between BP indicators and stroke. In total 415 cases of stroke detected during the study period were selected as the case group and 415 non-stroke subjects, matched with factors of age and gender, were randomly selected from the cohort as control group., Results: Multivariate logistic regression analysis revealed that systolic blood pressure (SBP) (adjusted odds ratio [AOR] 1.02, 95% confidence interval [CI] 1.02-1.03), pulse pressure (PP) (AOR 1.03, 95% CI 1.02-1.04), mean arterial pressure (MAP) (AOR1.02, 95% CI 1.01-1.04) and pulse pressure index (PPI) (AOR 25.68, 95% CI 3.19-206.90) increased the risk of stroke, respectively. After fitting both BP indicators and covariates, isolated abnormal SBP (AOR 2.55, 95% CI 1.74-3.72) or PP ≥50 mmHg (AOR 1.66, 95% CI 1.08-2.56) independently increased risk of stroke., Conclusion: Besides SBP, PP and multiple factors, assessment should be taken into account comprehensively for stroke prevention and management., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Ren et al.)

Background : The association of four-limb systolic blood pressure differences (SBPDs) including inter-arm (IASBPD), inter-leg (ILSBPD) and ankle-brachial index (ABI) with cardiovascular risk factors and target organ changes (TOCs) remains controversial. This study aims at investigating the association of those parameters with cardiovascular risk factors and TOCs in an elderly Chinese population. Methods : A total of 1528 subjects derived from the Northern Shanghai Study were studied. Four-limb BPs were simultaneously measured by VP-1000 device. Cardiovascular risk factors and TOCs including parameters of left ventricular structure and function, carotid intima-media thickness, carotid-femoral pulse-wave velocity (CF-PWV), estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine ratio, were evaluated with standardized methods. Results : ABI significantly associated age (β = -0.004, p < .01), female gender (β = 0.02, p < .01), body mass index (β = -0.004, p < .01), smoking (β = -0.04, p < .01), high-density lipoprotein (β = 0.04, p < .01), low-density lipoprotein (β = -0.01, p = .01) and diabetes mellitus (β = -0.02, p < .01), while the fourth root of IASBPD significantly associated with body mass index (β = 0.03, p < .01), high-density lipoprotein (β = -0.10, p = .02) and brachial SBP (β = 0.003, p < .01); the fourth root of ILSBPD significantly associated with high-density lipoprotein (β = -0.12, p < .01) and diabetes mellitus (β = 0.09, p = .01). IASBPD, ILSBPD, and ABI all significantly associated with CF-PWV and eGFR (all p < .05) in either unadjusted or adjusted models, but not with other TOCs. Conclusion : Four-limb SBPDs, namely ABI, IASBPD, and ILSBPD, bore various burdens of cardiovascular risk factors and significantly and independently associated with CF-PWV and eGFR.

Whether the combination of inter-arm and inter-leg systolic blood pressure differences (BPDs) and ankle-brachial index is of clinical significance remains unclear. In this study, we aimed to investigate the association of the combination of inter-limb systolic BPDs with cardiovascular risk factors and hypertension-mediated organ damage (HMOD). A total of 2621 elderly subjects from the Northern Shanghai Study were divided into Group A, B, and C consisting of participants with 0, 1, and ≥2 abnormal inter-limb systolic BPDs, respectively. Comparisons of cardiovascular risk factors and parameters of cardiac, vascular, and renal damage between groups and logistic regression models were conducted. The proportions of subjects presenting 0, 1, and ≥2 abnormal inter-limb systolic BPDs were 60.9%, 25.1%, and 14.0%, respectively. Upward trends, from Group A, through Group B, to Group C, were observed for the level or prevalence of nearly all cardiovascular risk factors and HMOD (P for trend ≤0.007 for all). In multiple logistic regression, Group C showed significantly higher odds for carotid plaque (vs Group A: Odds ratio [OR] = 1.88, 95% confidence interval [CI] = 1.43-2.48; vs Group B: OR = 1.46, 95% CI = 1.08-1.97), arterial stiffness (vs Group A: OR = 1.26, 95% CI = 0.96-1.65; vs Group B: OR = 1.36, 95% CI = 1.01-1.83), and left ventricular hypertrophy (vs Group A: OR = 1.35, 95% CI = 1.04-1.76; vs Group B: OR = 1.25, 95% CI = 0.93-1.67), when compared with Group A and B. In conclusion, the combination of abnormal inter-limb systolic BPDs significantly associates with greater burden of cardiovascular risk factors and higher likelihood for HMOD, especially carotid plaque, arterial stiffness, and left ventricular hypertrophy., (©2019 Wiley Periodicals, Inc.)

Objectives: Vascular aging represents a mediating step between risk factors and cardiovascular events, and preclinical target organ damage (TOD) integrates the cumulative effect of cardiovascular risk factors. This study is aimed at the relationships between vascular aging and TOD., Methods: Two thousand and ninety-eight participants (45.52% men, aged 71.3 ± 6.1 years) were recruited from June 2014 to June 2017 from the communities in the northern Shanghai area. Preclinical TOD was assessed in all the participants. Other clinical information was obtained by standard questionnaire. Healthy vascular aging (HVA) was defined as absence of hypertension and a relatively normal carotid-femoral PWV based on participants' age and blood pressure. We fitted logistic regression models to assess the probability of non-HVA in association with all the preclinical TOD., Results: Six hundred and forty-two (30.6%) elderly participants had HVA, and the prevalence of HVA decreased from 30.84% (aged 65-66) to 20.72% (aged ≥75). Increased age, increased SBP, metabolic syndrome, increased BMI and family history of premature cardiovascular disease (CVD) were significantly associated with accelerated vascular aging (P = 0.031 to P < 0.001). After multivariate adjustments, accelerated vascular aging was associated with left ventricular diastolic dysfunction (LVDD; OR (95% CI) 1.83 (1.23, 2.71), P = 0.003), left ventricular hypertrophy (LVH; OR (95% CI) 1.97 (1.54, 2.51), P < 0.001) and micro-albuminuria (MAU; OR (95% CI) 1.66 (1.35, 2.03), P < 0.001)., Conclusion: Management of blood pressure and metabolic profile may help to alleviate vascular aging and accelerated vascular aging is associated with LVH, LVDD and MAU, which may serve as a potential target to reverse cardiac and renal TOD.

Objective: Secreted frizzled related protein 5 (SFRP5) is a novel anti-inflammatory adipokine that is implicated in metabolic and cardiovascular disease (CVD). However, little is known about the relevance of SFRP5 with asymptomatic hypertensive target organ damages (TODs). We aimed to investigate the association between SFRP5 and TOD in a large population., Clinical Trial Registration: NCT02368938., Methods: A total of 1,745 community-dwelling elderly subjects aged over 65 years from northern Shanghai were recruited in the study. Plasma SFRP5 level was measured by an enzyme-linked immunosorbent assay. Asymptomatic TODs, including left ventricular mass index, peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity, carotid intima-media thickness (CIMT), pulse wave velocity (PWV), estimated glomerular filtration rate, and urinary albumin-creatinine ratio were evaluated., Results: Plasma SFRP5 level was negatively associated with body mass index, waist/hip ratio, and fasting blood glucose (all P <0.001). Men, compared with women, had lower plasma SFRP5 level (4.19 vs 5.13 ng/mL, P <0.001). Additionally, plasma SFRP5 level was lower in diabetics than in those without diabetes (4.30 vs 4.81 ng/mL, P <0.05). Furthermore, an inverse association was observed between SFRP5 and PWV and CIMT (both P <0.05). Lastly, the multivariate logistic regression analysis showed lower SFRP5 level was significantly associated with increased arterial stiffness in the elderly (odds ratio 0.83, 95% confidence interval 0.71 to 0.99 per 1 standard deviation increase, P <0.05)., Conclusion: Plasma SFRP5 level was inversely correlated with conventional cardiovascular risk factors, and low plasma SFRP5 was also significantly associated with arterial stiffening in the elderly Chinese population., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

We aimed to investigate the prevalence of central hypertension and its association with target organ damage (TOD). 1983 community-dwelling elderly Chinese people were recruited for this analysis. Brachial and central blood pressure (BP) were measured by an oscillometric device and SphygmoCor (type I device), respectively. Brachial hypertension was defined by brachial systolic BP/diastolic BP ≥140/90 mmHg or using antihypertensive medications. Central hypertension was defined by central systolic BP/diastolic BP ≥130/90 mmHg or using antihypertensive medications. TOD included left ventricular hypertrophy and diastolic dysfunction, carotid-femoral pulse wave velocity, and urinary albumin-creatinine ratio. In this cohort, there were 563 (28.4%) brachial and central consistent normotension, 46 (2.3%) isolated brachial hypertension, 27 (1.4%) isolated central hypertension, and 1347 (67.9%) brachial and central combined hypertension (BCCH). In analysis of variance, BCCH showed significantly higher levels in all TOD than brachial and central consistent normotension. In multiple logistic regression, all TOD were significantly associated with BCCH (left ventricular hypertrophy: adjusted odds ratios [95% confidence interval] = 2.03 [1.55, 2.68]; left ventricular diastolic dysfunction: 2.29 [1.53, 3.43]; carotid-femoral pulse wave velocity >10 m/s: 3.41 [2.55, 4.58]; urinary albumin-creatinine ratio >30 mg/g: 1.97 [1.58, 2.44]), rather than isolated brachial hypertension or isolated central hypertension. In conclusion, central hypertension was prevalent (69.3%) in this elderly cohort. BCCH was independently and significantly associated with cardiac, arterial, and renal damage. This finding implies that both brachial and central BPs need to be considered for managing hypertension., (Copyright © 2018 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.)

