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The purpose of our study was to explore the association of blood pressure (BP) changes on short-and long-term outcomes of major adverse cardiovascular events (MACEs) in rural China. This study was designed to learn the effects of BP changes (2004-2008) on short-term (2008-2010, within 2 years of the initial examination) and long-term (2008-2017) outcomes of MACE, including 24 285 and 27 290 participants, respectively. In this study, 423 (short-term) and 1952 (long-term) MACEs were identified. For prehypertension to hypertension, the risk of long-term stroke was increased (hazard ratio [HR] = 1.18 [1.00-1.39]). For hypertension to prehypertension, the short-term MACE risk (0.65 [0.47-0.90]), short-term stroke risk (0.45 [0.26-0.76]), and long-term stroke risk (0.83 [0.70-0.99]) all decreased. Short-term outcomes conferred a stronger impact than long-term outcomes (Fisher Z test, measured as the difference of β coefficients, all P <.05). [ABSTRACT FROM AUTHOR]

Background The study was performed to investigate the impact of prehypertension defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) on the risk of major adverse cardiovascular events (MACE) in a Chinese rural cohort. Methods The epidemiological prospective cohort study included 38,765 participants aged ≥35 years followed for a median of 12.5 years—divided into normal BP (n = 7,366), prehypertension (n = 18,095), and hypertension groups (n = 13,304)—were enrolled for the final analysis. Follow-up for MACE including cardiovascular disease (CVD) death, stroke and myocardial infarction (MI) was conducted. Adjusted Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results The age and sex-adjusted incidence of MACE and its subtypes rose progressively with elevation of BP levels (P < 0.001). After adjusting multivariable Cox proportional hazards, significant increases were observed from the prehypertensive group for incident MACE (HR = 1.337, 95% CI: 1.186–1.508, P < 0.001), CVD mortality (HR = 1.331, 95% CI: 1.109–1.597, P = 0.002), and stroke (HR = 1.424, 95% CI：1.237–1.639, P < 0.001) but not MI (P > 0.05) compared with normal BP. Conclusion Prehypertensive individuals had a greater risk of incident MACE, CVD mortality, and stroke, implying that improvements in BP monitoring and early intervention in individuals with prehypertension in rural China are urgently needed. [ABSTRACT FROM AUTHOR]

Background: Even though the effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention of hypertension and its complications have been demonstrated in randomized controlled trials, the benefits of adhering to these treatments have not been popularized among the general public. Studies suggest that incentive approaches based on behavioral economic concepts can improve patients' adherence to treatment. Therefore, we aimed to test whether financial incentives will reduce the blood pressure (BP) of hypertensive patients in China.Methods/design: This is a multicenter, randomized controlled trial with two parallel arms. A total of 400 participants from six cities in the Liaoning and Shanxi provinces of China are block-randomized into intervention and control group with a 1:1 ratio. Patients in the control group will receive interactive management of mobile devices, including patient education and communication. Patients in the intervention group will receive financial incentives in addition to interactive management of mobile devices, conditional on them achieving their antihypertensive goals or hypertension control. Masking the arm allocation will be precluded by the behavioral nature of the intervention and investigators of BP measurement and statistics are masked to clinic assignment. The primary outcome is net change in systolic BP (SBP) from baseline to month 12 between the intervention and control groups. The secondary outcomes are net change in diastolic BP (DBP), BP control, change in medication adherence and lifestyle, and cost-effectiveness.Discussion: This trial will determine whether financial incentives will improve hypertension control and generate necessary data for controlling hypertension and concomitant cardiovascular diseases among hypertensive patients in China.Trial Registration: ISRCTN13467677. Registered on 16 May 2019. [ABSTRACT FROM AUTHOR]

Background: The new ACC/AHA hypertension guideline lower the definition of hypertension from 140/90 mmHg to 130/80 mmHg and eliminate the category of prehypertension thus increasing the prevalence of hypertension. A purpose of this study is to explore the applicability of the new guidelines in rural China.Methods: In total, 3229 participants aged ≥35 years and free of stroke at baseline were followed for up to 4.8 years during 2012 to 2017 in a rural community-based prospective cohort study of Xifeng County. The hazard ratio (HR) and 95% Confidence interval (CI) of different blood pressure (BP) levels for risk of incident stroke were analyzed by multivariable Cox proportional hazard models.Results: During the follow-up, 81 new strokes occurred among the 3229 participants. Compared with normal BP (Systolic BP (SBP)<120 mmHg and Diastolic BP (DBP)<80 mmHg), stage 2 hypertension (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg) had approximately 2.1 greater risks for stroke (HR: 2.10, 95% CI: 1.13 to 3.91, P = 0.020). However, there was no significant association between elevated (SBP:120-129 mmHg and DBP<80 mmHg), stage1 hypertension (SBP:130-139 mmHg or DBP:80-89 mmHg) and stroke incidence (HR: 0.93, 95% CI: 0.33 to 2.61, P = 0.888; HR: 0.96, 95% CI: 0.46 to 2.02, P = 0.920, respectively). An increase of the SBP by 1-SD increases the risk for stroke by 56% (HR: 1.56, 95%CI: 1.29 to 1.88, P < 0.001). An increase of the SBP by 20 mmHg increases the risk for stroke by 51% (HR: 1.51, 95%CI: 1.27 to 1.80, P < 0.001).Conclusions: Compared with normal BP, the stage 2 hypertension based on 2017 ACC/AHA guideline significantly increases the risk of stroke incidence, but this association was not observed between elevated, stage1 hypertension and stroke incidence in Chinese rural adults. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

Abstract: 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. [Copyright &y& Elsevier]

Background: Few studies investigate sex difference in stroke incidence in rural China hypertensive population. Methods: A total of 5097 hypertensive patients aged ≥35 years (mean age, 56.3 ± 11.2 years; 43.8% men) were included in our analysis with a median follow-up 8.4 years in Fuxin county of Liaoning province in China. Cox proportional hazard models were used to analyze the association between the potential factors and incident stroke. Results: We observed 501 new strokes (310 ischemic, 186 hemorrhagic, and 5 unclassified stroke) during the follow-up. The overall incidence of stroke was 1235.21 per 100,000 person-years; for men, the rates were 1652.51 and 920.80 for women. This sex difference in all stroke can be explained by approximately 25% through age, systolic blood pressure, body mass index, low-density lipoprotein-cholesterol, current smoking, current drinking, antihypertensive drugs, education and physical activity. Subgroup analysis indicated that in hemorrhagic stroke this sex difference was more remarkable (63.89% can be explained). Conclusions: The incidence of stroke was higher in men than that in women and this difference was partly explained by several traditional cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Abstract: 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 &y& Elsevier]

