高血压亚型饮食、行为等危险因素的异质性研究
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摘要
目的：研究江苏省铜山县35岁及以上农村居民新检出高血压的流行特征及饮食、行为等危险因素；研究脉压水平的分布及危险因素；研究高血压亚型危险因素的异质性,为针对性开展高血压防控、提高防控效果提供科学的决策依据。
方法：使用分层随机整群抽样,对铜山县农村35岁及以上且常住5年以上的20390人在知情同意的基础上进行问卷调查和体格检查,具有有效问卷的有20364人,其中572人已接受抗高血压药物治疗,以其他19792人为主要研究对象(包括非高血压人群和新检出的高血压患者)。研究的第一部分描述非高血压人群和新检出高血压患者的人口统计学特征；应用广义线性模型分析新检出高血压的影响因素；分析高血压患者诊断后饮食、行为因素的变化。研究的第二部分运用单因素分析研究脉压水平的分布及影响因素；应用回归树方法确定脉压的危险因素及其重要程度。研究的第三部分对研究对象的血压进行聚类分析；应用χ2检验比较常见不同因素对高血压三种亚型患病率的影响；应用分类树方法,以高血压不同亚型和血压正常人群建立相应的分类树判别模型,比较高血压亚型危险因素的差异。
结果：本地农村35岁及以上新检出高血压的患病率为31.62%(男性患病率32.80%,女性患病率30.48%),70%以上的新检出患者为一级高血压。调查人群的高血压知晓率、治疗率和控制率分别为8.37%、2.81%和0.72%。
1.新检出高血压的常见保护性饮食、行为因素主要包括低年龄、低体重、低腰臀比、清洁燃料、清洁饮用水、少被动吸烟、无经常饮酒、适当食用海产品、蛋类、水果、肉、偏淡口味、适当的睡眠时间、良好的睡眠质量和每周适当次数的体育锻炼等。高血压诊断后患者可能改变部分饮食、行为危险因素(戒酒、限盐、少食猪肉、少吃主食、适当食用海产品和牛羊肉、生活变得紧张),而被动吸烟、缺乏优质蛋白和水果的摄入、缺乏适当的体育锻炼、肥胖等危险因素无统计学意义的改变。
2.新检出高血压患者和血压正常人群的脉压为49.88±12.21 mmHg,宽脉压(60mmHg及以上)者达到22.17%,达到动脉粥样硬化形成危险界限(63 mmHg以上)者的比例为12.90%。回归树模型表明脉压最重要的影响因素是年龄,其它重要影响因素主要有常驻年限、家庭总人口、家庭月伙食费、家庭月收入、居住面积、家用燃料、脉搏次数、文化程度、婚姻、职业、体重指数、每天主食摄入量、吸烟年限、剂量及深度、喝茶种类、每日摄入蔬菜量、食用海产品的频率；女性的月经情况和生产次数也是非常重要的影响因素。
3.新检出高血压亚型的患病率以ISH为最高(13.68±0.24%),其次是SDH(11.70±0.23%)和IDH(6.24±0.17%),患病率差异两两之间有统计学意义(P<0.01)。分类树模型表明高血压不同亚型的危险因素涉及人口、社会经济、遗传、饮食和行为等多方面,但是差异明显。ISH的危险因素是以年龄和社会经济因素为主,IDH的危险因素是以饮食、行为和遗传因素为主,SDH的危险因素体现了ISH和IDH危险因素的双重性。ISH的危险因素中,年龄的重要程度为最高,其它依次为节育措施、月经情况、补充维生素的种类、常驻年限、吸烟年限、生产次数、家庭总人口、家庭月收入、家庭月伙食费、饮酒年限、婚姻状况、饮酒年限、合计吸烟剂量、文化程度、烟草类型、喝茶种类、居住面积、每天主食摄入量、祖父母高血压史等。IDH的危险因素中,每天吸烟量的重要程度为最高,其它依次为补充维生素的种类、食用海产品频率、喝茶种类、饮水类型、合计吸烟剂量、外祖父母疾病史(冠心病、中风、肿瘤、糖尿病、高血压)、祖父母疾病史(肿瘤、糖尿病、中风、高血压、冠心病)、食用油种类、日吸烟量、家用燃料、腰围等。SDH的危险因素兼具ISH和IDH的主要危险因素,重要程度排序依次为补充维生素的种类、年龄、节育措施、吸烟年限、常驻年限、家庭月收入、月经情况、饮酒年限、家庭月伙食费、合计吸烟剂量、生产次数等。结论：铜山县农村35岁及以上居民新检出高血压的患病率高,其流行特征有地域性,有特定的保护性饮食、行为因素,人群知晓率、治疗率、控制率低,高血压诊断后患者只改变了部分饮食、行为因素,人群脉压水平高,面临着较大的心血管病风险,需要实施血压筛查和长期监测,因地制宜地开展饮食和行为干预。脉压是以年龄为最重要和独立的影响因素,受内外多因素的综合影响。ISH和IDH的危险因素有明显差异,是内在异质性的外在表现,SDH的危险因素是ISH和IDH危险因素异质性的综合体现。ISH的危险因素是以年龄和社会经济因素为主,IDH的危险因素是以饮食、行为和遗传因素为主,SDH的危险因素体现了ISH和IDH危险因素的双重性。
Objective:To investigate hypertension epidemiological characteristics of countryside dwellers who were 35 years or older and not treated with antihypertensive drug in Tongshan Couty, China, study the risk factors of their pulse pressure, and study the heterogeneity of risk factors including demographic, socioeconomic, dietary, and behavioral factors among three hypertension subtypes, namely, ISH, IDH and SDH. The content of this study was also useful to provide the scientific and effective evidence for making decision to prevent hypertension subtypes.
