[Relationship of Cognitive Function With Menarche Age,Menopause Age, and Reproductive Period in Female Patients With Hypertension].

Objective To explore the relationship of menarche age,menopause age,and reproductive period with cognitive function in the female patients with hypertension.Methods Hypertension screening was carried out in Wuyuan county of Jiangxi province from July to August in 2018.Data were collected through a face-to-face questionnaire survey,physical measurement,and biochemical tests.The cognitive function was scored according to the mini-mental state examination(MMSE)scale.Multiple linear regression and Logistic regression were employed to analyze the effects of menarche age,menopause age,and reproductive period on cognitive function,and the penalized spline regression to fit the curves.Results A total of 4595 postmenopausal women with hypertension were included in the analysis,with the mean age of(65.1±8.4)years,mean menarche age of(16.6±2.2)years,mean menopause age of(48.2±5.0)years,mean reproductive period of(31.7±5.5)years,mean MMSE score of(19.0±6.3)points,and total cognitive impairment detection rate of 40.4%(1859/4595).The detection rates of cognitive impairment were 28.4%,39.1%,and 45.8% in the females with the menarche ages of <15,15-16,and ≥17 years,47.9%,39.7%,and 38.3% in the females with the menopausal ages of <45,45-49,and ≥50 years,and 56.0%,44.4%,40.6%,and 32.6% in the females with the reproductive periods of <25,25-29,30-34,and ≥35 years,respectively.Moreover,the detection rates of cognitive impairment among different age groups were statistically significant(all P<0.05).Compared with the group with the menarche age <15 years,the groups with the menarche ages of 15-16 years and ≥17 years showed increased detection rates of cognitive impairment(OR=1.45,95%CI=1.19-1.75,P<0.001;OR=1.65,95%CI=1.37-1.98,P<0.001).Compared with the group with the menopausal age <45 years,the groups with the menopausal ages of 45-49 years and ≥50 years showed decreased detection rates of cognitive impairment(OR=0.80,95%CI=0.66-0.95,P=0.013;OR=0.78,95%CI=0.65-0.93,P<0.001).Compared with the group with the reproductive period <25 years,the groups with the reproductive periods of 25-29,30-34,and ≥35 years showed decreased detection rates of cognitive impairment(OR=0.66,95%CI=0.52-0.84,P<0.001;OR=0.62,95%CI=0.50-0.76,P<0.001;OR=0.51,95%CI=0.41-0.63,P<0.001).Conclusion The detection rate of cognitive impairment had a positive correlation with menarche age and negative correlations with menopause age and reproductive period in the female patients with hypertension.

Different adiposity indices and their associations with hypertension among Chinese population from Jiangxi province.

BACKGROUND: To date, the best adiposity index that predicts or associates strongly with hypertension remains controversial. Therefore, we aimed to compare the performance of different adiposity indices [BMI (body mass index), WC (waist circumference), WHtR (waist-to-height ratio), ABSI (a body shape index), VAI (visceral adipose index), BFP (body fat percentage)] as associates and potential predictors of risk of hypertension among Chinese population. METHODS: A cross-sectional survey was conducted in Jiangxi province, China from 2013 to 2014. A total of 14,573 participants were included in the study. The physical measurements included body height, weight, WC, BFP and VAI. Multivariate logistic regression analysis was performed to assess the associations between different adiposity indices and the prevalence of hypertension. Receiver operating characteristic (ROC) analysis was also performed. RESULTS: All adiposity indices were independently and positively associated with the prevalence of hypertension in a dose response fashion. The area under the curves (AUCs) for WHtR, BFP and VAI were significantly larger than those for other adiposity indices in both males and females (all P < 0.01). For males, no statistically significant difference was found in AUCs among WHtR and BFP (0.653 vs. 0.647, P = 0.4774). The AUC of WHtR was significantly higher than VAI (0.653 vs. 0.636, P < 0.01). For females, the AUCs demonstrated that WHtR was significantly more powerful than BFP and VAI (both P < 0.05) for predicting hypertension [WHtR, 0.689 (0.677-0.702); BFP, 0.677 (0.664-0.690); VAI, 0.668 (0.655-0.680)]. Whereas no significant differences were found in AUCs for hypertension among BFP and VAI in both sexes (all P > 0.1). The AUCs for hypertension associated with each adiposity index declined with age in both males and females. For subjects aged < 65 years, WHtR still had the largest AUC. However, for participants aged ≥65 years, BMI had the largest AUC. CONCLUSION: The findings indicated that WHtR was the best for predicting hypertension, followed by BFP and VAI, especially in younger population.