Background: The sex difference in the association between grip strength and mild cognitive impairment (MCI) remains controversial and unclear., Methods: This is a part of a chronic disease cohort study conducted in rural areas, Fuxin, Liaoning Province, China. At the baseline survey, a total of 2633 participants aged 35- 85 were included in the cross-sectional study. Handgrip strength (HGS, kg) was measured by a dynamometer (Jamar +). MCI were assessed using the Chinese version of the Montreal Cognitive Assessment-Basic (MOCA-BC). Then, a total of 1667 cognitively normal individuals (NCs) were planed to follow up and to assess the incident MCI after two years. We used logistic regression to examine the association between HGS (as a continuous variable and quintiles) and MCI and analyzed the interaction between sex and HGS on MCI. Models stratified by sex were adjusted for demographic information (age, ethnicity, education, marital status, income, physical labor level), modifiable risk factors (body mass index, smoking, drinking) and disease history (hypertension, diabetes, dyslipidemia and coronary heart disease). Baseline MOCA-BC scores were additionally adjusted in the longitudinal study., Results: In the cross-sectional study, participants were on average 56.6 ± 9.8 years, and 1713 (65.1%) were females. In the cohort study, 743 individuals were followed up with an average age of 55.9 ± 9.6 years, which included 530 (71.3%) females. The cumulative incidence of MCI over a two-year period was 17.1%. In the cross-sectional study, compared to the highest quintile of HGS, the lowest HGS was associated with higher risk of MCI in males (odds ratio [OR]: 2.66; 95% confidence interval [CI]: 1.54, 4.64) and females (OR: 1.70; 95% CI: 1.17, 2.49) with adjustment of potential confounding factors. In the cohort study, compared to the highest quintile of HGS, the lowest HGS was associated with an increased risk of incident MCI in females (OR: 3.93; 95% CI: 1.39, 13.01) but not in males (OR: 0.56; 95% CI: 0.11, 2.94, P  for interaction  = 0.015)., Conclusions: Lower grip strength is a risk factor for mild cognitive impairment and predicts a higher risk of MCI in females., (© 2023. The Author(s).)

Background and Aims: Little is known about the long-term trends in ethnic differences in cardiovascular health (CVH) in China in recent years. This study aimed to investigate ethnic differences in CVH and identify long-term trends in China., Methods and Results: This survey was based on the physical examination data of Tacheng Prefecture in China from 2016 to 2020, and included 1,947,938 physical examination participants aged over 20 years for analysis. The American Heart Association (AHA) criteria were used to evaluate the clinical CVH of the subjects. The time trends from 2016 to 2020 were assessed using a weighted linear regression model stratified by ethnicity. The ethnic groups included Han, Kazakh, Hui, Mongolian, Uyghur, among others. The mean ideal clinical cardiovascular score was highest in Hui and lowest in Uyghur. The scores increased from 5.99 (5.95-6.03) to 6.11 (6.08-6.14) in Kazakh males and from 6.05 (5.99-6.11) to 6.11 (6.06-6.16) in Hui males among participants (P linear trend < 0.001). The scores for the other groups declined significantly from 2016 to 2020(P linear trend ＜ 0.05). In the sensitivity analysis, the trend remained unchanged after calculating the body mass index (BMI) cut-off for China., Conclusion: Clinical CVH differences still exist among different ethnic groups, with a decline in CVH from 2016 to 2020 in all except Kazakh and Hui males. This may indicate a higher incidence and poorer prognosis of cardiovascular disease in the future and can provide guidelines for improving CVH., Competing Interests: Declaration of competing interest None declared., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Traditional risk estimations for cardiovascular disease (CVD) are based on current blood pressure (BP); however, whether cumulative exposure to elevated BP among rural individuals has additional prognostic value is unclear. We aimed to validate the association of cumulative BP with CVD occurrence and assess the prognostic value of cumulative BP in CVD risk prediction., Methods: A total of 13,057 participants who underwent three examinations from 2004 to 2010 were included in this rural epidemiological study and followed up until 2017. Cumulative BP was defined as the sum of the product of the average BP values between consecutive examinations and the time interval for each pair of successive tests prior to the follow-up period. CVD incidents that occurred during the follow-up period were noted and verified by qualified researchers. We used multivariate Cox models to assess the association of cumulative BP with CVD risk. The receiver operating characteristic curve was constructed to determine the predictive differentiation of single baseline BP measurements and cumulative BP values for CVD outcomes., Results: During the follow-up period, 1,312 participants underwent CVD incidents. We found that cumulative systolic BP (hazard ratio = 1.334, 95% confidence interval: 1.245, 1.430) and cumulative diastolic BP (hazard ratio = 1.253, 95% confidence interval: 1.168, 1.343) were associated with CVD incidence above and beyond that of the current BP. These stronger associations persisted for stroke, myocardial infarction, and CVD mortality. The area under the curve for the model increased significantly ( p < 0.001) from 0.735 (0.720, 0.750) to 0.742 (0.728, 0.757) when integrating cumulative systolic BP instead of baseline systolic BP., Conclusion: Cumulative BP in Chinese rural adults showed a stronger association with CVD incidence than that of current BP. Furthermore, cumulative BP slightly improved the predictive performance for CVD. Our findings underline the incremental predictive value of cumulative BP in CVD risk assessment among Chinese rural adults., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wang, Zhang, Jiao, Zheng, Sun and Sun.)