To compare central and brachial blood pressure (BP) in the association of target organ damage (TOD) in a community-based elderly population, 1599 (aged 71.4 ± 6.1 years) participants in northern Shanghai were recruited. TOD included left ventricular hypertrophy (n = 1556), left ventricular diastolic dysfunction (n = 1524), carotid plaque (n = 1558), arteriosclerosis (n = 1485), and microalbuminuria (n = 1516). Both central and brachial BP significantly correlated with TOD. In full-model regression, central BP was significantly associated with all TOD (P ≤ .04), whereas brachial BP was only significantly associated with left ventricular hypertrophy and arteriosclerosis (P ≤ .01). Similarly, in stepwise regression, central BP was significantly associated with left ventricular hypertrophy, left ventricular diastolic dysfunction, arteriosclerosis, and microalbuminuria (P ≤ .04), while brachial BP was not associated with any TOD. Receiver operating characteristic analyses indicated that central BP identified arteriosclerosis and microalbuminuria better than brachial BP (P ≤ .01). In conclusion, central BP showed superiority over brachial BP in the association of hypertensive TOD in a community-based elderly population., (©2017 Wiley Periodicals, Inc.)

Background: With increasing age, estimated glomerular filtration rate (eGFR) decline is a frequent manifestation and is strongly associated with other preclinical target organ damage (TOD). In literature, many equations exist in assessing patients' eGFR. However, these equations were mainly derived and validated in the population from Western countries, which equation should be used for risk stratification in the Chinese population remains unclear, as well as their comparison. Considering that TOD is a good marker for risk stratification in the elderly, in this analysis, we aimed to investigate whether the recent eGFR equations derived from Asian and Chinese are better associated with preclinical TOD than the other equations in elderly Chinese., Methods: A total of 1,599 community-dwelling elderly participants (age >65 years) in northern Shanghai were prospectively recruited from June 2014 to August 2015. Conventional cardiovascular risk factors were assessed, and hypertensive TOD including left ventricular mass index (LVMI), carotid-femoral pulse wave velocity (cf-PWV), carotid intima-media thickness (IMT), ankle-brachial index (ABI) and urine albumin to creatinine ratio (UACR) was evaluated for each participant. Participant's eGFR was calculated from the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Chinese-abbreviated MDRD (c-aMDRD), Asian-modified CKD-EPI (aCKD-EPI) equation and Chinese-modified CKD-EPI (cCKD-EPI) equation., Results: In multivariate regression analysis, only eGFRs from aCKD-EPI were significantly and inversely associated with carotid IMT ( P =0.005). In multivariate logistic models, decreased eGFR from all the equations were significantly associated with lower ABI ( P <0.001), microalbuminuria ( P =0.02 to P <0.001) and increased cf-PWV ( P <0.001). Only decreased eGFRs from aCKD-EPI and cCKD-EPI equations were significantly associated with increased IMT (both crude P <0.05). In the receiver operator characteristic (ROC) analysis, only aCKD-EPI and cCKD-EPI equations presented significant associations with all the listed preclinical TODs ( P -value from <0.05 to <0.001)., Conclusion: In community-dwelling elderly Chinese, eGFRs from aCKD-EPI and cCKD-EPI equations are better associated with preclinical TOD. aCKD-EPI and cCKD-EPI equations should be preferred when making risk assessment., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The aim of the study was to investigate the association of left ventricular diastolic dysfunction (LVDD) with central and peripheral hemodynamics. A total of 1599 community-based senior residents (aged ≥ 65 years) in northern Shanghai, China, were recruited as of August 2015. Echocardiography was performed for each participant using the MyLab30 Gold CV system. According to the recommendations from the American Society of Echocardiography, the ratio of E (peak early diastolic transmitral flow velocity) to E' (early diastolic lateral mitral annulus velocity) was assessed for the evaluation of LVDD. Central blood pressure (BP) components were measured using the SphygmoCor system. In community older population (72.7 ± 6.01 years), brachial systolic BP (mm Hg) was higher than central systolic BP (141.9 ± 19.5 vs. 130.3 ± 20.1 mm Hg). A total of 214 subjects (13.4%) showed LVDD, and female showed higher prevalence of diastolic dysfunction than male (17.3% vs. 8.4%, P < .01). After adjustment for confounding variables, only central systolic BP, not brachial systolic BP, was significantly associated with E/E' in the total population. Similar result was found in the subgroup analysis (participants without antihypertensive agents treatment, man, woman). Similar findings were obtained for the pulse pressure (PP) analysis. Within central hemodynamics, only central PP, but not central systolic BP or augmentation pressure, was significantly associated with E/E' after adjustment. When LVDD was defined by E/E' and other echocardiographic parameters, our findings remained unaltered in the multivariate logistic regression with similar adjustment in the total population and subgroup analysis. In the Chinese elderly cohort, central hemodynamics, especially central PP, is superior to other BP components in identifying LVDD (NCT02368938)., (Copyright © 2017 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.)

Background: The Eighth Joint National Committee Panel (JNC8) recommended a novel blood pressure (BP) goal for individuals with hypertension, which was less stringent than the Seventh Joint National Committee (JNC7) guideline and is still under debate. In our study, we aimed at finding a better BP goal for the elderly Chinese., Methods: About 1599 community-based elderly participants were recruited in the northern Shanghai and were classified by chronic kidney disease or diabetes mellitus to investigate their BP control conditions based on both the JNC7 and JNC8. Then, participants were categorized into four groups: normotensive individuals (Group 1), individuals at BP goal by JNC7 (Group 2), individuals at BP goal by JNC8 but not by JNC7 (Group 3), and individuals not at-goal by both guidelines (Group 4). Patients' hypertensive target organ damages as left ventricular mass index (LVMI), peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity (E/Ea), pulse wave velocity (PWV), etc. were evaluated., Results: According to the JNC8, 19.0% of the population were reclassified as at-goal. Group 4 had significantly greater LVMI than Group 2 (96.5 vs 91.5 g/m 2 , p < 0.05) and also had significantly greater E/Ea (10.3 vs 9.7 and 10.3 vs 9.7, p < 0.05) and PWV (10.3 vs 9.3 m/s and 10.3 vs 9.7 m/s, p < 0.05) than both Group 2 and Group 3; however, there were no significant differences of these variables between Group 2 and Group 3., Conclusion: In the community-based elderly Chinese, the JNC8 hypertension guideline may set a better BP goal than the JNC7 in identifying patients' left ventricular diastolic dysfunction and arterial stiffening.

Background: A prediction model from the US Framingham Heart Study (FHS) population has been established to estimate an individual's risk of developing hypertension. However, this model has not been widely tested in other cohorts. In this study, we examined the predictive capability of the FHS prediction model in a rural Chinese population., Methods: A total of 24,434 rural Chinese adults aged ≥35 years, without prevalent hypertension, diabetes mellitus, stroke, and coronary heart disease at baseline, were followed for the incidence of hypertension. Standard clinical examinations of blood pressure, weight and height, smoking status, and parental history of hypertension were observed biennially., Results: The mean age was 47.9 (SD = 10.2) years, and 49.5% of subjects were women. During a median 4.8 years of follow-up, we recorded a total of 8,675 incident hypertension cases. The cumulative 2-year and 4-year hypertension incidence rates were 7.7% and 25.6%, respectively. The C statistics for the 2-year and 4-year incidences of hypertension were 0.537 (95% confidence interval (CI) = 0.524-0.550) and 0.610 (95% CI = 0.602-0.618) for the FHS model, respectively. The Hosmer-Lemeshow χ(2) test results for 2-year and 4-year incidence of hypertension were 2,287.7 (P < 0.0001) and 8,227.1 (P < 0.0001), respectively. Sensitivity analysis indicates that the FHS prediction model still has a poor performance, although the predictive ability was better than for the overall population., Conclusions: The FHS hypertension prediction model is not a valid tool with which to estimate the risk of incidence of hypertension among the rural Chinese population. A new hypertension risk equation for the rural Chinese population is needed.