Methods:The survey employed a stratified multistage probability sampling design. A total of 20,390 subjects were enrolled for physical examination. After obtaining their consent and administering standardized questionnaires, information sought through the questionnaires was available for 20,364 individuals.19,792 individuals (572 individuals who had been treated with antihypertensive drug not included) were analyzed. First, the demographic characteristic of untreated hypertension patients and normotension was analyzed. Theχ2-test was used for comparing the various risk factors associated with hypertension prevalence. Generalized linear models (GLM) were used to study the risk factors of untreated hypertension patients. Logistic regression was used to study the change of dietary and behavior habits after hypertension diagnosis. Second, the pulse pressure of 19,792 individuals was studied by univariate analysis, and regression tree method was used to decide the risk factors of the pulse pressure. At last, the blood pressure was analyzed by cluster analysis, andχ2-test was used to describe the impacts of common risk factors on hypertension subtypes. The classification trees which were build from the ISH, IDH, SDH patients and normotension were used to compare the different risk factors of three hypertension subtypes.
Results:The hypertension prevalence in 19,792 individuals was 31.62%. More than 70% untreated hypertension patients were in the first grade of hypertension. Overall,8.37% of all hypertension patients were aware of their hypertension,2.18% was treated, and 0.72% was controlled.
1. The main protective factors of hypertension supported by GLM were as following: young age, low weight, low WHR, clean family fuel, clean drinking water, little passive smoking, no excessive drinking, tasteless, adequate bedtime, good sleep quality, adequate frequency of physical exercise and adequate eating sea foods, egg, meat, and fruit. Some people who had hypertension would change some dietary and behavioral habits including reducing their intaking of salt, alcohol and staple food consumption, eating less pork, more beef and mutton, and their life became more tense. Other dietary and behavioral habits were not changed.