Background: Poorly controlled hypertension is a great challenge to global public health. Incentive approaches, based on behavioral and economic concepts, may improve patients' adherence to treatment., Methods: We conducted a 2-arm randomized controlled trial to test whether financial incentives can help patients with poorly controlled hypertension in China reduce their blood pressure (BP). Participants were randomized 1:1 to the control and intervention groups. All participants received WeChat-based standard education and support for hypertension management. The intervention group received financial incentives, including process- and outcome-based incentives., Results: No statistically significant differences in BP reduction and hypertension control rates were found between the two groups from baseline to 12-month follow-up. Mean systolic BP decreased from 158.7 to 149.8 mm Hg in the intervention group and 159.7 to 149.5 mm Hg in the control group ( P =0.639). Mean diastolic BP decreased from 93.7 to 86.6 mm Hg in the intervention group and 93.9 to 86.3 mm Hg in the control group ( P =0.667). Hypertension control rates in the intervention and control groups were 20.8% and 15.8%, respectively ( P =0.318). Medication adherence was 84.2% in the intervention group and 86.2% in the control group ( P =0.705)., Conclusions: Financial incentives were effective in the short term for BP control, but a sustained effect of incentive-based BP control was not identified beyond 3 months of intervention. Future studies that focus on identifying the appropriate amount and structure of financial incentives for BP control are warranted., Registration: URL: www.isrctn.org; Unique identifier: ISRCTN13467677.

There has been no evidence on the effects of birth season and birth month on mortality in China. We aimed to explore the association between birth season, birth month and all-cause and cardiovascular disease (CVD) death. A population-based sample of 21,338 Chinese rural participants aged ≥35 years at baseline was included in our analysis. Age and multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the relationship between astronomical birth season (autumn as the reference), birth month (November as the reference), and all-cause and CVD mortality. During a median follow-up period of 11.9 years, 2,207 people died from all-cause and 1,214 people were attributed to CVD death. In multivariable adjusted analyses, for all-cause death, spring and winter had HRs (95% CIs) of 1.134 (1.005-1.280) and 1.162 (1.038-1.301), respectively; January, March, May, and August had HRs (95% CIs) of 1.249 (1.027-1.518), 1.234 (1.008-1.512), 1.276 (1.037-1.571), and 1.232 (1.003-1.513), respectively. For CVD death, spring and winter with HRs (95% CIs) of mortality were 1.232 (1.048-1.449) and 1.174 (1.007-1.369), respectively; March with HR (95% CI) of mortality were 1.343 (1.030-1.750) (all P < 0.05). Our study indicated that people born in the winter or spring were significantly associated with all-cause and cardiovascular disease mortality in rural areas of China., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Background and Aims: Most studies assess the relationship between alcohol and stroke at some point. Little is known about the effect on stroke of drinking status changes over time. This study aimed to examine the association of median 2.4-year drinking status changes with risk of stroke., Methods and Results: We examined 22,691 adults from rural China. Drinking status was assessed at 2004-2006 and in 2008. Participants were divided into four change patterns: consistent non-drinkers, abstainers, starters, and consistent drinkers. A Cox proportional hazards model were performed. We observed 1215 cases of stroke during a median follow-up period of 11.8 years. A faint J-shaped association between alcohol consumption and risk of stroke was found in this population. Based on the amount of alcohol consumption, only current drinkers with ≥721 g/week at baseline in both males and females had a higher risk of stroke [hazard ratio (HR): 1.342; 95% confidence interval (CI): 1.070-1.683 and HR: 2.130; CI: 1.041-4.357, respectively]. Based on change patterns, Compared with consistent non-drinkers, the HR (95% CI) for consistent drinkers, abstainers and starters was 1.298 (1.070-1.576), 1.093 (0.877-1.362) and 1.263 (1.034-1.543), respectively. The same trend was observed in male. The HR (95% CI) for consistent drinkers, abstainers and starters was 1.360 (1.098-1.685), 1.139 (0.883-1.470) and 1.364 (1.092-1.703), respectively. No difference was observed in females., Conclusion: High alcohol consumption was associated with increased risk of stroke in both males and females. However, based on change patterns, consistent drinkers and starters were at higher risk of stroke only in males., Competing Interests: Declaration of competing interest None., (Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background and Aims: Obesity-related diseases play a significant role in the epidemiology of stroke; however, the exact effects of obesity and transitions in obesity status on stroke risk are still unclear. This study was performed to investigate the association of general and abdominal obesity and their changes with stroke in Chinese adults., Methods and Results: A total of 26,815 subjects (13,684 men and 13,131 women) aged ≥35 years participated in the study. The association of general and abdominal obesity and their changes with stroke was estimated by Cox proportional hazards models. During a median follow-up period of 11.8 years, 1507 people developed an incident stroke event. The multivariable-adjusted hazard ratios (HRs) (95% CIs) for stroke comparing the highest vs. lowest quartiles of these measurements were 1.276 (1.068-1.524) for BMI, 1.245 (1.035-1.499) for WC, 0.940 (0.786-1.125) for WHR, and 1.221 (1.019-1.464) for WHtR in men. For women, the corresponding values were 1.368 (1.089-1.718), 1.424 (1.119-1.813), 0.971 (0.765-1.232), and 1.341 (1.059-1.699), respectively. C- statistics showed no difference in the predictive value for stroke among various measures of adiposity. Compared with participants who maintained a normal BMI, the HRs for reversed general obesity was 1.272 (95% CI: 1.044-1.550) among men and 1.240 (95% CI: 0.948-1.623) among women., Conclusion: Increasing levels of general or abdominal adiposity consistently predict increased risk of stroke, and maintenance of a normal BMI or WC may aid in stroke prevention., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Objectives: The present study estimated the percentage of rural Chinese adults with hypertension and recommended pharmacological antihypertensive treatment according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline compared with the 2010 Chinese Guideline for the Management of Hypertension., Design: Cross-sectional study., Setting: Three counties in rural areas of northeastern China., Participants: A total of 11 747 eligible individuals aged ≥35 years from rural areas of northeastern China were selected for the present analysis., Main Outcome Measures: The percentage of rural Chinese adults with hypertension and recommended pharmacological antihypertensive treatment according to the 2017 ACC/AHA guideline and the 2010 Chinese Guideline for the Management of Hypertension, and the proportion of rural Chinese adults taking antihypertensive medication with blood pressure (BP) above the 2017 ACC/AHA guideline and the 2010 Chinese guideline treatment goal., Results: The mean age of the study population was 53.9±10.8 years and 53.7% of the participants were women. According to the 2017 ACC/AHA guideline and the 2010 Chinese guideline, the crude prevalence of hypertension was 72.2% and 49.8%, respectively, and the percentage of recommended antihypertensive medications for rural Chinese adults was 56.4% and 51.4%, respectively. Among these rural Chinese adults taking antihypertensive medications, 96.7% had above goal BP according to the 2017 ACC/AHA guideline compared with 86.1% with above goal BP according to the 2010 Chinese guideline., Conclusion: The present analysis demonstrated that compared with the 2010 Chinese guideline, the 2017 ACC/AHA hypertension guideline will result in a substantial increase in the percentage of rural Chinese adults defined as having hypertension and a small increase in the percentage of adults who are recommended antihypertensive medications. More intensive management is suggested to improve the control rate of hypertension among rural Chinese adults., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This study aimed to investigate the effect of body mass index (BMI) changes on hypertension among rural areas of China. A population-based sample of 13,263 and 5944 rural Chinese people aged ≥35 years and without hypertension at baseline was included in our analysis of BMI changes (from (2004-2006) to 2008) and short- and long-term outcomes of hypertension (from 2008 to 2010 and 2010 to 2017). The participants were divided into four groups by a comprehensive cross-sectional combination according to baseline BMI (18.5-24 vs. ≥24 kg/m 2 ) and follow-up changes (decreased vs. increased). Adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs). During a median follow-up period of 4.8 (short-term) and 11.7 (long-term) years, 2299 (17.33%) and 2020 (33.98%) participants developed hypertension, respectively. For participants with a baseline BMI ≥ 24 kg/m 2 , when BMI decreased in follow-ups, the multivariable-adjusted HRs (95% CI) of short-term hypertension were 0.898 (0.857-0.942). For baseline 18.5 kg/m 2  ≤ BMI < 24 kg/m 2 , when BMI increased in follow-ups, the risks of short-term hypertension were 1.103 (1.068-1.139). We detected that BMI changes had a lower impact on the incidence of hypertension in long-term than short-term. Our study indicated that BMI changes were significantly associated with the incidence of hypertension for the short-term, and it had a stronger impact on short-term outcomes than long-term. Managing weight by lifestyle modification was particularly important for the primary prevention of hypertension in rural Chinese population.