Effect of hypertension status on the association between sleep duration and stroke among middle-aged and elderly population.

We aimed to examine whether hypertension status modified the association between sleep duration and stroke among middle-aged and elderly population. This cross-sectional study included 10 516 participants aged ≥45 years from the China Hypertension Survey study. Sleep duration and history of stroke were assessed by questionnaires. Multivariate logistic regression analyses, a generalized additive model (GAM) and smooth curve fitting (penalized spline method) and a two-piecewise logistic regression models were performed to evaluate the association between sleep duration and stroke in different status of hypertension. 95% confidence interval (CI) for turning point was obtained by bootstrapping. Multiple logistic analyses showed that per 1 hour increase in sleep duration was associated with a 37% increased prevalence of stroke among participants without hypertension and associated with a 8% increased prevalence of stroke among hypertensive participants (without hypertension: odds ratio [OR] = 1.37, 95% CI 1.09-1.71; with hypertension: OR = 1.08, 95% CI 0.95-1.21; PInteraction  = .029). The fully adjusted smooth curves presented a linear association between sleep duration and stroke among participants without hypertension, but a threshold, nonlinear association among hypertensive participants. The turning point for the curve was found at a sleep duration of 8 (95% CI 5-9) h among hypertensive patients. The ORs (95% CIs) for stroke were 0.92 (0.79, 1.06) and 1.60 (1.23, 2.08) to the left and right of the turning point, respectively. In conclusion, we found a linear association between sleep duration and stroke among middle-aged and elderly participants without hypertension, but a threshold, nonlinear association among hypertensive participants.

Association between Age at Menarche and Hypertension among Females in Southern China: A Cross-Sectional Study.

BACKGROUND: Association between age at menarche (AAM) and hypertension remains a controversial topic, and data in China were sparse. Therefore, we aimed to investigate the association between AAM and hypertension in Chinese female population. METHODS: In this cross-sectional study, 5,102 females aged ≥15 years were enrolled. Self-reported AAM was assessed by the questionnaire. Multiple linear regression analysis was used to evaluate the association between systolic blood pressure (SBP), diastolic blood pressure (DBP), and AAM. Logistic regression analysis was performed to evaluate the association between hypertension and AAM. Generalized additive model (GAM) and smooth curve fitting (penalized spline method) were conducted to explore the exact shape of curve between them. RESULTS: The overall mean of AAM was 15.5 years. Each additional year of AAM was associated with a 15% higher risk of hypertension (odds ratio (OR) = 1.15, 95% confidence interval (CI): 1.11-1.19). Among females with hypertension, there was a significant positive association between AAM and SBP (ß = 0.88, 95% CI: 0.29-1.46) and DBP (ß = 0.80, 95% CI: 0.47-1.13). A significantly higher risk of hypertension was found in younger subjects (15-44 y: OR = 1.37, 95% CI: 1.21-1.55; P for interaction = 0.009) compared with those aged between 62 and 97 y. CONCLUSIONS: AAM was positively associated with hypertension and blood pressure, especially among females in early adulthood from southern China.

Peripheral leukocyte count and risk of bleeding in patients with non-valvular atrial fibrillation taking dabigatran: a real-world study.

