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Wang J.,Peking University | Zhang L.,Peking University | Wang F.,Peking University | Liu L.,Beijing Hypertension League Institute | Wang H.,Peking University
American Journal of Hypertension | Year: 2014

BACKGROUND Hypertension is one of the major risk factor for cardiovascular disease worldwide. The objective of this study was to investigate the prevalence, awareness, treatment, and control of hypertension in China.METHODS A multistage, stratified sampling method was used to obtain a representative sample of persons aged 18 years or older in the general population of China. Blood pressure (BP) was measured by sphygmomanometer 3 times at 5-minute intervals. Hypertension was defined as a systolic BP ≥ 140mm Hg, or diastolic BP ≥ 90mm Hg, or self-reported use of antihypertensive medications in the last 2 weeks irrespective of the BP.RESULTS Altogether 50,171 subjects finished the survey across the entire country. The adjusted prevalence of hypertension was 29.6% (95% confidence interval (CI) = 28.9%-30.4%) and was higher among men than among women (31.2%, 95% CI = 30.1%-32.4%; vs. 28.0%, 95% CI = 27.0%-29.0%). The awareness, treatment among all hypertensive participants, control among all hypertensive participants, and control among treated hypertensive participants were 42.6%, 34.1%, 9.3%, and 27.4%, respectively. Multiple lifestyle factors were independently associated with presence of hypertension, including physical inactivity, habitual drinking, chronic use of nonsteroidal anti-inflammatory drugs, high body mass index, and central obesity.CONCLUSIONS Hypertension is an important public health burden in China, and control of hypertension is still suboptimal. Several modifiable lifestyle activities were associated with hypertension and thus should be considered potential targets for intervention, with special attention to socioeconomically disadvantaged subpopulations in China. © 2014 American Journal of Hypertension, Ltd. All rights reserved.

O'Donnell M.,Hamilton Health Sciences | O'Donnell M.,National University of Ireland | Mente A.,Hamilton Health Sciences | Rangarajan S.,Hamilton Health Sciences | And 27 more authors.
New England Journal of Medicine | Year: 2014

BACKGROUND: The optimal range of sodium intake for cardiovascular health is controversial. METHODS: We obtained morning fasting urine samples from 101,945 persons in 17 countries and estimated 24-hour sodium and potassium excretion (used as a surrogate for intake). We examined the association between estimated urinary sodium and potassium excretion and the composite outcome of death and major cardiovascular events. RESULTS: The mean estimated sodium and potassium excretion was 4.93 g per day and 2.12 g per day, respectively. With a mean follow-up of 3.7 years, the composite outcome occurred in 3317 participants (3.3%). As compared with an estimated sodium excretion of 4.00 to 5.99 g per day (reference range), a higher estimated sodium excretion (≥7.00 g per day) was associated with an increased risk of the composite outcome (odds ratio, 1.15; 95% confidence interval [CI], 1.02 to 1.30), as well as increased risks of death and major cardiovascular events considered separately. The association between a high estimated sodium excretion and the composite outcome was strongest among participants with hypertension (P=0.02 for interaction), with an increased risk at an estimated sodium excretion of 6.00 g or more per day. As compared with the reference range, an estimated sodium excretion that was below 3.00 g per day was also associated with an increased risk of the composite outcome (odds ratio, 1.27; 95% CI, 1.12 to 1.44). As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a reduced risk of the composite outcome. CONCLUSIONS: In this study in which sodium intake was estimated on the basis of measured urinary excretion, an estimated sodium intake between 3 g per day and 6 g per day was associated with a lower risk of death and cardiovascular events than was either a higher or lower estimated level of intake. As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a lower risk of death and cardiovascular events. Copyright © 2014 Massachusetts Medical Society.

Hu B.,Peking Union Medical College | Li Prof. W.,Peking Union Medical College | Wang X.,Beijing Hypertension League Institute | Liu L.,Peking Union Medical College | And 2 more authors.
Journal of Epidemiology | Year: 2012