Background: Hypertension is a definitive risk factor for stroke. We examined the associations between hypertension subtypes and stroke incidence in rural Chinese adults., Methods: We conducted a prospective study in a sample of 38,949 rural Chinese adults aged ≥35 years and free from stroke at baseline. The subtypes of hypertension were defined as isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), systolic and diastolic hypertension (SDH), and managed hypertension (MHT). The relative risks of stroke with the subtypes of hypertension, compared with normotensive subjects, were estimated using the Cox model after adjusting for age, sex, and other confounders., Results: The prevalence of hypertension was as follows: SDH = 18.6%, ISH = 10.2%, IDH = 5.8%, and MHT = 0.4%. During a total of 168,023 person-years of follow-up, 858 subjects developed stroke. The incidence rate per 100,000 person-years of overall first-ever stroke was 510.6. The SDH group was at the highest risk of stroke among all the hypertensive subjects. The hazard ratio was 2.13 (95% confidence interval (CI) = 1.78-2.55) for all stroke, 2.74 (95% CI = 2.08-3.60) for hemorrhagic stroke, and 1.92 (95% CI = 1.50-2.45) for ischemic stroke., Conclusions: SDH patients warrant the most attention for prevent of stroke. However, ISH and IDH are also independent predictors of stroke. The risk factors for stroke, especially hypertension, were not controlled in the rural population we studied. More aggressive efforts to control the risk factors for stroke in rural areas are needed.

Background: This study was conducted to examine the differences in the incidence of hypertension and associated risk factors between Mongolian and Han populations in northeast China., Methods: A population-based sample of 4753 Mongolian subjects and 20,247 Han subjects aged ≥ 35 years and free from hypertension at baseline were followed from 2004-2006 to 2010. Incident hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or current use of antihypertensive medication., Results: During mean 4.3 years follow-up, a total of 8779 individuals developed hypertension. The age-adjusted incidence of hypertension for Mongolian subjects was 12.64 per 100 person-years, for Han subjects was 9.77 per 100 person-years (P<0.05). The incidence of hypertension was positively correlated with age, physical activity, drinking, body mass index (BMI), family of hypertension and prehypertension in the Han population. In the Mongolian population, hypertension was positively correlated with age, physical activity, education level, drinking, BMI, prehypertension and family history of hypertension. The rates of awareness, treatment and control of hypertension for newly developed cases among both Han and Mongolian populations were low. (36.5% vs. 42.3%, 13.1% vs. 18.2%, 0.7% vs. 1.3%, P<0.05, respectively)., Conclusions: The incidence rate of hypertension is higher in the Mongolian populations than that in the Han populations, and hypertension in both ethnic populations was associated with similar risk factors. Our results suggest that most newly-diagnosed cases of hypertension are not adequately treated. Improvements in hypertension prevention and control programs in rural China are urgently needed.

Blood pressure (BP) remains poorly controlled among hypertensive patients with coronary heart disease (CHD) in China. Improvement of its management will require an understanding of the patient characteristics and treatment factors associated with uncontrolled hypertension. A cross-sectional survey of 3,279 patients from 52 centers in China was performed to examine potential barriers to adequate blood pressure control of hypertensive patients with CHD. Uncontrolled hypertension was defined as blood pressure ≥130/or 80 mmHg. Multivariable logistic regression was used to identify factors associated with poor blood pressure control. Mean age of the patients was 65 years, 40% were women, and mean BMI was 25 kg/m(2). Mean systolic blood pressure was 136±18 mmHg and mean diastolic blood pressure was 80±11 mmHg. Only 18% of patients had a mean blood pressure <130/80 mmHg during the study period. Multivariate analysis revealed several independent factors of poor blood pressure control: body mass index ≥23 kg/m(2), the presence of stable angina pectoris (SAP), family history of diabetes, and use of calcium channel blockers (CCB). Further analysis showed that non-dihydropyridine calcium antagonist was significantly correlated with low BP control rate. Some of these may be amenable to modification. The results of our study suggest that overweight, the presence of SAP and family history of diabetes are important factors for tight BP control in primary care. In addition, non-dihydropyridine calcium channel blockers appear less effective than other therapies in control of blood pressure and should not be the first choice among hypertensive patients with CHD. Further identification of patients at risk of poor BP control can lead to targeted interventions to improve management.

Objectives: We aim to assess if the relationship between short or long sleep duration and hypertension is present among adults from epidemiological evidence and to investigate the relationship quantitatively., Methods: We performed a comprehensive search of cross-sectional and longitudinal studies using PubMed and the Cochrane Library through February 2012. Our search was supplemented by reviewing reference lists of original and relevant reviews. After the related data were extracted by two investigators independently, pooled odds ratios (ORs) or relative risks (RRs) were estimated using a random-effects model or a fixed-effects model. Publication bias was evaluated, while sensitivity and meta-regression analyses were performed., Results: Twenty-four adult studies met our inclusion criteria, with ages ranging from 18 to 106 years. Twenty-one studies involving 225,858 subjects were included in the meta-analysis. The pooled results from the cross-sectional studies showed that short sleep duration was associated with a greater risk for hypertension (OR, 1.21; 95% confidence interval [CI], 1.09-1.34; P<0.001), and long sleep duration also increased the risk for hypertension (OR, 1.11; 95% CI, 1.04-1.18; P=0.003). There was no evidence of publication bias. Pooled analysis from the longitudinal studies indicated a significant association between short sleep duration and hypertension (RR, 1.23; 95% CI, 1.06-1.42; P=0.005), but an insignificant relationship between long sleep duration and hypertension (RR, 1.02; 95% CI, 0.91-1.14; P=0.732). The effects of sleep duration differed by gender, location of the population, and definitions of short or long sleep duration. Meta regression analysis including seven variables did not find the sources of heterogeneity., Conclusions: Among adults, a U-shaped relationship between habitual sleep duration and hypertension was found at the cross-sectional level. Short sleep duration was associated with a higher risk for hypertension even longitudinally. We must pay more attention to this lifestyle factor., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objectives: The present study is to explore the association between estimated glomerular filtration rate (eGFR) and stroke in hypertensive patients in rural areas of China., Methods: The prospective study was based on 3711 hypertensive patients who were aged at least 35 years, free from cardiovascular diseases, and had serum creatinine at baseline. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation., Results: During a median follow-up of 4.9 years, 176 first-ever strokes (98 ischemic, 75 hemorrhagic, and three were unspecified strokes) occurred. We found no independent association between eGFR and risk of hemorrhagic stroke. In contrast, with decreasing eGFR, the risk of total and ischemic stroke strongly increased; the sex and age-adjusted hazard ratios for overall and ischemic stroke were 3.34 [95% confidence interval (CI) 1.61-6.93] and 3.79 (95% CI 1.33-10.81) for patients with eGFR below 60 versus eGFR at least 90  ml/min per 1.73 m, respectively. In addition, patients with an eGFR of 60-90 relative to eGFR at least 90  ml/min per 1.73 m had hazard ratios of 2.31 (95% CI 1.53-3.51) and 3.24 (95% CI 1.76-6.00) for overall and ischemic stroke after adjustment for sex and age, respectively. Adjustment for other cardiovascular factors only slightly attenuated the associations., Conclusions: The patients with decreased eGFR, also included those with eGFR range between 60 and 90  ml/min per 1.73 m, had an independently increased risk of overall and ischemic stroke in hypertensive patients in rural areas of China.