BACKGROUND: The association between peripheral leukocyte count and bleeding events in nonvalvular atrial fibrillation (NVAF) patients treated with dabigatran remains unclear. This study aimed to explore the association between leukocyte count and bleeding events after excluding other confounders in NVAF patients taking dabigatran. METHODS: A total of 851 NVAF patients treated with dabigatran (110 mg bid) were recruited from 12 centers in China from February 2015 to December 2017. Follow-up was completed by May 2018. The exposure and outcome variables were leukocyte count measured at baseline and the number of bleeding events within the subsequent 6 months. Multivariate Cox proportional hazards models were constructed to analyze independent associations, and a Cox proportional hazards regression with cubic spline functions and smooth curve fitting (penalized spline method) was used to address nonlinearity between leukocyte count and bleeding. The inflection point was calculated using a recursive algorithm, and then a two-piecewise Cox proportional hazards model for both sides of the inflection point was constructed. RESULTS: During 6-month follow-up, 87 participants occurred bleeding events. For every 1 × 10/L increase in leukocyte count, the risk of bleeding increased by 11% (hazard ratio [HR]: 1.11, 95% confidence interval [CI]: 0.99-1.25). The smooth curve showed nonlinear relationship between leukocyte count and bleeding events. The inflection point of the leukocyte count was 6.75 × 10/L. For leukocyte counts < 6.75 × 10/L, the HR (95% CI) was 0.88 (0.69-1.13), and for leukocyte counts ≥ 6.75 × 10/L, the HR (95% CI) was 1.28 (1.09-1.51). CONCLUSION: This study found a J-shaped association between baseline leukocyte count and risk of bleeding in NVAF patients treated with dabigatran. CLINICAL TRIAL REGISTRATION: NCT02414035, https://clinicaltrials.gov.

Efficacy of Nifekalant in Patients With Wolff-Parkinson-White Syndrome and Atrial Fibrillation: Electrophysiological and Clinical Findings.

Background The efficacy of nifekalant in preexcited atrial fibrillation ( AF ) has not been assessed. Methods and Results The study populations consisted of patients with sustained preexcited AF (n=51), paroxysmal supraventricular tachycardia (n=201), and persistent AF (n=87). Effects of intravenous infusion of nifekalant were assessed on electrophysiological and clinical parameters. Nifekalant prolonged the shortest preexcited R-R, the average preexcited R-R, and the average R-R intervals from 290±35 to 333±44 ms, 353±49 to 443±64 ms, and 356±53 to 467±75 ms, respectively, in patients with preexcited AF (all P<0.001). Nifekalant also decreased the percentage of preexcited QRS complexes, heart rate, and increased systolic pressure (all P<0.001). Nifekalant terminated AF in 33 of 51 patients (65%). Similar effects were also observed in a subgroup of 12 patients with preexcited AF and impaired left ventricular function. In patients with paroxysmal supraventricular tachycardia, nifekalant significantly prolonged the effective refractory period, the block cycle length of the antegrade accessory pathway, and the atrial effective refractory period (all P<0.001). Nifekalant had no effect on the effective refractory period of the antegrade atrioventricular node. Finally, in patients with persistent AF without an accessory pathway, nifekalant did not significantly decrease the ventricular rate of AF . One patient developed Torsades de Pointes. No other adverse effects were observed. Conclusions Nifekalant prolongs the effective refractory period of the antegrade accessory pathway and atrium without blocking antegrade conduction through the atrioventricular node, leading to slowing and/or to termination of preexcited AF . Thus, nifekalant might be an effective and a relatively safe drug in patients with preexcited AF .

Associations between resting heart rate, hypertension, and stroke: A population-based cross-sectional study.

Uncertainty remains regarding the association between resting heart rate (RHR) with hypertension and stroke because of limited and inconsistent data. We assessed the association between RHR, hypertension, and stroke. In this cross-sectional study, 14 677 participants from the China Hypertension Survey study were analyzed. The history of stroke was conducted by questionnaires. RHR was measured by the standardized electronic monitors. Multivariate logistic regression analyses were performed to evaluate the association between RHR, hypertension, and stroke. Moreover, a generalized additive model (GAM) and smooth curve fitting (penalized spline method) were conducted to assess the association between RHR and stroke in different status of hypertension. Overall, each 10 beats per minute (bpm) increase in RHR was associated with an 18% increased prevalence of stroke (P = 0.017). Subjects with RHR > 80 bpm were associated with a higher prevalence of stroke (OR = 1.47; 95% CI, 1.08-2.01) compared with those with RHR ≤ 80 bpm. Similarly, hypertensives had a higher prevalence of stroke than normotensives (OR = 3.76; 95% CI, 2.39-5.92). Hypertensives with RHR > 80 bpm had the highest prevalence of stroke compared with their counterparts (OR = 5.47; 95% CI, 3.13-9.56). The fully adjusted smooth curve fitting presented a linear association between RHR and stroke among participants with hypertension, but almost horizontal association among participants without hypertension. In conclusion, elevated RHR and hypertension were independently and jointly associated with the increased prevalence of stroke. These findings suggested that elevated RHR was associated with increased prevalence of stroke especially among hypertensives.