Objectives: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for high blood pressure (BP) in adults redefined hypertension as SBP at least 130 mmHg or DBP at least 80 mmHg. However, the optimal BP for different BMI population to reduce stroke incidence is uncertain., Methods: A prospective cohort study was designed by four examinations: baseline (2004-2006), 2008, 2010 and 2017 follow-up. The study group composed of 36 352 individuals, to determine the ideal BP range to reduce stroke incidence of two BMI level, adjusted Cox proportional hazards models were utilized to establish the associations between SBP/DBP and the risk of stroke incident. Then, the restricted cubic spline regression was applied to find the ideal range of SBP/DBP values for two kinds of BMI categories definitions., Results: During a median follow-up period of 12.5 years, 2548 (7.0%) nonstroke individuals at baseline developed incident stroke. After fully adjusting confounding factors, SBP (per 20 mmHg increase) and DBP (per 10 mmHg increase) are independently associated with the risk of stroke incidence [SBP, hazard ratio = 1.277, 95% confidence interval (95% CI), 1.217-1.340, P < 0.001; DBP, hazard ratio = 1.138, 95% CI, 1.090-1.189, P < 0.001]., Conclusion: Our study revealed that the ideal BP for a population with BMI less than 24 kg/m was less than 130/80 mmHg, whereas the ideal BP for BMI at least 24 kg/m was less than 120/80 mmHg. The sensitivity analyses between BMI less than 25 kg/m and BMI at least 25 kg/m showed similar findings. This finding provides more accurate primary prevention strategies based on various BMI populations.

To investigate the potential effect of intracoronary administration of the glycoprotein IIb/IIIa inhibitor tirofiban on the microvascular obstruction (MVO) assessed by cardiac magnetic resonance (CMR) imaging compared to the intravenous route in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Two hundred eight patients were randomized into two groups (tirofiban i.v. and tirofiban i.c.). CMR was completed within 3-7 days after ST-segment-elevation myocardial infarction. One hundred thirty-two patients had a follow-up CMR at 6 months after discharge. The primary end point was the CMR measurements including myocardium strain, myocardial perfusion index, final infarct size, prevalence and extent of MVO, and the change of left ventricular end-diastolic volume (LVEDV) at six months follow-up. The second endpoint was major adverse cardiovascular events (composite of all-cause death, nonfatal reinfarction and congestive heart failure) in one year. The MVO prevalence and extent [56% versus 36%, p = 0.004; 2.08 (IQR: 1.18-5.07) g versus 1.68 (IQR: 0.30-3.28) g, p = 0.041] showed a significant difference between the intravenous and intracoronary groups. Global left ventricular peak longitudinal strain was significantly different in intracoronary groups compared to intravenous groups, - 12.5 [IQR: - 13.4 to - 10.9] versus - 12.3 [IQR: - 13.4 to - 10.4], respectively (P = 0.042). Infarcted myocardial perfusion index was significantly different in intracoronary groups compared to intravenous groups, 0.11 [IQR: 0.08 to 0.15] versus 0.09 [IQR: 0.07 to 0.14], respectively (P = 0.026). Intracoronary tirofiban was associated with a higher change in LVEDV compared with intravenous group (- 10.2% [IQR: - 13.7% to - 2.6%] versus 1.3% [IQR: - 5.6% to 6.1%], p < 0.001). Intracoronary tirofiban application showed no benefit on the occurrence of major adverse cardiovascular events during follow-up compared to intravenous administration. This CMR study in ST-segment-elevation myocardial infarction patients showed a benefit in MVO and left ventricular remodeling for intracoronary tirofiban administration compared to intravenous administration in patients undergoing PCI.