2. The mean pulse pressure of subjects with untreated hypertension and normotension was 49.88±12.21 mmHg. The proportion of the subjects with pulse pressure≥60 mmHg was 22.17%, and the proportion with pulse pressure>63 mmHg was 12.90%. The regression tree method indicated that the age was the most important risk factor, and the other important risk factors included resident time, total family person, family monthly income, family monthly expenditure on food, house area, type of cooking fuel used at home, pulsation times, education level, the state of marriage, occupation, BMI, the weight of staple foods consumed daily, years of smoking, kind of drinking, the weight of vegetables ingested daily, frequency of consuming seafood, the state of menstruation and the times of partuaition.
3. ISH was the predominant untreated subtype (13.68±0.24%), followed by SDH (11.70±0.23%) and then by IDH (6.24±0.17%). The impacts of common risk factors on subjects with hypertension subtypes were different. Different variables were selected by the program of the classification trees for ISH, IDH, and SDH. For ISH, age was the most important determining factor. The other independent variables that split at various levels included the types of vitamins ingested, family history of stroke, total number of cigarettes smoked, the type of tea consumed, menstruation status, waistline measurement, family history of hypertension, type of edible oil consumed, and body weight. For IDH, the number of cigarettes smoked per day was the most important determining factor. The other independent variables that split at various levels included the types of vitamins ingested, total alcohol intake, family history of tumors, frequency of consuming seafood, waistline measurement, type of tea consumed, type of drinking water consumed, and type of cooking fuel used at home. For SDH, the type of vitamins ingested was the most important determining factor. The other independent variables that split at various levels included age, family history of tumors, frequency of consumption of seafood, body weight, BMI, total number of cigarettes smoked, hip circumference, and frequency of alcohol intake during a week.
Conelusions:The hypertension epidemiological characteristics of the people in this study was endemic and serious, the mean pulse pressure was also higher than the mean level of China. The local hypertension patients only changed some dietary and behavioral habits after hypertension diagnosis. The people faced the great risk of cardiovascular disease and living intervention including health diet habit should be taken necessarily and immediately. The age was the most important and independent risk factor of pulse pressure. The pulse pressure was the result of exterior and interior risk factors. ISH and IDH had the different exterior risk factors, caming from interior heterogeneity. The main risk factors of ISH were age and socioeconomic factors. The main risk factors of ISH were dietary, behavioral and hereditary factors. The main risk factors of SDH came from the risk factors of ISH and IDH.