Objective: Obesity increases the risk of hypertension and other chronic diseases, which are little known in rural China. This study aimed to investigate the epidemiologic features and the association with hypertension of obesity in rural Chinese women., Methods: A cross-sectional survey was conducted during 2004 through 2006, which used a multistage cluster sampling method to select a representative sample in Liaoning Province, China. In total 23 178 rural participants at least 35 y of age were examined (the percentage of subjects >64 y old was 14.5%). Data on demographic variables (age, sex, and race), smoking status, use of alcohol, physical activity, and education level were obtained by interview. Overweight and obesity were defined according to the World Health Organization classification. Hypertension was defined according to the criteria established by the Seventh Report of the Joint National Committee, and untreated hypertensive subjects were further classified into three subtypes: isolated systolic hypertension, isolated diastolic hypertension, and systolic and diastolic hypertension. Multivariable models and performed Poisson logistic regression analysis were used to determine associations among body mass index (BMI), waist circumference, and variables., Results: Overall, the prevalences of overweight and obesity were 24.4% and 2.7%, respectively, as defined by BMI, whereas the prevalences were 48.6% and 4.9% as defined by waist circumference. Poisson regression revealed that high levels of physical activity (defined by BMI, moderate: prevalence ratio [PR] 0.976, 95% confidence interval [CI] 0.965-0.988, high: PR 0.985, 95% CI 0.971-0.999; defined by waist circumference, moderate: PR 0.955, 95% CI 0.944-0.965, high: PR 0.973, 95% CI 0.960-0.985) and current smoking status (defined by BMI, PR 0.950, 95% CI 0.938-0.962; defined by waist circumference, PR 0.966, 95% CI 0.954-0.978) were protective factors and ethnicity was a risk factor (defined by BMI, Mongolian nationality: PR 1.042, 95% CI 1.030-1.054; defined by waist circumference, PR 1.043, 95% CI 1.033-1.054) for overweight or obese participants. There were other risk factors for overweight or obese participants such as high levels of education defined by BMI (PR 1.033, 95% CI 1.010-1.058) and diet score defined by waist circumference (PR 1.004, 95% CI 1.000-1.008). After adjustment, BMI and waist circumference were associated with the greatest likelihood of systolic and diastolic hypertension (for BMI ≥30 kg/m², PR 2.455, 95% CI 1.786-3.374; for waist circumference ≥88 cm, PR 1.517, 95% CI 1.133-2.031). BMI was more related to isolated diastolic hypertension than to isolated systolic hypertension, whereas waist circumference was more related to isolated systolic hypertension than to isolated diastolic hypertension., Conclusion: Although the prevalence of overweight and obesity as defined by BMI was low, it was relatively high as defined by waist circumference in rural Chinese women. High levels of physical activity and current smoking status had negative relations to overweight or obesity, whereas ethnicity, high levels of education, and diet score showed positive relations. Obese women defined by BMI or waist circumference had an increased risk of hypertension., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Few studies reported the associations between decreased glomerular filtration rate (GFR) and mortality, coronary heart disease (CHD), and stroke in hypertensive patients. We aim to assess the associations between GFR and mortality, CHD, and stroke in hypertensive patients and to evaluate whether low GFR can improve the prediction of these outcomes in addition to conventional cardiovascular risk factors., Methods and Findings: This is an observational prospective study and 3,711 eligible hypertensive patients aged ≥5 years from rural areas of China were used for the present analysis. The associations between eGFR and outcomes, followed by a median of 4.9 years, were evaluated using Cox proportional hazards models adjusting for other potential confounders. Low eGFR was independently associated with risk of all-cause mortality, cardiovascular mortality, and incident stroke [multivariable adjusted hazard ratios (95% confidence intervals) for eGFR <60 ml/min/1.73 m(2) relative to eGFR ≥90 ml/min/1.73 m(2) were 1.824 (1.047-3.365), 2.371 (1.109-5.068), and 2.493 (1.193-5.212), respectively]. We found no independent association between eGFR and the risk of CHD. For 4-year all-cause and cardiovascular mortality, integrated discrimination improvement (IDI) was positive when eGFR were added to traditional risk factors (1.51%, P = 0.016, and 1.99%, P = 0.017, respectively). For stroke and CHD events, net reclassification improvements (NRI) were 5.9% (P = 0.012) and 1.8% (P = 0.083) for eGFR, respectively., Conclusions: We have established an inversely independent association between eGFR and all-cause mortality, cardiovascular mortality, and stroke in hypertensive patients in rural areas of China. Further, addition of eGFR significantly improved the prediction of 4-year mortality and stroke over and above that of conventional risk factors. We recommend that eGFR be incorporated into prognostic assessment for patients with hypertension in rural areas of China., Limitations: We did not have sufficient information on atrial fibrillation to control for the potential covariate. These associations should be further confirmed in future.

We investigated the prevalence and risk factors of prehypertension, as well as the predictors of progression from prehypertension to hypertension. To do this, we performed a systematic review and meta-analysis of cross-sectional and longitudinal studies, after unrestricted searches of PubMed and The Cochrane Library through September 2010. In addition, we reviewed references, major textbooks, and review articles. Pooled prevalence, standardized mean differences, and odds ratios were estimated by using a random-effects model. Twenty-six articles met our inclusion criteria; these included 20 cross-sectional and 6 longitudinal studies, with a total sample of 250,741 individuals. The overall pooled prevalence of prehypertension was 36%. The pooled prevalence among males was higher than that among females (40% vs 33%). The pooled standardized mean difference for body mass index was 1.37 (95% confidence interval [CI], 1.20-1.55); for total cholesterol, 8.08 (95% CI, 6.71-9.46); for low-density-lipoprotein cholesterol, 5.14 (95% CI, 3.09-7.18); and for fasting plasma glucose, 4.23 (95% CI, 3.28-5.18); all of which showed more significant results in females. The pooled odds ratio was 1.13 (95% CI, 0.93-1.37) for smoking and 0.98 (95% CI, 0.69-1.39) for drinking. In addition, factors such as older age at baseline, male sex, Mongolian race, and being overweight or obese were predictors of progression to hypertension, according to descriptive analysis. The prevalence of prehypertension was relatively high, especially for males. There were many modifiable risk factors associated with prehypertension, to which healthcare providers should pay more attention.

Objectives: To assess the risk of progression to hypertension across baseline blood pressure (BP) level among rural Chinese adults., Methods: A population-based sample of 24 052 rural Chinese adults aged at least 35 years and free from hypertension at baseline were followed up from 2004-2006 to 2008. Incident hypertension was defined as SBP of at least 140 mmHg, DBP of at least 90 mmHg, current use of antihypertensive medication, or all., Results: During a median follow-up of 28 months, 26.5% participants developed clinical hypertension, most of which were untreated and uncontrolled. The cumulative incidence of hypertension in participants with optimal, normal, and high-normal BP was 21.2, 25.2, and 32.4%, respectively. The higher incidence of hypertension (per 100 person-years) was obviously observed in higher BP category at baseline among both older and younger groups (both P for trend <0.05). Compared with optimal BP, the adjusted hazard ratios of participants with normal and high-normal BP for incident hypertension were 1.16 (95% confidence interval 1.08-1.24) and 1.28 (95% confidence interval 1.20-1.36), respectively. In addition, older age, men, Mongolian ethnicity, alcohol drinking, family history of hypertension, BMI, and change in BMI during follow-up were also independently associated with incident hypertension., Conclusion: There was a stepwise increase in risk of progression to hypertension across baseline BP level. This information could help us define a population at high risk of progression to hypertension, to underscore the importance of frequent BP monitoring, and early interventions in rural Chinese adults.

Background: To determine the incidence of hypertension and its risk factors among rural Chinese women with prehypertension and normotension., Methods: A population-based sample of 12,060 rural Chinese women aged > or = 35 years and free from hypertension at baseline were followed from 2004-2006 to 2008. Incident hypertension was defined as systolic blood pressure (SBP) > or = 140 mm Hg, diastolic blood pressure (DBP) > or = 90 mm Hg, or current use of antihypertensive medication., Results: Over a median follow-up of 28 months (range, 14-47 months), 23.4% of women developed hypertension. The age-adjusted incidence rate was higher in prehypertension than in normotension (11.2/100 person-years vs. 7.9/100 person-years, P < 0.05). Among women with prehypertension, independent predictors of incident hypertension were baseline age, Mongolian ethnicity, low physical activity, baseline body mass index (BMI), baseline salt intake and family history of hypertension. Among women with normal blood pressure (BP), independent predictors were baseline age, low physical activity, baseline BMI and baseline salt intake. The awareness, treatment, and control rates for newly developed hypertension were 33.2, 23.0, and 2.1%, respectively., Conclusions: These data indicate that the incidence of hypertension is high among rural Chinese women and it is associated with many risk factors, and the data also suggest that most newly developed hypertension cases are not treated. This high incidence of hypertension may be related to rapid social changes in our country and may apply to other areas of the developing world. These results call for urgent improvements in hypertension prevention, detection and treatment.