Background: The current analysis was performed to estimate the percentage and number of Chinese adults with hypertension and the percentage and number of Chinese adults recommended to receive pharmacological antihypertensive treatment according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline compared with the same parameters according to the 2010 Chinese guideline., Methods: We used 2011 data from the China Health and Nutrition Survey (CHNS). A total of 12,499 Chinese adults aged ≥18 years with complete blood pressure (BP) values were selected for the present analysis., Results: The crude prevalence rates (95% CI) of hypertension according to the definitions from the 2017 ACC/AHA guideline and the 2010 Chinese guideline were 58.0% (57.2 to 58.9%) and 25.4% (24.7 to 26.2%), respectively. Moreover, the percentage of the participants recommended to take antihypertensive medications were 31.5 and 28.8%, respectively. Among adults who took antihypertensive medications, 88.8% had above-goal BP levels compared to 53.3%. Overall, 613.3 million Chinese adults (aged ≥18 years) met the criteria for hypertension according to the 2017 ACC/AHA guideline, and 267.7 million met the criteria according to 2010 Chinese guideline. An additional 28.4 million (2.7%) Chinese adults were recommended to take antihypertensive medication., Conclusions: The present analysis revealed that the 2017 ACC/AHA hypertension guideline will result in a substantial increase in the percentage and number of Chinese adults defined as having hypertension and a small increase in the percentage of adults who are recommended to take antihypertensive medications compared to the same parameters based on the 2010 Chinese guideline. More intensive management and antihypertensive medications use are suggested to improve the control rate of hypertension among Chinese adults.

Background: The 2017 American College of Cardiology and American Heart Association hypertension guideline updated stage 1 hypertension definition as systolic blood pressure range from 130 to 139 mmHg or diastolic blood pressure from 80 to 89 mmHg. However, the association of stage 1 hypertension with stroke and its subtypes among the older population in rural China remains unclear., Methods: This population-based cohort study consisted of 7,503 adults aged ≥60 years with complete data and no cardiovascular disease at baseline from rural areas of Fuxin County, Liaoning province, China. Follow-up for the new cases of stroke was conducted from the end of the baseline survey to the end of the third follow-up survey (January 1, 2007-December 31, 2017). Adjusted Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals with the normal blood pressure as a reference, and calculated population attributable risk was based on prevalence and hazard ratios., Results: During a median follow-up of 12.5 years, we observed 1,159 first-ever incident stroke (774 ischemic, 360 hemorrhagic, and 25 uncategorized). With the blood pressure <120/<80 mmHg as a reference, stage 1 hypertension showed the adjusted hazard ratios (95% confidence intervals) of 1.45 (1.11-1.90) for all stroke, 1.65 (1.17-2.33) for ischemic stroke, and 1.17 (0.74-1.85) for hemorrhagic stroke, respectively. In this study, the population attributable risk values of stage 1 hypertension were 10.22% (2.64%-18.56%) for all stroke and 14.34% (4.23%-25.41%) for ischemic stroke., Conclusion: Among adults aged ≥60 years in rural China, stage 1 hypertension defined by 2017 American College of Cardiology and American Heart Association hypertension guideline was independently associated with the increased risk of all stroke and ischemic stroke, excluding hemorrhagic stroke., Competing Interests: All authors approved the manuscript, and there are no conflicts of interest., (Copyright © 2020 Jinyue Gao et al.)

Background: Thyroid hormones profoundly influence the cardiovascular system, but the effects of mild thyroid dysfunction on the clinical outcome of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) are not well defined. This study aimed to determine the effect of mild thyroid dysfunction on 12-month prognosis in ACS patients undergoing PCI., Methods: In this prospective cohort study with a 12-month follow-up, 1560 individuals were divided into four groups based on thyroid hormone levels upon admission: euthyroidism (used as a reference group), subclinical hypothyroidism, subclinical hyperthyroidism, and low triiodothyronine syndrome (low T3 syndrome). The outcomes measured were all-cause mortality, cardiac mortality, nonfatal rein-farction, and unplanned repeat revascularization., Results: In this study, the prevalence of mild thyroid dysfunction was 10.8%. Multivariate analysis showed that low T3 syndrome, but not subclinical hypothyroidism or subclinical hyperthyroidism, was associated with a higher rate of all-cause (HR 2.553, 95% CI 1.093-5.964, p = 0.030) and cardiac mortality (HR 2.594, 95% CI 1.026-6.559, p = 0.034), compared with the euthyroidism group., Conclusions: Mild thyroid dysfunction was frequent in patients with ACS undergoing PCI. Low T3 syndrome was the predominant feature and was associated with 12-month adverse outcomes in these patients.

The 2017 American College of Cardiology and American Heart Association (ACC/AHA) hypertension guideline updated stage 1 hypertension defined as systolic blood pressure (SBP) of 130-139 mm Hg or diastolic blood pressure (DBP) of 80-89 mm Hg. However, the impact of 1 hypertension that affects future cardiovascular risk remains unclear among older adults in rural China. The prospective cohort study included 7503 adults aged ≥60 years with complete data and no cardiovascular disease (CVD) at baseline. Follow-up for the new adverse events was conducted from the end of the baseline survey to the end of the third follow-up survey (2007.01-2017.12). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for blood pressure (BP) classifications and adverse events with normal BP as reference (< 120/80 mm Hg). During the 57 290 person-years follow-up period, 2261 all-cause mortality, 1271 CVD mortality, 1159 stroke, and 347 myocardial infarctions (MI) occurred. Patients with stage 1 hypertension versus normal BP had HRs (95% CI) of 1.068 (0.904-1.261) for all-cause mortality, 1.304 (1.015-1.675) for CVD mortality, 1.449 (1.107-1.899) for stroke, and 1.735 (1.051-2.863) for MI, respectively. In conclusion, among adults aged ≥60 years, stage 1 hypertension revealed an increased hazard of CVD mortality, stroke, and MI, which is complementary evidence for the application of 2017 ACC/AHA hypertension guidelines in an older Chinese population. Therefore, BP control in patients with stage 1 hypertension may be beneficial to reduce the hazard of CVD in elderly Chinese individuals., (©2019 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals, Inc.)