方法：使用分层随机整群抽样,对铜山县农村35岁及以上且常住5年以上的20390人在知情同意的基础上进行问卷调查和体格检查,具有有效问卷的有20364人,其中572人已接受抗高血压药物治疗,以其他19792人为主要研究对象(包括非高血压人群和新检出的高血压患者)。研究的第一部分描述非高血压人群和新检出高血压患者的人口统计学特征；应用广义线性模型分析新检出高血压的影响因素；分析高血压患者诊断后饮食、行为因素的变化。研究的第二部分运用单因素分析研究脉压水平的分布及影响因素；应用回归树方法确定脉压的危险因素及其重要程度。研究的第三部分对研究对象的血压进行聚类分析；应用χ2检验比较常见不同因素对高血压三种亚型患病率的影响；应用分类树方法,以高血压不同亚型和血压正常人群建立相应的分类树判别模型,比较高血压亚型危险因素的差异。
结果：本地农村35岁及以上新检出高血压的患病率为31.62%(男性患病率32.80%,女性患病率30.48%),70%以上的新检出患者为一级高血压。调查人群的高血压知晓率、治疗率和控制率分别为8.37%、2.81%和0.72%。
1.新检出高血压的常见保护性饮食、行为因素主要包括低年龄、低体重、低腰臀比、清洁燃料、清洁饮用水、少被动吸烟、无经常饮酒、适当食用海产品、蛋类、水果、肉、偏淡口味、适当的睡眠时间、良好的睡眠质量和每周适当次数的体育锻炼等。高血压诊断后患者可能改变部分饮食、行为危险因素(戒酒、限盐、少食猪肉、少吃主食、适当食用海产品和牛羊肉、生活变得紧张),而被动吸烟、缺乏优质蛋白和水果的摄入、缺乏适当的体育锻炼、肥胖等危险因素无统计学意义的改变。
2.新检出高血压患者和血压正常人群的脉压为49.88±12.21 mmHg,宽脉压(60mmHg及以上)者达到22.17%,达到动脉粥样硬化形成危险界限(63 mmHg以上)者的比例为12.90%。回归树模型表明脉压最重要的影响因素是年龄,其它重要影响因素主要有常驻年限、家庭总人口、家庭月伙食费、家庭月收入、居住面积、家用燃料、脉搏次数、文化程度、婚姻、职业、体重指数、每天主食摄入量、吸烟年限、剂量及深度、喝茶种类、每日摄入蔬菜量、食用海产品的频率；女性的月经情况和生产次数也是非常重要的影响因素。
3.新检出高血压亚型的患病率以ISH为最高(13.68±0.24%),其次是SDH(11.70±0.23%)和IDH(6.24±0.17%),患病率差异两两之间有统计学意义(P<0.01)。分类树模型表明高血压不同亚型的危险因素涉及人口、社会经济、遗传、饮食和行为等多方面,但是差异明显。ISH的危险因素是以年龄和社会经济因素为主,IDH的危险因素是以饮食、行为和遗传因素为主,SDH的危险因素体现了ISH和IDH危险因素的双重性。ISH的危险因素中,年龄的重要程度为最高,其它依次为节育措施、月经情况、补充维生素的种类、常驻年限、吸烟年限、生产次数、家庭总人口、家庭月收入、家庭月伙食费、饮酒年限、婚姻状况、饮酒年限、合计吸烟剂量、文化程度、烟草类型、喝茶种类、居住面积、每天主食摄入量、祖父母高血压史等。IDH的危险因素中,每天吸烟量的重要程度为最高,其它依次为补充维生素的种类、食用海产品频率、喝茶种类、饮水类型、合计吸烟剂量、外祖父母疾病史(冠心病、中风、肿瘤、糖尿病、高血压)、祖父母疾病史(肿瘤、糖尿病、中风、高血压、冠心病)、食用油种类、日吸烟量、家用燃料、腰围等。SDH的危险因素兼具ISH和IDH的主要危险因素,重要程度排序依次为补充维生素的种类、年龄、节育措施、吸烟年限、常驻年限、家庭月收入、月经情况、饮酒年限、家庭月伙食费、合计吸烟剂量、生产次数等。结论：铜山县农村35岁及以上居民新检出高血压的患病率高,其流行特征有地域性,有特定的保护性饮食、行为因素,人群知晓率、治疗率、控制率低,高血压诊断后患者只改变了部分饮食、行为因素,人群脉压水平高,面临着较大的心血管病风险,需要实施血压筛查和长期监测,因地制宜地开展饮食和行为干预。脉压是以年龄为最重要和独立的影响因素,受内外多因素的综合影响。ISH和IDH的危险因素有明显差异,是内在异质性的外在表现,SDH的危险因素是ISH和IDH危险因素异质性的综合体现。ISH的危险因素是以年龄和社会经济因素为主,IDH的危险因素是以饮食、行为和遗传因素为主,SDH的危险因素体现了ISH和IDH危险因素的双重性。
Objective:To investigate hypertension epidemiological characteristics of countryside dwellers who were 35 years or older and not treated with antihypertensive drug in Tongshan Couty, China, study the risk factors of their pulse pressure, and study the heterogeneity of risk factors including demographic, socioeconomic, dietary, and behavioral factors among three hypertension subtypes, namely, ISH, IDH and SDH. The content of this study was also useful to provide the scientific and effective evidence for making decision to prevent hypertension subtypes.