Background: Individuals with prehypertension are at a high risk of developing hypertension. Little is known about the predictors of progression from prehypertesion to hypertension in rural Chinese adults., Methods: A population-based sample of 15 061 rural Chinese aged > or =35 years with prehypertension free cardiovascular diseases at baseline were followed-up from 2004-2006 to 2008. Incident hypertension was defined as systolic blood pressure (BP) > or =140 mmHg, diastolic BP > or =90 mmHg, or current use of antihypertensive medications., Results: During the 28-month follow-up period, 4917 individuals (32.6%) with prehypertension developed hypertension, in which only 1.5% (n = 73) of incident cases reached BP control target. After Cox stepwise regression analysis, baseline age (per 5 years) [hazard ratio (HR): 1.111; 95% confidence interval (CI): 1.095-1.126], Mongolian (HR: 1.079; 95% CI: 1.010-1.152), alcohol drinking, overweight and obese (HR: 1.349; 95% CI: 1.261-1.444), salt intake everyday, inappropriate physical activity, and family history of hypertension were associated with incident hypertension independent of initial systolic and diastolic BP. Among these predictors, current alcohol drinking (odds ratio: 1.126; 95% CI: 1.049-1.209), salt intake, and overweight and obese were associated only with increased systolic BP, whereas inappropriate physical activity contributed only to increase diastolic BP., Conclusion: These data suggest a high incidence of hypertension in individuals with prehypertension. Lifestyle modifications such as cessation of drinking, healthy diet, and moderate physical activity are advised to prevent or delay the progression of prehypertension to hypertension in rural areas of China.

Objective: To evaluate the therapeutic effects of combination administration of hydrochlorothiazide and nitrendipine at low dosage in the treatment of rural hypertension patients., Methods: By the method of cluster random sampling, 5292 primary hypertension patients from Fuxin, Liaoning Province were divided into health education group (control group) and drug intervention group in June 2006. The drug intervention group were treated with hydrochlorothiazide, nitrendipine and captopril by stepwise approach and we observe the antihypertensive effect of drug and the effect on the onset of stroke., Results: The average follow-up time was 15 months. At last, 308 patients were lost to follow-up (the lost follow-up rate was 5.8 percent). The 4984 in cohort, including 2530 of intervention group and 2454 of control group, had examination of all indicators. Through health education and drug intervention, the average blood pressure in drug intervention group decreased by 16.1/9.4 mm Hg (1 mm Hg = 0.133 kPa) while the average blood pressure in control group decreased by 6.7/3.5 mm Hg. The control rate of blood pressure in drug intervention group was higher than control group (33.1% vs. 15.1%, P < 0.001). Through drug intervention, the morbidity risk of nonfatal stroke in drug intervention group decreased by 57.3% compared to control group, the total morbidity risk of stroke decreased by 59.4%. The results had significant statistical difference. And, the morbidity of severe hypopotassaemia (K(+) < 3.0 mmol/L) and diabetes mellitus had no significant statistical difference between two groups., Conclusions: The low-cost antihypertensive program based on thiazide had good antihypertensive effect, high safety and good cost-effect ratio. The program could be used in rural areas of China.

Objective: The objective of the study was to estimate the prevalence of hypertension and associated factors among older rural adults in Liaoning Province, China., Subjects and Methods: The study was conducted in 2004-2006, using a multistage, stratified clustering sampling scheme to select a representative sample. A total of 10,065 adults aged 60 years or older were examined. A survey of blood pressure and associated factors was carried out. All data analyses were conducted using SPSS 11.5 statistical software package., Results: Overall, the prevalence rates of hypertension are 57, 64.4 and 64.9% for the age groups 60-69, 70-79 and >or=80 years, respectively. The prevalence of hypertension was positively correlated with age, female gender, Mongolian ethnicity, overweight and obesity, smoking and drinking, whereas income level was a protective factor for hypertension. The rates of awareness, treatment and control among older rural adults were very low (overall 35.2, 28.7 and 1.0%, respectively)., Conclusion: Hypertension was highly prevalent among older rural adults in Liaoning Province, and it was associated with many factors. The percentages of hypertensives who were aware, treated, and controlled were very low. These data underscore the urgent need to strengthen the public health education and blood pressure monitoring system to better manage hypertension among older adults in rural China., (Copyright 2009 S. Karger AG, Basel.)

Unlabelled: OBJECTIVE We wanted to determine the incidence of hypertension and its risk factors among rural Chinese adults., Methods: A population-based sample of 24,360 rural Chinese adults aged 35 years and older and free from hypertension at baseline was observed from 2004-2006 to 2008. Incident hypertension was defined as a systolic pressure of 140 mm Hg or greater, diastolic pressure of 90 mm Hg or greater, or current use of antihypertensive medication., Results: During a mean follow-up period of 28 months, 29.6% of men and 23.4% of women developed hypertension. The age-adjusted incidence was higher in men (12.75 per 100 person-years) than in women (10.04 per 100 person-years). Among men, independent predictors of incident hypertension were baseline age (hazard ratio [HR] = 1.11; 95% confidence interval [CI], 1.10-1.13), Mongolian ethnicity (HR = 1.09; 95% CI, 1.01-1.18), use of alcohol, (HR = 1.14; 95% CI, 1.06-1.23), high income vs low income (HR = 1.11; 95% CI, 1.00-1.22; and HR = 1.11; 95% CI, 1.03-1.20), prehypertension vs normotension (HR = 1.18; 95% CI, 1.08-1.28), overweight and obesity (HR = 1.28; 95% CI, 1.17-1.40), baseline salt intake (HR = 1.00; 95% CI, 1.00-1.01) and family history of hypertension (HR = 1.14; 95% CI, 1.03-1.27). With the exception of use of alcohol and mean income, the results were similar for women, except that low physical activity was shown as a risk factors as well. The awareness, treatment, and control rates for newly developed hypertension were 29.9%, 19.5%, and 1.5%, respectively., Conclusions: These data indicate that the incidence of hypertension is high among these rural Chinese adults and that it is associated with many risk factors. Our findings further suggest that most newly developed hypertension cases are not treated. The increases in hypertension are probably related to rapid social changes in our country and may apply to other areas of the developing world. These findings call for urgent improvements in hypertension prevention and control programs in rural China.

Aim: The purpose of this study was to estimate the prevalence of diabetes and impaired fasting glucose (IFG) and their associated risk factors in the hypertensive rural Chinese., Methods: A cross-sectional survey was conducted during 2004-2006 with a cluster multistage sampling design. Data from a comprehensive questionnaire, physical examination, and blood tests were obtained from a resident group of 6,412 individuals with hypertension, aged > or = 35 years., Results: The prevalence of diabetes among the hypertensive rural adults was 10.0%. The prevalence of IFG was 26.0%, using the new American Diabetes Association (ADA) criteria (fasting plasma glucose 5.6-6.9 mmol/l); according to the 1997 ADA criteria (fasting plasma glucose 6.1 - 6.9 mmol/l), the prevalence of IFG was 9.7%. By using multivariate logistic regression analysis, age, sex (male gender), systolic blood pressure, overweight or obesity, total cholesterol and triglycerides were determined to be risk factors for diabetes (P < 0.05)., Conclusions: This study shows that diabetes and IFG are common among hypertensive rural Chinese. In view of the huge number of hypertensive adults in rural China, the results of this study emphasize the need to improve the early detection and prevention of diabetes in China to prevent the emerging diabetes epidemic.

Background: Both dyslipidemia and hypertension are important risk factors for cardiovascular disease. Studies have found that there is a higher risk of dyslipidemia among hypertensive patients. This study was designed to investigate the epidemiologic features of some forms of dyslipidemia in rural hypertensive adults in China., Methods: A cross-sectional survey was conducted during 2004 to 2006 through a cluster multistage sampling of a resident group of 6412 hypertensive individuals (2805 men and 3607 women), aged >/= 35 years, in the countryside of Liaoning, China. The cutpoints of lipid phenotypes were based on the 1992 recommendations of the European Atherosclerosis Society., Results: The most prevalent abnormality was isolated hypercholesterolemia (34.1% for men and 37.3% for women). Mixed dyslipidemias was the second most prevalent abnormality (14.3%). Isolated hypertriglyceridemia was observed in 5.6% of the sample. The prevalence of normotriglyceridemic hypoalphalipoproteinemia and severe dyslipidemia was 2.0% and 3.3%, respectively. Only a few samples had the abnormality of hypertriglyceridemia/hypoalphalipoproteinemia (.8% for men and .3% for women). The prevalence of isolated hypertriglyceridemia, mixed dyslipidemias, and severe dyslipidemia was higher in diabetic patients compared with nondiabetic patients, in either men or women. Compared with those of normal weight, obese men had a higher prevalence of mixed dyslipidemias and hypertriglyceridemia/hypoalphalipoproteinemia, whereas isolated hypertriglyceridemia was prevalent in both genders., Conclusion: The prevalence of lipid phenotypes among these hypertensive patients was relatively high, even in rural China. Diabetes and obesity, the modifiable risk factors, increased the likelihood of having several forms of an atherogenic lipid profile.