Relationship of sleep duration on workdays and non-workdays with blood pressure components in Chinese hypertensive patients.

Objectives: This study aimed to assess the relationship of sleep duration on workdays and non-workdays with BP components [systolic BP (SBP), diastolic (DBP), pulse pressure (PP), and mean arterial pressure (MAP)] among Chinese hypertensive adults. Methods: The study included 3,376 hypertensive patients without antihypertensive treatment. Self-reported sleep durations on workdays and non-workdays were measured by the questionnaire. Multiple linear regression analyses were performed to evaluate the association of sleep duration with BP components. Results: Overall, compared with a sleep duration of 5-9 h, individuals who slept ≥10 h on both workdays and non-workdays were positively correlated with SBP [ß (95% CIs) = 3.99 (1.06, 6.93) and 4.33 (1.79, 6.87)] and PP [ß (95% CIs) = 3.25 (0.71, 5.79) and 3.05 (0.85, 5.25)], but not with DBP. Moreover, individuals who slept ≥10 h only on non-workdays had higher MAP [ß (95% CIs) = 2.30 (0.63, 3.97)]. The stratified analyses showed that subjects with a BMI ≥24 kg/m2 in the longer sleep duration group (≥10 h) only on workdays compared to the reference group had higher SBP, DBP and MAP (all P for interaction <0.05). The effect of longer sleep duration on BP components showed no difference in the following subgroups: sex, age, smoking and drinking (all P for interaction >0.05). Conclusion: Compared with a sleep duration of 5-9 h, longer sleep duration (≥10 h) on workdays and non-workdays was associated with high SBP and PP among Chinese hypertensive adults without antihypertensive treatment.

Association between physical activity and stroke in a middle-aged and elderly Chinese population.

BACKGROUND: Accumulating evidence has reported that physical activity (PA) is effective in reducing stroke and mortality. However, whether PA levels are associated with stroke in middle-aged and elderly people in Jiangxi Province of China remains unclear. In the present study, we evaluated the association between PA and the risk of stroke in Jiangxi Province of China. METHODS: A cross-sectional survey was conducted in Jiangxi Province of China from November 2013 to August 2014, using standardized questionnaire forms and physical measurements. Self-reported PA was assessed using the international PA questionnaire. A history of stroke was self-reported by answering the questionnaire. Multivariate logistic regression analysis was performed to evaluate the association between PA levels and the risk of stroke after adjustment for sociodemographic characteristics, lifestyle factors, and disease-related risk factors. RESULTS: A total of 10,398 participants (4240 men and 6158 women, aged 45 to 97 years) completed the International Physical Activity Questionnaire (IPAQ). Compared with low-intensity PA, vigorous PA was associated with graded reduction in the risk of stroke (odds ratio [OR] of 0.763, 95% confidence interval [CI] 0.717-0.812, P < .001 for trend). However, there were no significant differences between individuals in the low-intensity PA and moderate-intensity PA group (P > 0.05). CONCLUSIONS: Compared with low PA, vigorous PA, but not moderate PA, was associated with a lower risk of stroke in middle aged and elderly people in southern China, specifically among men. These findings suggested that increasing PA is beneficial.

Sedentary behavior and the risk of cardiac-cerebral vascular diseases in southern China.