Methods:The survey employed a stratified multistage probability sampling design. A total of 20,390 subjects were enrolled for physical examination. After obtaining their consent and administering standardized questionnaires, information sought through the questionnaires was available for 20,364 individuals.19,792 individuals (572 individuals who had been treated with antihypertensive drug not included) were analyzed. First, the demographic characteristic of untreated hypertension patients and normotension was analyzed. Theχ2-test was used for comparing the various risk factors associated with hypertension prevalence. Generalized linear models (GLM) were used to study the risk factors of untreated hypertension patients. Logistic regression was used to study the change of dietary and behavior habits after hypertension diagnosis. Second, the pulse pressure of 19,792 individuals was studied by univariate analysis, and regression tree method was used to decide the risk factors of the pulse pressure. At last, the blood pressure was analyzed by cluster analysis, andχ2-test was used to describe the impacts of common risk factors on hypertension subtypes. The classification trees which were build from the ISH, IDH, SDH patients and normotension were used to compare the different risk factors of three hypertension subtypes.
Results:The hypertension prevalence in 19,792 individuals was 31.62%. More than 70% untreated hypertension patients were in the first grade of hypertension. Overall,8.37% of all hypertension patients were aware of their hypertension,2.18% was treated, and 0.72% was controlled.
1. The main protective factors of hypertension supported by GLM were as following: young age, low weight, low WHR, clean family fuel, clean drinking water, little passive smoking, no excessive drinking, tasteless, adequate bedtime, good sleep quality, adequate frequency of physical exercise and adequate eating sea foods, egg, meat, and fruit. Some people who had hypertension would change some dietary and behavioral habits including reducing their intaking of salt, alcohol and staple food consumption, eating less pork, more beef and mutton, and their life became more tense. Other dietary and behavioral habits were not changed.
2. The mean pulse pressure of subjects with untreated hypertension and normotension was 49.88±12.21 mmHg. The proportion of the subjects with pulse pressure≥60 mmHg was 22.17%, and the proportion with pulse pressure>63 mmHg was 12.90%. The regression tree method indicated that the age was the most important risk factor, and the other important risk factors included resident time, total family person, family monthly income, family monthly expenditure on food, house area, type of cooking fuel used at home, pulsation times, education level, the state of marriage, occupation, BMI, the weight of staple foods consumed daily, years of smoking, kind of drinking, the weight of vegetables ingested daily, frequency of consuming seafood, the state of menstruation and the times of partuaition.
3. ISH was the predominant untreated subtype (13.68±0.24%), followed by SDH (11.70±0.23%) and then by IDH (6.24±0.17%). The impacts of common risk factors on subjects with hypertension subtypes were different. Different variables were selected by the program of the classification trees for ISH, IDH, and SDH. For ISH, age was the most important determining factor. The other independent variables that split at various levels included the types of vitamins ingested, family history of stroke, total number of cigarettes smoked, the type of tea consumed, menstruation status, waistline measurement, family history of hypertension, type of edible oil consumed, and body weight. For IDH, the number of cigarettes smoked per day was the most important determining factor. The other independent variables that split at various levels included the types of vitamins ingested, total alcohol intake, family history of tumors, frequency of consuming seafood, waistline measurement, type of tea consumed, type of drinking water consumed, and type of cooking fuel used at home. For SDH, the type of vitamins ingested was the most important determining factor. The other independent variables that split at various levels included age, family history of tumors, frequency of consumption of seafood, body weight, BMI, total number of cigarettes smoked, hip circumference, and frequency of alcohol intake during a week.
Conelusions:The hypertension epidemiological characteristics of the people in this study was endemic and serious, the mean pulse pressure was also higher than the mean level of China. The local hypertension patients only changed some dietary and behavioral habits after hypertension diagnosis. The people faced the great risk of cardiovascular disease and living intervention including health diet habit should be taken necessarily and immediately. The age was the most important and independent risk factor of pulse pressure. The pulse pressure was the result of exterior and interior risk factors. ISH and IDH had the different exterior risk factors, caming from interior heterogeneity. The main risk factors of ISH were age and socioeconomic factors. The main risk factors of ISH were dietary, behavioral and hereditary factors. The main risk factors of SDH came from the risk factors of ISH and IDH.
引文
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