Introduction: Peripheral arterial disease (PAD) is an important manifestation of systemic atherosclerosis.The present study was to estimate the prevalence of and risk factors for PAD in Chinese hypertensive patients with and without known cardiovascular disease (CVD) which consisted of coronary heart disease, angina, stroke, and transient ischaemic attack., Material and Methods: A cross-sectional study consisting of 5,186 hypertensive patients was conducted from July to November 2004 in Beijing and Shanghai, China. PAD was defined as an ankle-brachial index < or = 0.90 in either leg., Results: The prevalence of PAD was 29.0% among hypertensive patients with known CVD, higher than in patients without known CVD (16.6%, P <0.0001). After multivariable logistic regression analysis, older age and current smoking were independently associated with prevalent PAD among all hypertensive patients.Among hypertensive patients without known CVD, higher total cholesterol (OR and 95% CI: 1.518, 1.162-1.984 in men and 1.460, 1.097-1.944 in women), was independently associated with prevalent PAD. Higher fasting glucose (OR and 95% CI: 1.027, 1.001-1.054 in men and 1.033, 1.006-1.061 in women) and higher uric acid (OR and 95% CI: 1.002, 1.001-1.003 in men and 1.003, 1.001-1.005 in women) were risk factors for PAD among hypertensive patients with known CVD. No association was found between obesity and PAD in hypertensive patients with and without known CVD., Conclusions: Prevalence of and risk actors for PAD among Chinese hypertensive patients with and without CVD were different. Cessation of smoking should be stressed to inhibit the progression of PAD in hypertensive patients.

Background: The metabolic syndrome has become a major public health issue worldwide.This study was designed to evaluate and compare the epidemiological features of the metabolic syndrome in hypertensive rural Chinese women., Methods and Results: A cross-sectional survey was conducted during 2004-2006, which undertook cluster multistage sampling to a representation sample of hypertensive women living in 50 rural villages of Liaoning, China. A total of 3607 women aged > or =35 years were selected.At baseline, lifestyle and other factors were obtained. The metabolic syndrome was proposed by the International Diabetes Federation definition. Of the study population 49.6% (age-adjusted: 49.3%) had metabolic syndrome. Overall, 64.7%, 39.2%, 33.8%, and 33.9% of the hypertensive women had central obesity, hypertriglyceridaemia, low HDL cholesterol, and high fasting plasma glucose, respectively. 87.7% of the sample had at least one component of the metabolic syndrome. Multivariate logistic regression revealed that Mongolian nationality and obesity were risk factors for metabolic syndrome. Moderate levels of physical activity and current drinking status were shown as protective factors. There was a positive association between metabolic syndrome and age in the age group between 55 and 64 years., Conclusions: The current study demonstrated that the prevalence of metabolic syndrome was dramatically high in hypertensive women, even in the rural areas of China. Further, our study indicated that remarkable ethnic differences exist in the prevalence of metabolic syndrome. Obese and moderate levels of physical activity were a modifiable risk factor.

Background: The present study aimed to determine the prevalence of prehypertension, hypertension, and associated risk factors between Mongolian and Han populations in Northeast China., Methods: The study was conducted in 2004-2006, and used a multistage cluster sampling method to select a representative sample. A total of 9236 Mongolian people and 36,154 Han people in the same area, age 35 years or older, were examined. The survey on blood pressure and associated risk factors was carried out., Results: Overall, the prevalence of prehypertension for Mongolian people was 43.6%, for Han people was 44.3%. The prevalence of hypertension in Mongolian was higher than in Han (42% vs 36.7%, p<0.05). The prevalence of hypertension was positively correlated with age, smoking, body mass index (BMI), waist circumference (WC), lipid disorder, diabetes, salt intake and family history of hypertension in Mongolian, whereas it was positively correlated with age, female, smoking, drinking, BMI, WC, lipid disorder, diabetes, salt intake and family history of hypertension in Han. The rates of awareness, treatment and control in Mongolian and Han were very low (29.7% vs 29.2%, 23.6% vs 23.5%, 0.7% vs 1.2%)., Conclusions: Hypertension and prehypertension were common in Mongolian and Han populations in Northeast China, and it were associated with many risk factors. The percentages of hypertensives who were aware, treated, and controlled were unacceptably low. These results place great emphasis on the urgent need for a public health program to improve the detection, prevention and treatment of hypertension in the rural area of Northeast of China.

Background & Objective: Hypertension is a major risk factor for cardiovascular and renal diseases. In PR China, the prevalence of hypertension has substantially increased during the past four decades. Information on prevalence as well as awareness regarding treatment and prevention of hypertension is scarce particularly in rural settings. The objective of this study was therefore to estimate the prevalence and distribution of hypertension and to determine the status of hypertension awareness, treatment, and control in the general rural adult population in northeast China., Methods: During 2005--2007, in Liaoning province of northeast China a probability proportional to size sampling method was used to select a nationally representative sample. A total of 45,925 adults (aged > 35 yr) were examined. Three blood pressure measurements were obtained by trained observers using a standardized sphygmomanometer after a 5-minute sitting rest. Information on history of hypertension and use of antihypertensive medications was obtained. Hypertension was defined as a mean systolic blood pressure > 140 mm Hg, diastolic blood pressure > 90 mm Hg, and/or use of antihypertensive medications., Results: Overall, 37.8 per cent of the rural adult population from northeast China aged 35 to 85 yr had hypertension. Among hypertensives, only 29.5 per cent were aware of their high blood pressure, 20.2 per cent were taking antihypertension medication and 0.9 per cent achieved blood pressure control (< 140/90 mm Hg). Of all subjects, 43.9 per cent did not think that high blood pressure would endanger their lives. The reasons why not taking antihypertensive medication in hypertensives aware of having hypertension was 40.2 per cent for their lack of knowledge about the fatalness of hypertension and 32.3 per cent for financial straits., Interpretation & Conclusion: Our results indicated that hypertension is highly prevalent in rural areas of northeast China. The percentages of those with hypertension who were aware, treated and controlled were unacceptably low. These results underscore the urgent need to take comprehensive controlling measures and improve the awareness of hypertension at the same time to control hypertension in rural population of Liaoning province.

Background: The objective of the study was to assess prevalence, awareness, treatment, and control of hypertension and its risk factors in rural women in Liaoning Province in northeast China., Methods: We conducted a cross-sectional analysis of 23,178 women of minimum age 35 years, living in rural Liaoning province in northeast China. We measured their blood pressure (BP) and investigated associated factors. Hypertension was defined as an average systolic BP > or =140 mm Hg, and/or an average diastolic BP > or =90 mm Hg, and/or self-report of current treatment for hypertension with antihypertensive medication., Results: The overall prevalence of hypertension in this study was 38.6%. Among those with hypertension, 32.8% were aware that they had high BP, 27.4% were being treated with antihypertensive medications, and in 1.4% of the women the hypertension was controlled. Multivariate analysis revealed that higher age, Mongolian ethnicity, higher body mass index (BMI), higher waist circumference (WC), excessive salt intake, smoking, alcohol consumption, lipid disorder, diabetes, and family history of hypertension were associated with the prevalence of hypertension; a higher level of education (high school or beyond) and a higher income level were inversely related to hypertension prevalence., Conclusions: Our results indicate that hypertension is highly prevalent in rural women in Liaoning province and it is associated with known risk factors. There are unacceptably low percentages of those with hypertension who are aware of their condition, are receiving treatment, and in whom hypertension is controlled. Our study suggests the urgent need for a public health program to improve the prevention, detection, and treatment of hypertension in rural Chinese women.

Background and Purpose: Information has been sparse on the comparison of pulse pressure (PP) and mean arterial pressure (MAP) in relation to ischemic stroke among patients with uncontrolled hypertension. The present study examined the relation among PP, MAP, and ischemic stroke in uncontrolled hypertensive subjects in China., Methods: A total of 6104 uncontrolled hypertensive subjects aged > or = 35 years were screened with a stratified cluster multistage sampling scheme in Fuxin county of Liaoning province of China, of which 317 had ischemic stroke., Results: After multivariable adjustment for age, gender, and other confounders, individuals with the highest quartile of PP and MAP had ORs for ischemic stroke of 1.479 (95% CI: 1.027 to 2.130) and 2.000 (95% CI: 1.373 to 2.914) with the lowest quartile as the reference. Adjusted ORs for ischemic stroke were 1.306 for MAP and 1.118 for PP with an increment of 1 SD, respectively. Ischemic stroke prediction of PP was annihilated when PP and MAP were entered in a single model. In patients aged < 65 years, on a continuous scale using receive operating characteristics curve, ischemic stroke was predicted by PP (P=0.001) and MAP (P<0.001). The area under the curve of PP (0.570, 95% CI: 0.531 to 0.609) differed from the area under the curve of MAP (0.633, 95% CI: 0.597 to 0.669; P<0.05). Among patients aged > or = 65 years, presence of ischemic stroke was only predicted by MAP., Conclusions: PP and MAP were both associated with ischemic stroke. Ischemic stroke prediction of PP depended on MAP. On a continuous scale, MAP better predicted ischemic stroke than PP did in diagnostic accuracy.