Accumulating evidence has reported that prolonged periods of sedentary time have been recognized as a risk factor for cardiocerebrovascular disease. However, whether high levels of sedentary behavior are associated with an increased risk of cardiocerebrovascular disease in different regions remains unclear.The aim of this study was to evaluate the association between sedentary behavior and the risk of myocardial infarction (MI) and stroke in Jiangxi Province of China.A cross-sectional survey was conducted among 15,364 participants in Jiangxi Province of China from November 2013 to August 2014, using standardized questionnaire forms and physical measurements. Self-reported sedentary behavior in daily life and a history of MI and stroke were conducted by answering the questionnaire. The participants were examined for weight, height, waist circumference (WC), body fat percentage (BFP), visceral fat index (VAI), basal metabolic rate (BMR), and blood pressure (BP). Multivariate logistic regression analysis was performed to evaluate the association between sedentary behavior and the risk of MI and stroke after adjustment for sociodemographic characteristics, lifestyle factors, and disease-related risk factors.Of the 15,364 eligible participants, 13,710 participants (5604 men and 8106 women, aged 15-97 years) completed the questionnaire. Subjects who had longer sedentary behavior were significantly associated with an increased risk of MI and stroke [odds ratio (OR) = 1.22, 95% confidence interval (95% CI): 1.168-1.281, P < .001; OR = 1.59, 95% CI: 1.50-1.67, P < .001]. After stratification by the categorical variable of sedentary behavior, individuals with a longer time of sedentary behavior (≥8 hours) were also related to a higher risk of MI and stroke than those in the sedentary behavior (<4 hours) group (OR = 176.62, 95% CI: 43.33-719.90, P < .001; OR = 478.52, 95% CI: 118.50-1932.36, P < .001). However, there were no significant differences between individuals in the short time of sedentary behavior (<4 hours) group and the middle time (4-8 hours) group (p > 0.05).Excessive time spent in sedentary behavior was associated with a higher risk of MI and stroke. The results provide robust evidence to support the guideline recommendations regarding reduction of sedentary behavior in daily life.

Association between subjective sleep duration on workdays or non-workdays and uncontrolled blood pressure in Southern China.

OBJECTIVES: To examine the association between sleep duration on workdays or non-workdays and unsatisfactory blood pressure (BP) control in Southern China. METHODS: We analyzed 4370 hypertensive patients, including their self-reported sleep duration on workdays or non-workdays and their BP. Unsatisfactory BP control was defined as systolic BP of ≥140 mm Hg or diastolic BP of ≥90 mm Hg. Multivariate logistic regression analyses were performed to evaluate the association between sleep duration and unsatisfactory BP control. RESULTS: Overall, the multivariable-adjusted odds ratios of unsatisfactory BP control risk were 1.59 (95% confidence interval, 1.14-2.22) for 9-10 hours of sleep on workdays and 1.47 (95% confidence interval, 1.07-2.03) for ≥10 hours of sleep on non-workdays compared with a sleep duration of 5-9 hours. No association between a short sleep duration and unsatisfactory BP control was noted. The association between a longer sleep duration (≥10 hours) and unsatisfactory BP control was more pronounced among women aged 65-70 years, with a body mass index ≥ 24 kg/m2. CONCLUSION: People with hypertension who slept 9-10 hours on workdays and ≥10 hours on non-workdays were more likely to have unsatisfactory BP control compared with those with a sleep duration of 5-9 hours; these associations tended to vary by age, sex, and body mass index. These findings indicate that a longer sleep duration might be a way to predict uncontrolled BP in hypertensive adults.

Sleep duration on workdays or nonworkdays and cardiac-cerebral vascular diseases in Southern China.

OBJECTIVES: This study aimed to assess the relationship between sleep duration on work or nonworkdays and myocardial infarction (MI) and stroke in Southern China. METHODS: A cross-sectional survey was conducted among 15,364 participants of age ≥15 years in Southern China from November 2013 to August 2014. Data on self-reported duration of sleep on workdays or nonworkdays as well as history of MI and stroke were collected in the questionnaire. The subjects were examined for weight, height, waist circumference, and blood pressure. Multivariate logistic regression analyses were performed to evaluate the association of sleep duration with MI and stroke. RESULT: Overall, compared with a sleep duration of 6-8 h, individuals who slept <6 h on workdays and nonworkdays were associated with increased risk for MI (odds ratio [OR] = 3.17, 2.04). Furthermore, individuals who slept >8 h on workdays and nonworkdays were associated with an increased risk for stroke (OR = 1.86, 1.54). Although this association persisted in men and subjects aged <65 years, we also observed that long sleep duration on workdays was associated with MI, especially among women, and short sleep duration on nonworkdays was associated with stroke among those aged 65 years or older. Participants with abnormal sleep duration and hypertension had higher risk of MI and stroke. Sleep debt was independently associated with MI risk, but not stroke (OR = 1.40; 95% confidence interval [CI]: 1.06-1.86), specifically among men aged <65 years. CONCLUSIONS: Compared with a sleep duration of 6-8 h, both short and long sleep duration were associated with the prevalence of MI and stroke and these associations were more pronounced among hypertensive persons, and tended to vary by age and sex. Moreover, sleep debt was linked to greater MI risk among men aged <65 years. These findings suggest that we should develop a healthy biological clock.