Background: We investigated the effects of marital status and education on the risk of acute myocardial infarction (AMI) in a large-scale case-control study in China. Methods: This study was part of the INTER-HEART China case-control study. The main outcome measure was first AMI. Incident cases of AMI and control patients with no past history of heart disease were recruited. Controls were matching by age (±5 years) and sex. Marital status was combined into 2 categories: single and not single. Education level was classified into 2 categories: 8 years or less and more than 8 years. Results: From 1999 to 2002, we recruited 2909 cases and 2947 controls from 17 cities. After adjustment for age, sex, BMI, psychosocial factors, lifestyle, other factors, and mutually for other risk factors, the odds ratio (OR) for AMI associated with being single was 1.51 (95% confidence interval: 1.18-1.93) overall, 1.19 (0.84-1.68; P = 0.072) in men and 2.00 (1.39-2.86; P < 0.0001) in women. The interaction of sex and marital status was statistically significant (P = 0.045). Compared with a high education level, a low education level increased the risk of AMI (1.45, 1.26-1.67); the odds ratios in men and women were 1.29 (1.09-1.52) and 1.55 (1.16-2.08), respectively. Single women with a low education level had a high risk of AMI (2.95, 1.99-4.37). Conclusions: Being single was consistently associated with an increased risk for AMI, particularly in women. In addition, as compared with high education level, low education level was associated with a higher risk of AMI in both men and women. © 2011 by the Japan Epidemiological Association.

Campbell N.R.C.,University of Calgary | Lackland D.T.,Medical University of South Carolina | Lisheng L.,Fu Wai Hospital | Niebylski M.L.,World Hypertension League | And 2 more authors.
Journal of Clinical Hypertension | Year: 2015

Increased blood pressure and high dietary salt are leading risks for death and disability globally. Reducing the burden of both health risks are United Nations' targets for reducing noncommunicable disease. Nongovernmental organizations and individuals can assist by ensuring widespread dissemination of the best available facts and recommended interventions for both health risks. Simple but impactful fact sheets can be useful for informing the public, healthcare professionals, and policy makers. The World Hypertension League has developed fact sheets on dietary salt and hypertension but in many circumstances the greatest impact would be obtained from national-level fact sheets. This manuscript provides instructions and a template for developing fact sheets based on the Global Burden of Disease study and national survey data. ©2015 Wiley Periodicals, Inc.

Wu L.,Capital Institute of Pediatrics | Xi B.,Capital Institute of Pediatrics | Zhang M.,Capital Institute of Pediatrics | Shen Y.,Beijing Hypertension League Institute | And 7 more authors.
Diabetes | Year: 2010

OBJECTIVE - Childhood obesity strongly predisposes to some adult diseases. Recently, genome-wide association (GWA) studies in Caucasians identified multiple single nucleotide polymorphisms (SNPs) associated with BMI and obesity. The associations of those SNPs with BMI and obesity among other ethnicities are not fully described, especially in children. Among those previously identified SNPs, we selected six (rs7138803, rs1805081, rs6499640, rs17782313, rs6265, and rs10938397, in or near obesity-related genes FAIM2, NPC1, FTO, MC4R, BDNF, and GNPDA2, respectively) because of the relatively high minor allele frequencies in Chinese individuals and tested the associations of the SNPs with BMI and obesity in Chinese children. RESEARCH DESIGN AND METHODS - We investigated the associations of these SNPs with BMI and obesity in school-aged children. A total of 3,503 children participated in the study, including 1,229 obese, 655 overweight, and 1,619 normal-weight children (diagnosed by the Chinese age- and sex-specific BMI cutoffs). RESULTS - After age and sex adjustment and correction for multiple testing, the SNPs rs17782313, rs6265, and rs10938397 were associated with BMI (P = 1.0 × 10-5, 0.038, and 0.00093, respectively) and also obesity (P = 5.0 × 10-6, 0.043, and 0.00085, respectively) in the Chinese children. The SNPs rs17782313 and rs10938397 were also significantly associated with waist circumference, waist-to-height ratio, and fat mass percentage. CONCLUSIONS - Results of this study support obesity-related genes in adults as important genes for BMI variation in children and suggest that some SNPs identified by GWA studies in Caucasians also confer risk for obesity in Chinese children. © 2010 by the American Diabetes Association.

Tobe S.W.,University of Toronto | Clase C.M.,McMaster University | Gao P.,McMaster University | McQueen M.,McMaster University | And 6 more authors.
Circulation | Year: 2011