Objective: The objective of this study was to assess the prevalence and correlative risk factors of isolated untreated systolic hypertension and other hypertension subtypes among Mongolians and Han rural adults of China., Methods and Results: The study was conducted in 2004-2006 and used a multistage cluster sampling method to select a representative sample. A total of 41,356 people who did not take antihypertensive drugs during the last 2 weeks and aged 35 years or older were examined. A survey on blood pressure and associated risk factors was carried out. Overall, 10.2% of rural adults had isolated systolic hypertension, 6.3% had isolated diastolic hypertension and 15.3% had systolo-diastolic hypertension (Han: 9.8%, 6.2%, 14.7%; Mongolians: 11.6%, 6.4%, 17.6%, respectively). The prevalence of ISH and SDH increased with age. Mongolians had a higher prevalence of ISH and SDH than Han people. Age, gender, BMI, and salt intake were risk factors of ISH and SDH both for Han people and Mongolians., Conclusions: Hypertension was very common in rural people of China, and it was associated with many risk factors. These results place great emphasis on the urgent need for a public health programme to improve the detection, prevention and treatment of hypertension in the rural population of China.

Background: To evaluate the status of overweight and obesity in a Chinese rural adult population and describe relationships between body mass index (BMI) and blood pressure according to JNC-7., Methods: The study was conducted in 2004-2006, used a multistage cluster sampling method to select a representative sample. A total of 45,925 adults, age 35 years or older, were examined. Height, weight and blood pressure were obtained by trained doctors. Overweight and obesity were defined according to the World Health Organization classification and Chinese definition., Results: The prevalence of overweight and obesity were 16.3% and 1.3% in males, and 24.4% and 2.7% in females (p for gender differences <0.05) according to the World Health Organization classification; The prevalence of overweight and obesity were 29.5% and 5.3% according to the Chinese definition.The prevalence of elevated blood pressure (prehypertension and hypertension) and mean levels of systolic and diastolic blood pressure increased as BMI increased. Multivariate logistic regression revealed that overweight and obesity were risk factors for prehypertension and hypertension whether in males or females., Conclusions: Overweight and obesity has become very prevalent in the Chinese rural adult population. It is a great health problem. Our study quantifies the strong associations of BMI and elevated blood pressure. It is time to pay more attention to overweight and obese in the county of China.

Objective: To evaluate the risk factors for peripheral arterial disease (PAD) and the relationship of low ankle brachial index (ABI) to all-cause and cardiovascular disease (CVD) mortality in Chinese male patients with hypertension., Methods: The data of 1606 male participants with hypertension from the eight hospitals in Beijing and Shanghai were analyzed. ABI was ascertained at baseline by measuring the systolic pressures on bilateral brachial and tibial arteries. ABI < or = 0.9 was used as the diagnostic criteria for PAD identification. The follow-up survey was conducted from November 2005 to January 2006., Results: Of 1606 male participants with hypertension at baseline, 406 (25.3% ) were in low-ABI group and 1200 (74.7%) were in normal-ABI group. Older age, TC, history of diabetes, history of smoking and 2-grade hypertension were associated with low ABI in male patients with hypertension. During the (12.87 +/- 2.94) months follow-up, there were 153 deaths. Of which, 62 were attributable to CVD. Low ABI was associated with adjusted all-cause and CVD mortality risk of 1.728 (1.223-2.441) and 2.388 (1.409-4.046) respectively in Cox regression models. Rate of survival for the low-ABI group was significantly worse than for the normal-ABI group. The risk of all-cause and CVD mortality was increased with the decline of ABI., Conclusion: Low ABI is independently associated with the high risks of all-cause and CVD mortality in Chinese male patients with hypertension. The utility of ABI as a tool for predicting mortality in the patients with hypertension should be popularized.

Liaoning Province is located in northeast China, which has distinct weather conditions, geographic characteristics and lifestyles compared with other regions of the country; the lifestyle differences are especially pronounced in the rural parts of this region, where there is a dearth of financial and other resources. However, information on the prevalence, awareness, treatment, and control of hypertension in these impoverished areas is very scarce. We therefore performed multistage cluster random sampling of a group of 29,970 adult residents (>or=5 years of residency; >or=35 years of age) of the rural portions of Liaoning Province from 2005 to 2006. The sampling included a survey on blood pressure and associated risk factors. The overall prevalence of hypertension in the community was 36.2%, and 73.0% of hypertensives were unaware of their condition. Among the total group of hypertensives, only 19.8% were taking prescribed medication to lower their BP, and 0.9% had controlled hypertension. Of all subjects, 46.4% did not think that high blood pressure would endanger their lives. As to the reasons given by hypertensives who were aware of their hypertension for not taking antihypertensive medication, 47.4% reported that they lacked knowledge about the mortality of hypertension. The average salt intake in hypertensives was 16.6+/-9.9 g/day, and the percentages of smoking (44.3%), drinking (31.7%) and salt intake>6 g/day (86.8%) in hypertensives were high. Logistic regression analysis indicated that the relative risks (95% confidence interval [CI]) of overweight, obesity, smoking, drinking, increased salt intake and family history of hypertension for hypertension were 1.95 (range, 1.82-2.08), 2.92 (2.40-3.55), 1.19 (1.12-1.27), 1.16 (1.08-1.25), 1.26 (1.20-1.33) and 2.85 (2.66-3.05), respectively. A higher education level was found to be a protective factor. In conclusion, the prevalence of hypertension in adults living in the rural parts of Liaoning Province was high, and the rates of awareness, treatment, and control were unacceptably low, which may have been due to unique geographical characteristics, unwholesome lifestyles, greater sodium intake, lower education levels, and genetic risk factors.

Background: Though large epidemiological studies have not established associations between blood lipids and ischemic stroke, increasing evidences have suggested that lipid-modifying agents may reduce cerebrovascular events., Aims: To determine whether blood lipids are risk factors for ischemic stroke among hypertensive rural adults in China., Settings and Design: A cross-sectional survey was conducted during 2004-2006, which underwent cluster multistage sampling to a hypertensive resident group in the countryside of China., Materials and Methods: A total of 6,412 individuals (2,805 men, 3,607 women) with age>or=35 years were included. At baseline, lifestyle and other factors were obtained and blood lipids were assessed at a central study laboratory. Ischemic stroke was defined according to the criteria established by the National Survey of Stroke and all cases were further classified into lacunar infarction and other ischemic strokes., Statistical Analysis: Univariable and multivariable logistic regression were used., Results: In the univariable logistic regression model, LDL cholesterol (LDLc) in men and total cholesterol (TC), LDLc and TC-to-HDL cholesterol (TC: HDLc ratio) in women were risk factors for other ischemic strokes, with OR 1.42 (95% CI, 1.16-1.75), 1.31 (95% CI, 1.11-1.55), 1.47 (95% CI, 1.16-1.88) and 1.67 (95% CI, 1.28-2.14), respectively. After adjusting for independent variables, an increase in non-HDL cholesterol (non-HDLc) was associated with a significant increased risk of other ischemic strokes in women, with adjusted OR 1.45 (95% CI, 1.08-1.93)., Conclusions: LDLc was the common risk factor for ischemic stroke in men and women, whereas Non-HDLc, TC and TC: HDLc ratio levels were related to ischemic stroke as risk factors only in women.

Background: Dyslipidemia plays a crucial rule in the development of cardiovascular disease, which has become the leading cause of death in most developed countries as well as in developing countries. This study was designed to investigate the epidemiological features of dyslipidemia in rural adults with hypertension in China., Methods: A cross-sectional survey was conducted during 2004-2006 through a cluster multistage sampling to a resident group of 6,412 individuals (2,805 men, 3,607 women) with hypertension, aged >/=35 years, in the countryside of Liaoning, China. Serum lipids levels were proposed by National Cholesterol Education Program Adult Treatment Panel III., Results: Of the study population 34.4% had borderline high total cholesterol (TC), 16.9% had high TC, and 8.8% had low high-density lipoprotein cholesterol (HDL-C). The population with borderline high, high, and very high low-density lipoprotein cholesterol (LDL-C) was 15.7, 3.5, and 0.9%, respectively. In addition, 15.9% had borderline high triglycerides (TG), 17.8% had high TG and 2.0% had very high TG. After adjusting for independent variables, TC and TG had the same risk with fasting plasma glucose (FPG) and body mass index. Risk factors of TC and LDL-C were women, age and FPG. Mongolia nationality as a protective factor positively correlated with TC, LDL-C, and TG. Women, age, drinking, and classification of blood pressure were protective factors but Mongolia nationality was a risk factor for HDL-C., Conclusions: This study demonstrated that the prevalence of dyslipidemia was relatively high among rural hypertensive patients in China and there were many modifiable risk factors for dyslipidemia such as hypertension, weight, and impaired glucose metabolism. To prevent dyslipidemia and to reduce the increasing burden of cardiovascular disease in rural areas with the undeveloped economy of China, the first aim for us is to reduce these risk factors.