Prevalence of overweight, obesity, abdominal obesity and obesity-related risk factors in southern China.

OBJECTIVES: The purpose of this study is to assess the prevalence of overweight/obesity, abdominal obesity and obesity-related risk factors in southern China. METHODS: A cross-sectional survey of 15,364 participants aged 15 years and older was conducted from November 2013 to August 2014 in Jiangxi Province, China, using questionnaire forms and physical measurements. The physical measurements included body height, weight, waist circumference (WC), body fat percentage (BFP) and visceral adipose index (VAI). Multivariate logistic regression analysis was performed to evaluate the risk factors for overweight/obesity and abdominal obesity. RESULTS: The prevalence of overweight was 25.8% (25.9% in males and 25.7% in females), while that of obesity was 7.9% (8.4% in males and 7.6% in females). The prevalence of abdominal obesity was 10.2% (8.6% in males and 11.3% in females). The prevalence of overweight/obesity was 37.1% in urban residents and 30.2% in rural residents, and this difference was significant (P < 0.001). Urban residents had a significantly higher prevalence of abdominal obesity than rural residents (11.6% vs 8.7%, P < 0.001). Among the participants with an underweight/normal body mass index (BMI), 1.3% still had abdominal obesity, 16.1% had a high BFP and 1.0% had a high VAI. Moreover, among obese participants, 9.7% had a low /normal WC, 0.8% had a normal BFP and 15.9% had a normal VAI. Meanwhile, the partial correlation analysis indicated that the correlation coefficients between VAI and BMI, VAI and WC, and BMI and WC were 0.700, 0.666, and 0.721, respectively. A multivariate logistic regression analysis indicated that being female and having a high BFP and a high VAI were significantly associated with an increased risk of overweight/obesity and abdominal obesity. In addition, living in an urban area and older age correlated with overweight/obesity. CONCLUSION: This study revealed that obesity and abdominal obesity, which differed by gender and age, are epidemic in southern China. Moreover, there was a very high, significant, positive correlation between WC, BMI and VAI. However, further studies are needed to explore which indicator of body fat could be used as the best marker to indirectly reflect cardiometabolic risk.

Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China.

BACKGROUND: This study aimed to describe the prevalence and risk factors of prehypertension and hypertension in Jiangxi Province, China. Individuals with prehypertension frequently progress into hypertension and are at high risk of developing cardiovascular disease and stroke. METHODS: A cross-sectional survey of 15,296 participants (15 years or older) was conducted in Jiangxi Province, China, in 2013, using questionnaire forms and physical measurements. RESULTS: The prevalence of prehypertension and hypertension was 32.3% (39.2% in men and 27.6% in women) and 29.0% (30.1% in men and 28.2% in women), respectively. The awareness, treatment, and control rates among all hypertensive participants were 64.8%, 27.1%, and 12.6%, respectively. The prevalence of prehypertension in males declined with age, but the prevalence of hypertension increased in different genders. The prevalence of prehypertension and hypertension increased with increasing body mass index (BMI). The prevalence of prehypertension decreased, in parallel to an increase in the prevalence of hypertension, with increasing waist circumference (WC). A combination of WC and BMI was superior to individual indices in identifying hypertension. A multivariate logistic regression analysis indicated that increasing age, high BMI, high visceral adipose index, and high heart rate were risk factors for prehypertension and hypertension. The high body fat percentage was significantly associated with prehypertension. Living in an urban area, male sex, abdominal obesity, and menopause were correlated with hypertension. CONCLUSIONS: Prehypertension and hypertension are epidemic in southern China. Further studies are needed to explore an indicator that can represent the visceral fat accurately and has a close relationship with cardiovascular disease.