Background-In the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET), dual therapy did not reduce cardiovascular or renal outcomes compared with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers alone. Previous controlled trials with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers have demonstrated greater cardiovascular and renal benefit in people with renal risk. We hypothesized that dual therapy would be more effective than monotherapy in patients with low glomerular filtration rate and elevated albuminuria. Methods and Results-Post hoc analysis was performed of renal subgroups of dual therapy versus monotherapy for the ONTARGET study and angiotensin receptor blocker versus placebo for the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease (TRANSCEND). The studies featured hazard ratios by subgroups and Cox regression models with factors for treatment, subgroup, and interactions. The main cardiovascular outcome was the composite of cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure, and the main renal outcome was the composite of chronic dialysis or doubling of creatinine. In ONTARGET, there was no cardiovascular or renal benefit from dual over monotherapy in any subgroup, even with low glomerular filtration rate and/or elevated albuminuria. In TRANSCEND, in the comparison of angiotensin receptor blocker with placebo, there was a significant interaction for the main renal outcome (P=0.01) in the direction of harm for patients with normoalbuminuria (0.37 versus 0.16 events per 100 patient-years; hazard ratio, 2.35; confidence interval, 1.33 to 4.15) but a trend to benefit with microalbuminuria (0.52 versus 0.89 events per 100 patient-years; hazard ratio, 0.60; confidence interval, 0.25 to 1.46) and macroalbuminuria (1.57 versus 2.60 events per 100 patient-years; hazard ratio, 0.71; confidence interval, 0.21 to 2.44). Conclusions-This post hoc analysis does not support dual therapy over monotherapy in high-vascular risk patients with low glomerular filtration rate or albuminuria. This observation is a post hoc comparison and should be interpreted appropriately. Clinical Trial Registration-URL: http:// clinicaltrials.gov Identifier: NCT00153101. © 2011 American Heart Association. All rights reserved.

Xi B.,Shandong University | Xi B.,Capital Institute of Pediatrics | Cheng H.,Capital Institute of Pediatrics | Shen Y.,Capital Institute of Pediatrics | And 4 more authors.
Atherosclerosis | Year: 2012

Background: Childhood hypertension is a complex disease influenced by both genetic and environmental factors. We aimed to examine the effect of interactions of five polymorphisms with physical activity on blood pressure (BP)/hypertension in the Chinese children. Methods and results: A population-based case-control study was carried out in Beijing of China in 2004, which included 619 hypertensive cases and 2458 normal BP controls. Physical activity information was collected through the use of a validated questionnaire, and five polymorphisms were genotyped using TaqMan. In active group, there was no significant association of five polymorphisms and genetic risk score with systolic/diastolic BP (SBP/DBP) and risk of hypertension (all p > 0.05). In contrast, in inactive group, two polymorphisms and genetic risk score were significantly associated with SBP (rs17249754: β = 1.26, 95% confidence interval (CI) 0.61-1.90, p < 0.001; rs1004467: β = 0.68, 95%CI 0.03-1.32, p = 0.039; genetic risk score: β = 1.54, 95%CI 0.74-2.33, p < 0.001); three polymorphisms and genetic risk score were significantly associated with hypertension (rs17249754: odds ratio (OR) = 1.27, 95%CI 1.08-1.49, p = 0.004; rs1378942: OR = 1.25, 95%CI 1.00-1.57, p = 0.050 (marginally significant); rs16998073: OR = 1.17, 95%CI 1.01-1.37, p = 0.044; genetic risk score: OR = 1.38, 95%CI 1.13-1.68, p = 0.001). Conclusions: The present study provides evidence that interactions between recently identified variants and physical activity play important roles in the regulation of BP and development of hypertension. Physical activity should be prescribed for hypertensive children, especially for those with high risk genetic alleles. © 2012 Elsevier Ireland Ltd.

Xi B.,Shandong University | Zhao X.,Capital Institute of Pediatrics | Shen Y.,Capital Institute of Pediatrics | Wu L.,Capital Institute of Pediatrics | And 5 more authors.
International Journal of Obesity | Year: 2013

Context: Recent genome-wide association studies have identified several single-nucleotide polymorphisms (SNPs) that are associated with body mass index (BMI)/obesity.Objective: As obesity is an independent risk factor for hypertension, the objective of the study was to investigate the associations of obesity susceptibility loci with blood pressure (BP)/hypertension in a population of Chinese children.Design, setting and participants: This was a genotype-phenotype association study. Participants included 3077 Chinese children, aged 6-18 years. Based on the Chinese age- and sex-specific BP standards, 619 hypertensive cases and 2458 controls with normal BP were identified.Main outcome measures:BP was measured by auscultation using a standard clinical sphygmomanometer. Results: Of the 11 SNPs, only FTO rs9939609 was significantly associated with systolic BP (SBP; P=0.034) and three SNPs were significantly associated with diastolic BP (DBP; GNPDA2 rs10938397: P=0.026; FAIM2 rs7138803: P=0.015; NPC1 rs1805081: P=0.031) after adjustment for age, sex and hypertension status. In addition, three SNPs were significantly associated with hypertension risk after adjustment for age and sex (FTO rs9939609: odds ratio (OR)=1.35, 95% confidence interval (CI) 1.12-1.62, P=0.001; MC4R rs17782313: OR=1.22, 95% CI 1.06-1.42, P=0.007; GNPDA2 rs10938397: OR=1.17, 95% CI 1.02-1.34, P=0.021). After additional adjustment for BMI, none remained significant. The genetic risk score (GRS), based on three significant SNPs (FTO rs9939609, MC4R rs17782313, GNPDA2 rs10938397), showed a positive association with SBP (P=5.17 × 10-4) and risk of hypertension (OR=1.22, 95% CI 1.12-1.33, P=6.07 × 10-6). Further adjustment for BMI abolished the positive associations (SBP: P=0.220; DBP: P=0.305; hypertension: P=0.052). Only FTO rs9939609 and GRS were statistically associated with hypertension risk in the age- and sex-adjusted model after correction for multiple testing. Conclusions: The present study demonstrated that FTO rs9939609 and combined SNPs were significantly associated with risk of hypertension, which seems to be dependent on BMI. © 2013 Macmillan Publishers Limited.