Background: Prehypertension is a new category of blood pressure (BP) classification according to the Seventh Report of The Joint National Committee. Little is known about the epidemiology of prehypertension in rural China. The purpose of the present study is to determine the prevalence of prehypertension and associated risk factors in rural adult people of China., Methods and Results: Through cluster multistage and random sampling method, a resident group of 29,970 people aged > or =35 years old in Liaoning Province was selected from 2004 to 2005. The survey on BP and associated risk factors was carried out. Prehypertension was defined as systolic BP between 120 and 139 mmHg or diastolic BP 80 and 89 mmHg. Overall, the prevalence of prehypertension was 47.0%, males 51.2% and females 42.6%, respectively. The prevalence of hypertension was 36.2%. Multivariable logistic regression showed overweightness, obesity and drinking were risk factors of prehypertension. Female and greater than high school education status were shown as protective factors., Conclusions: The prevalence of prehypertension of rural adult people in China is dramatically high and it was associated with many risk factors. Comprehensive lifestyle modifications are needed to be taken to decrease the incidence of prehypertension and to prevent prehypertension people from hypertension and cardiovascular disease.

Background: The objective of this study was to estimate the prevalence of prehypertension and hypertension in the rural adults of Liaoning province of China., Methods: The study was conducted in 2004-2006, using a multistage cluster sampling method to select a representative sample. A total of 45925 adults, 35 years or older, were examined. Two blood pressure measurements were obtained by trained observers by use of a standardized electric sphygmomanometer after a 5-min sitting rest. Information on the history of hypertension was obtained by use of a standard questionnaire., Results: Overall, the prevalence of prehypertension was 44.1%; for men 48.7 and women 39.6%. The prevalence of hypertension was 37.8%; for men 37.0 and women 38.6%. Among hypertensive patients, only 29.5% patients were aware of their high blood pressure, 23.6% patients were taking antihypertensive medication, and 1.1% patients achieved blood pressure control., Conclusions: Prehypertension and hypertension are highly prevalent in rural areas of China. The percentage of those with hypertension who are aware, treated, and controlled are unacceptably low. These results underscore the urgent need to develop strategies to improve prevention, detection, and treatment of hypertension in rural areas of China.

Objective: The purpose of this study was to compare the association of pulse pressure (PP) and mean arterial pressure (MAP) with stroke in uncontrolled hypertensive subjects., Methods: A total of 9,901 uncontrolled hypertensive subjects were included in a cross-sectional study in 62 villages of Fuxin county of Liaoning Province, China., Results: Among the 9,901, 406 cases of ischemic stroke and 145 cases of cerebral hemorrhage were identified. Older age, male gender, increased SBP, higher DBP, and history of hyperlipemia were positively associated with both ischemic stroke and cerebral hemorrhage by multivariate logistic regression analysis. However, the odds rations (ORs) of drinking for ischemic stroke and cerebral hemorrhage were 0.407 (95%CI: 0.304-0.544) and 0.595 (95%CI: 0.377-0.940), respectively. An increase of 10 mmHg of MAP had ORs of 1.430 (95%CI: 1.332-1.535) for ischemic stroke and 1.359 (95%CI: 1.220-1.514) for cerebral hemorrhage. The OR of PP (per 10 mmHg increase) for ischemic stroke was 1.085 (95%CI: 1.026-1.148). Subjects with the fourth quartile of PP and MAP had ORs of 1.555 (95%CI: 1.127-2.146) ischemic stroke and 5.127 (95%CI: 3.452-7.616) for cerebral hemorrhage, with the first quartile as the reference group. The OR of the fourth quartile of MAP for cerebral hemorrhage was 5.935 (95%CI: 2.932-12.012). There was no significant association between PP and cerebral hemorrhage. In sensitivity analysis, ORs of standard MAP for ischemic stroke were higher than those of PP in each stratified age subgroup., Conclusions: Increased MAP and PP were significant markers of ischemic stroke and cerebral hemorrhage was only associated with increased MAP. MAP was more closely associated with stroke than PP in patients with uncontrolled hypertension.

Objective: The prevalence of hypertension in individuals with diabetes mellitus is higher than that in individuals without diabetes mellitus. High fiber intake decreases blood glucose and lipids levels. This study investigated the effects of cereal fiber intake on systolic and diastolic blood pressures in a rat model of type 2 diabetes mellitus., Methods: Thirty male Goto Kakizaki rats were randomly assigned to one of three groups. Each group was fed a barley diet, a white rice diet, or cornstarch diet. The rats were pair fed for 16 wk. Systolic and diastolic blood pressures were measured once every 4 wk by the photoelectric oscillometric tail-cuff method without anesthesia., Results: The barley diet significantly decreased systolic blood pressure from week 12 and decreased the plasma levels of total cholesterol, triacylglycerol, and low-density lipoprotein cholesterol. There were significant positive correlations between plasma lipids levels and systolic blood pressure., Conclusions: High fiber intake has beneficial effects on systolic blood pressure and blood lipids levels and suggests that fiber intake should be increased in individuals who have diabetes mellitus to prevent complications.

Background: Although hypertension is highly prevalent in China, epidemiologic data of hypertension among people with disabilities remain largely unknown. This study aims to examine the prevalence and associated risk factors of hypertension in patients with disabilities. Methods: A cross-sectional study was carried out among 7348 adults with disabilities from February to December 2018 in Shanghai, and patient data from physical, imageological and routine blood examinations were collected and analyzed. Logistic regression models were performed to determine the associated risk factors of hypertension in adults with disabilities. Results: Among the 7348 disabled patients, the prevalence of hypertension, rate of receiving treatment, and blood pressure control were 42.5%, 85.0% and 46.0%, respectively. Increases in the levels of age, physical disability, body mass index (BMI), fasting plasma glucose (FBG), total triglyceride (TG), hyperuricemia (hyper-UA), serum urea (SU), and estimated creatinine clearance (eCrCl < 80 μmol/L) were independently correlated with hypertension. Conclusion: Patients with physical disabilities have a significantly higher prevalence of hypertension compared to the normal population. Patients with intellectual or mental disabilities have lower rates of blood pressure control compared to other types of disabilities. Assessment of associated risk factors highlights an increased likelihood of potential renal dysfunction among hypertensive disabled patients. [ABSTRACT FROM AUTHOR]

Objectives: Quantitative associations between prehypertension or its two separate blood pressure (BP) ranges and cardiovascular disease (CVD) or all-cause mortality have not been reliably documented. In this study, we performed a comprehensive systematic review and meta-analysis to assess these relationships from prospective cohort studies. Methods: We conducted a comprehensive search of PubMed (1966-June 2012) and the Cochrane Library (1988-June 2012) without language restrictions. This was supplemented by review of the references in the included studies and relevant reviews identified in the search. Prospective studies were included if they reported multivariate-adjusted relative risks (RRs) and corresponding 95% confidence intervals (CIs) of CVD or all-cause mortality with respect to prehypertension or its two BP ranges (low range: 120–129/80–84 mmHg; high range: 130–139/85–89 mmHg) at baseline. Pooled RRs were estimated using a random-effects model or a fixed-effects model depending on the between-study heterogeneity. Results: Thirteen studies met our inclusion criteria, with 870,678 participants. Prehypertension was not associated with an increased risk of all-cause mortality either in the whole prehypertension group (RR: 1.03; 95% CI: 0.91 to 1.15, P = 0.667) or in its two separate BP ranges (low-range: RR: 0.91; 95% CI: 0.81 to 1.02, P = 0.107; high range: RR: 1.00; 95% CI: 0.95 to 1.06, P = 0.951). Prehypertension was significantly associated with a greater risk of CVD mortality (RR: 1.32; 95% CI: 1.16 to 1.50, P<0.001). When analyzed separately by two BP ranges, only high range prehypertension was related to an increased risk of CVD mortality (low-range: RR: 1.10; 95% CI: 0.92 to 1.30, P = 0.287; high range: RR: 1.26; 95% CI: 1.13 to 1.41, P<0.001). Conclusions: From the best available prospective data, prehypertension was not associated with all-cause mortality. More high quality cohort studies stratified by BP range are needed. [ABSTRACT FROM AUTHOR]