Background: Elevated blood pressure (BP) is closely related to stroke and its subtypes. However, different time periods changes in BP may result in differential risk of stroke., Hypothesis: Short-term blood pressure changes have a more strong impact on stroke and its subtypes than long-term blood pressure changes., Methods: We designed the study on the effects of short- (2008-2010) and long-term (2004-2010) BP changes on stroke events (2011-2017), including 22 842 and 28 456 subjects, respectively. The difference in β coefficients between short- and long-term BP changes on the effects of stroke were examined using the Fisher Z test., Results: During a median 12.5-year follow-up period, 1014 and 1505 strokes occurred in short- and long-term groups. In short-term group, going from prehypertension to hypertension, the risk of stroke events increased (stroke: hazard ratio [HR] = 1.537 [1.248-1.894], ischemic stroke: 1.456 [1.134-1.870] and hemorrhagic stroke: 1.630 [1.099-2.415]); going from hypertension to prehypertension, the risk of stroke events decreased (stroke:0.757 [0.619-0.927] and hemorrhagic stroke:0.569 [0.388-0.835]). Similarly, in long-term group, going from prehypertension to hypertension, individuals had an increased risk of stroke (1.291, 1.062-1.569) and hemorrhagic stroke (1.818, 1.261-2.623); going from hypertension to prehypertension, participants had a decreased risk of stroke (0.825, 0.707-0.963) and hemorrhagic stroke (0.777, 0.575-0.949). Furthermore, the effects of BP changes during short-term period on stroke events were greater than that in long-term period., Conclusions: Short- and long-terms BP changes were both associated with the risk of stroke events. Furthermore, short-term BP changes had a stronger impact than did long-term changes on risk of stroke events., (© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.)

Background: Little was known about the different predictive power of blood pressure (BP) parameters (SBP, systolic BP; mean arterial pressure, MAP; pulse pressure, PP; and diastolic BP, DBP) and stroke incidence. This study's aim was to compare power of BP parameters predict stroke events among rural dwelling Chinese individuals with hypertension., Method: A total of 5097 hypertension patients (56.2% women; mean age, 56.3 ± 11.2 years) were included in the prospective cohort study with a median follow-up of 8.4 years., Results: Until the end of the last follow-up, there were 501 onset strokes (310 ischemic, 186 hemorrhagic, and 5 unclassified strokes) among the 5097 participants. The results showed that hazard ratio (HR) (95% confidence interval, 95% CI) with an increment of 5 mmHg were 1.095 (1.070-1.121) for PP, 1.173 (1.139-1.208) for MAP, 1.109(1.089-1.130) for SBP, 1.143(1.104-1.185) for DBP. The SBP indicated the largest β coefficient in the Cox proportional hazard model for all stroke except PP or MAP, and the SBP revealed slightly higher value than MAP (β SBP  = 0.435, β MAP  = 0.430, P = 0.756)., Conclusions: Both PP and MAP were predictive factors for stroke. The MAP showed a stronger ability to predict stroke events than PP, and slightly inferior to SBP for hypertension patients.

Objectives: Alkaline phosphatase (ALP) can promote vascular calcification, but the association between ALP and in-hospital mortality in patients with acute coronary syndrome (ACS) is not well defined., Design: A prospective cohort study., Setting and Participants: A total of 6368 patients with ACS undergoing percutaneous coronary intervention (PCI) from 1 January 2010 to 31 December 2017 were analysed., Main Outcome Measures: In-hospital mortality was used in this study., Results: ALP was analysed both as a continuous variable and according to three categories. After multivariable adjustment, in-hospital mortality was significantly higher in Tertile 3 group (ALP＞85 U/L) (OR: 2.399, 95% CI 1.080 to 5.333, p=0.032), compared with other two groups (Tertile 1: ＜66 U/L; Tertile 2: 66-85 U/L). When ALP was evaluated as a continuous variable, after multivariable adjustment, the ALP level was associated with an increased risk of in-hospital mortality (OR: 1.011, 95% CI 1.002 to 1.020, p=0.014). C-statistic of ALP for predicting in-hospital mortality was 0.630 (95% CI 0.618 to 0.642, p=0.001). The cut-off value was 72 U/L with a sensitivity of 0.764 and a specificity of 0.468. However, ALP could not significantly improve the prognostic performance of Global Registry of Acute Coronary Events (GRACE) score (GRACE score+ALP vs GRACE score: C-statistic: z=0.485, p=0.628; integrated discrimination improvement: 0.014, p=0.056; net reclassification improvement: 0.020, p=0.630)., Conclusions: In patients with ACS undergoing PCI, ALP was an independent predictor of in-hospital mortality. But it could not improve the prognostic performance of GRACE score., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Ischemic stroke is a complex disorder resulting from the interplay of genetic and environmental factors. Previous studies showed that kalirin gene variations were associated with cardiovascular disease. However, the association between this gene and ischemic stroke was unknown. We performed this study to confirm if kalirin gene variation was associated with ischemic stroke., Methods: We enrolled 385 ischemic stroke patients and 362 controls from China. Three SNPs of kalirin gene were genotyped by means of ligase detection reaction-PCR method. Data was processed with SPSS and SHEsis platform., Results: SNP rs7620580 (dominant model: OR = 1.590, p = 0.002 and adjusted OR = 1.662, p = 0.014; additive model: OR = 1.490, p = 0.002 and adjusted OR = 1.636, p = 0.005; recessive model: OR = 2.686, p = 0.039) and SNP rs1708303 (dominant model: OR = 1.523, p = 0.007 and adjusted OR = 1.604, p = 0.028; additive model: OR = 1.438, p = 0.01 and adjusted OR = 1.476, p = 0.039) were associated with ischemic stroke. The GG genotype and G allele of SNP rs7620580 were associated with a risk for ischemic stroke with an adjusted OR of 3.195 and an OR of 1.446, respectively. Haplotype analysis revealed that A-T-G,G-T-A, and A-T-A haplotypes were associated with ischemic stroke., Conclusions: Our results provide evidence that kalirin gene variations were associated with ischemic stroke in the Chinese Han population.

In recent years data from many investigations has shown a leveling-off trend in diabetes incidence. In order to explain the diabetes epidemic in rural China during the past ten years, we conducted a survey from July 2012 to August 2013. Data from comprehensive questionnaires, physical examinations, and blood tests were obtained from 5919 residents with hypertension, aged ≥ 35 years. Diabetes and impaired fasting glucose (IFG) were defined according to the American Diabetes Association (ADA) criteria. The overall prevalence of diabetes and IFG were 15.3% (13.6% in men, 16.8% in women) and 40.7% (44.1% in men, 34.7% in women) in the hypertensive rural Chinese population. The prevalence of previously diagnosed diabetes was 6.5% (4.6% in men, 8.4% in women). The prevalence of undiagnosed diabetes was 8.7% (9.0% in men, 8.5% in women). Multivariate logistic regression revealed that increasing age, drinking, overweight or obesity, systolic blood pressure, low HDL-C, high total cholesterol and triglycerides increased the risk of diabetes (p < 0.05). Diabetes is thus still prevalent in rural areas of China and is manifesting an accelerating trend. It remains an important public health problem in China, especially in rural areas and routine assessment for the early detection and treatment of diabetes should be emphasized.