Zhang Y.,Chinese Academy of Sciences | Zhang Y.,Beijing Hypertension League Institute | Zhang X.,Chinese Academy of Sciences | Zhang X.,Beijing Hypertension League Institute | And 3 more authors.
European Heart Journal | Year: 2011

AimsMajor guidelines recommend lowering systolic blood pressure (SBP) to <140 mmHg in all hypertensives, but evidence is missing whether this is beneficial in (i) uncomplicated hypertensives, (ii) grade 1 hypertensives, and (iii) elderly hypertensives. Providing this missing evidence is important to justify efforts and costs of aggressive therapy in all hypertensives.Methods and resultsFelodipine Event Reduction (FEVER) was a double-blind, randomized trial on 9711 Chinese hypertensives, in whom cardiovascular outcomes were significantly reduced by more intense therapy (low-dose hydrochlorothiazide and low-dose felodipine) achieving a mean of 138 mmHg SBP compared with less-intense therapy (low-dose hydrochlorothiazide and placebo) achieving a mean of 142 mmHg. FEVER included older and younger patients, and patients with and without diabetes or cardiovascular disease. In the analyses here reported, Cox regression models assessed outcome differences between more and less-intense treatments in groups of patients with different baseline characteristics. Significant reductions in stroke were found in uncomplicated hypertensives (-39, P 0.002), in hypertensives with randomization SBP <153 mmHg (-29, P 0.03), and in elderly hypertensives (-44, P < 0.001), when their SBP was lowered by more intense treatment. Significant reductions (between -29 and -47, P 0.02 to <0.001) were also found in all cardiovascular events and all deaths. Achieving mean SBP values <140 mmHg by adding a small dose of a generic drug prevented 2.1 (uncomplicated hypertensives) and 5.2 (elderly) cardiovascular events every 100 patients treated for 3.3 years.ConclusionsThese analyses provide strong support, missing so far, to guidelines recommending goal SBP <140 mmHg in uncomplicated hypertensives, individuals with moderately elevated BP and elderly hypertensives. © 2010 The Author.

Wu S.H.,Vanderbilt University | Woo J.,Chinese University of Hong Kong | Zhang X.-H.,Beijing Hypertension League Institute
International Journal for Equity in Health | Year: 2013

Introduction. The effect of socioeconomic status (SES) on stroke mortality at population level has been controversial. This study explores the association of SES in childhood and adulthood with stroke mortality, as well as variations in this association among countries/regions. Methods. Sex-specific stroke mortality at country level with death registry covering ≥ 70% population was obtained from the World Health Organization. Human Development Index (HDI) developed by the United Nations was chosen as the SES indicator. The associations between the latest available stroke mortality with HDI in 1999 (adulthood SES) and with HDI in 1960 (childhood SES) for the group aged 45-54 years among countries were examined with regression analysis. Age-standardized stroke mortality and HDI during 1974-2001 were used to estimate the association by time point. Results: The population data were available mostly for low-middle to high income countries. HDI in 1960 and 1999 were both inversely associated with stroke mortality in the group aged 45-54 years in 39 countries/regions. HDI in 1960 accounted for 37% of variance of stroke mortality among countries/regions; HDI in 1999 for 35% in men and 53% in women (P < 0.001). There was a quadratic relationship between age-standardized stroke mortality and HDI for the countries from 1974 to 2001: the association was positive when HDI < 0.77 but it became negative when HDI > 0.80. Conclusions: SES is a strong predictor of stroke mortality at country level. Stroke mortality increased with improvement of SES in less developed countries/region, while it decreased with advancing SES in more developed areas. © 2013 Wu et al.; licensee BioMed Central Ltd.

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