The present study aimed to investigate the association between xanthine dehydrogenase (XDH) gene polymorphism and essential hypertension in the rural Han Chinese population of Fuxin, Liaoning. Han Chinese individuals, who had lived in rural areas of Fuxin, were selected as subjects for the present study. A total of 521 unrelated patients with hypertension were selected, along with a further 533 unrelated individuals with normal blood pressure, in order to serve as controls. Five tag single nucleotide polymorphisms (SNP) of the XDH gene were selected. An estimation of SNP allele frequency was determined using DNA pooling and pyrosequencing methods. Prior to Bonferroni correction, T allele frequency for rs206811 was significantly higher in patients with hypertension, as compared with the controls (64.1 vs. 59.4%; P=0.031); C allele frequency for rs1042039 was significantly higher in patients with hypertension, as compared with the controls (66.1 vs. 60.6%; P=0.011), C allele frequency for rs1054889 was significantly lower in patients with hypertension, as compared with the controls (38.8 vs. 44.8%; P=0.007); and A allele frequency for rs2073316 was significantly lower in patients with hypertension, as compared with the controls (29.2 vs. 34.4%; P=0.013). However, once a Bonferroni correction for multiple testing was applied, the XDH gene polymorphisms rs1042039, rs1054889, and rs2073316 were shown to be associated with hypertension (P=0.044, 0.035, and 0.039, respectively). These results suggest that the XDH gene polymorphisms rs1042039, rs1054889, and rs2073316 may be associated with hypertension in the rural Han Chinese population.

The Eighth Joint National Committee (JNC-8) panel recently recommended a systolic blood pressure (BP) threshold of ≥ 150 mmHg for the initiation of drug therapy and a therapeutic target of <150/90 mmHg in patients ≥ 60 years of age. However, results from some post-hoc analysis of randomized controlled trials and observational studies did not support these recommendations. In the prospective cohort study, 5006 eligible hypertensive patients aged ≥ 60 years from rural areas of China were enrolled for the present analysis. The association between the average follow-up BP and outcomes (all-cause and cardiovascular death, incident coronary heart disease [CHD], and stroke), followed by a median of 4.8 years, were evaluated using Cox proportional hazards models adjusting for other potential confounders. The relationship between BP (systolic or diastolic) showed an increased or J-shaped curve association with adverse outcomes. Compared with the reference group of BP <140/90 mmHg, the risk of all-cause death (hazard ratio [HR]: 2.698; 95% confidence interval [CI]: 1.989-3.659), cardiovascular death (HR: 2.702; 95% CI: 1.855-3.935), incident CHD (HR: 3.263; 95% CI: 2.063-5.161), and stroke (HR: 2.334; 95% CI: 1.559-3.945) was still significantly increased in the group with BP of 140-149/<90 mmHg. Older hypertensive patients with BP of 140-149/<90 mmHg were at higher risk of developing adverse outcomes, implying that lenient BP control of 140-149/<90 mmHg, based on the JNC-8 guidelines, may not be appropriate for hypertensive patients aged ≥ 60 years in rural areas of China.

This study aimed to determine the present status of prehypertension in rural China. It was conducted between January and August 2013, using a multistage clustering method to select a representative sample of individuals (≥35 years old), resulting in a study population of 11,576 adults. Prehypertension was defined as a systolic blood pressure (BP) in the range of 120 mm Hg to 139 mm Hg and/or a diastolic BP between 80 mm Hg and 89 mm Hg according to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). The results showed that the mean±standard deviation systolic and diastolic BP values for the entire population were 141.8±23.5 mm Hg and 82.1±11.8 mm Hg, respectively. Among the whole population, 35.1% of men and 32.5% of women were prehypertensive. Multiple logistic regression analysis showed that high body mass index, advanced age, alcohol consumption, diabetes, high triglyceride and low-density lipoprotein cholesterol levels, and elevated diet score were risk factors for prehypertension. This study indicates that there is a high prevalence of prehypertension in rural China and confirms the importance of healthy lifestyles--including the control of obesity, diabetes, and dyslipidemia--to decrease the incidence of prehypertension., (© 2014 Wiley Periodicals, Inc.)

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: 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.

Background: The aim of this study was to describe the incidence, clinical sub-types, and associated risk factors of stroke among rural Chinese adults., Methods: A population-based sample of 38 949 rural Chinese adults, aged ≥35 years and free from stroke at baseline, were followed from 2004-2006 to 2010. Stroke was defined by the World Health Organization diagnosis criteria., Results: The age-standardized incidence rates per 100 000 person-years of overall, first ever stroke was 601·9 (95% confidence interval, 528·3 to 675·5), and mortality rate was 276·7 (95% confidence interval, 251·6 to 301·9). The age-standardized incidence rate was higher in men (775·9 per 100 000 person-years) than in women (435·6 per 100 000 person-years). Among 858 first ever stroke events, 56·3% were ischemic strokes, 40·6% were hemorrhagic strokes, and 3·1% were undetermined strokes. Hypertension and lipid disorder were common modifiable risk factors in the ischemic stroke and hemorrhagic stroke groups., Conclusions: The annual incidence of stroke and resulting mortality has increased at an accelerated rate. Furthermore, the incidence of stroke in rural China was higher than that found in urban China and Western countries. Hypertension and lipid disorder were important modifiable risk factors. The primary sub-type of stroke observed in rural China was ischemic stroke. These findings underscored the need for more aggressive efforts to control the risk factors of stroke and other cardiovascular diseases in rural areas., (© 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.)

Background: We determined the prevalence and risk profiles of being overweight or obese among children and adolescents in rural northeast China., Methods: We conducted a cross-sectional study consisting of 4,094 children and adolescents aged 5-18 y. Anthropometric measurements and information on health-related variables were collected by well-trained personnel. Odds ratios (ORs) are presented with 95% confidence intervals (CIs)., Results: The overall prevalence of subjects who were overweight or obese was 21.8% (15.4% overweight and 6.4% obese). Among boys, getting more sleep was found to be a protective factor against being overweight or obese, and a higher monthly family income (2,000-5,000 Chinese yuan (CNY); 1 CNY = 0.163 US dollar) was associated with an increased risk as compared with lower incomes. For girls, not having breakfast every day conferred higher odds of being overweight or obese (OR, 1.45 (95% confidence interval (CI), 1.11-1.91)). When both parents were overweight, this increased the risk of a child being overweight or obese in both boy (overweight father: OR, 1.54 (95% CI, 1.26-1.89); overweight mother: OR, 1.73 (95% CI, 1.35-2.22)) and girl participants (overweight father: OR, 2.01 (95% CI, 1.57-2.57); overweight mother: OR, 1.45 (95% CI, 1.07-1.96))., Conclusion: The prevalence of pediatric obesity in rural China was relatively high. Risk profiles should be fully considered when planning prevention and treatment programs for pediatric obesity.

Unlabelled: Little is known about the prevalence and risk profile of prehypertension among Chinese children and adolescents. The aim of the present study was to investigate the prehypertensive status and its associated risk factors among rural Chinese children and adolescents. We conducted a cross-sectional study including 5,245 children and adolescents (2,732 boys and 2,513 girls) aged 5-18 years in Northeast China. Main anthropometric data and related information were collected. The overall prevalence of prehypertension and hypertension was 15 % and 20.2 %, respectively. The prevalence of prehypertension among boys was 15.7 %, compared to that of 14.2 % among girls (P = 0.256). After adjusting for age, race, weight status, waist circumference, triceps skinfold, family income, smoking and drinking status, boys aged 12-14 and 15-18 years had a 2.86- and 5.97-fold risk of prehypertension, respectively, compared to those aged 5-8 years. Overweight and obese boys had an increased risk of prehypertension in comparison to those with normal weight (overweight: odds ratio [OR] = 1.837, 95 % confidence interval [CI] 1.321-2.556; obese: OR = 2.941, 95 % CI 1.783-4.851). A larger triceps skinfold (≥90th percentile) was significantly related to increased odds of prehypertension (OR = 2.32; 95 % CI, 1.516-3.55) among boys. For girls, only older age was found to be a risk factor for prehypertension., Conclusion: Pediatric prehypertension is highly prevalent in rural Northeast China. The risk factors for prehypertension differed among boys and girls. A more comprehensive risk profile of prehypertension among children and adolescents needs to be established for early prevention.

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: The present study was undertaken to investigate the role of neck circumference (NC) in predicting prehypertension in children and adolescents., Methods: We conducted a cross-sectional study including 6,802 children and adolescents (3,631 boys and 3,171 girls) aged 5-18 years. Main anthropometric data and related information were collected., Results: The prevalence of prehypertension was 14.4%, 16.4% and 17.1% in normal weight, overweight and obese group respectively. Among the participants with normal body mass index (BMI), higher NC was significantly associated with increased odds of prehypertension (OR: 1.439; 95% CI: 1.118 to 1.853) after adjustment for age, gender, BMI and WC. Significant associations between NC and either systolic blood pressure (SBP) (β=0.581 mmHg) or diastolic blood pressure (DBP) (β=0.236 mmHg) were found in the linear regression. No significant ORs were observed either in overweight or in obese categories., Conclusion: We concluded that additional measure of NC might expand the ability of BMI for the identification of prehypertension in normal weight children and adolescents.

Aims: Whether a low ankle-brachial index can improve the prediction of all-cause and cardiovascular mortality on top of conventional risk factors remains unclear among patients with ischemic heart disease. The present study aimed to assess the association between the ankle-brachial index and mortality in Chinese patients., Methods: This was an observational prospective study and 1,800 Chinese patients aged > or =35 years were followed-up from 2004 to 2007-2008., Results: There were 280 deaths, of which 165 were attributable to cardiovascular disease. Compared with patients with an ankle-brachial index > or =1.1, the risk of mortality increased linearly in lower ankle-brachial index categories: patients with an ankle-brachial index of 0.9 to 1.1, 0.7 to 0.9, <0.7 had hazard ratios of 1.60, 2.07, and 3.08 for all-cause mortality and 1.89, 2.33, and 4.09 for cardiovascular mortality (p for trend <0.001), respectively. Addition of the ankle-brachial index significantly (p<0.001) increased the predictive value of the model for 3-year deaths compared with a model including risk factors alone. Comparison of areas under receiver operator characteristics curves confirmed that a model including the ankle-brachial index discriminated better than without., Conclusion: There was an inverse association between the ankle-brachial index and mortality. Addition of the ankle-brachial index significantly improved the prediction of 3-year mortality over and above that of conventional risk factors. We recommend that the ankle-brachial index be incorporated into prognostic assessment for patients with ischemic heart disease.

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.

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: 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: 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: Ethnic differences in the prevalence of obesity are known to exist. However, little is known about obesity in different ethnic rural Chinese. This study was designed to investigate the epidemiologic features of overweight and obesity in Han and Mongolian rural Chinese., Methods: A cross-sectional survey was conducted during 2004-2006, which made use of a multistage cluster sampling method to select a representative sample in Fuxin county, Liaoning province, China. 36,154 Han people and 9236 Mongolian people aged > or =35 years were examined. At baseline, lifestyle and other factors were obtained. Overweight and obesity were defined according to the World Health Organization classification and Chinese criteria, respectively., Results: Using WHO criteria, 21.3% of the Han people and 26.1% of the Mongolians had overweight or obesity (P < 0.001). The corresponding figure was 33.4% of the Han people and 40.3% of the Mongolians by Chinese criteria (P < 0.001). The prevalence of overweight was significantly higher in Mongolian people than Han people (P < 0.001). Multivariate logistic regression revealed that female gender, high levels of education and current drinking status were the common risk factors for Han and Mongolian overweight or obese participants, while age > or =65 years and current smoking status were the common protective factors. Below the age of 65 years, a positive association was observed between age and overweight or obesity in Han people, but not in the Mongolian people. High levels of physical activity as a protective factor and diabetes as a risk factor were shown in Han but not in Mongolian people., Conclusions: There were ethnic differences in overweight and obesity between Han and Mongolian rural Chinese. These differences might be due to different factors between these two ethnicities such as age, physical activity and diabetes.

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 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.

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.