Assuntos
Artrite Reumatoide/complicações , Ecocardiografia Doppler , Insuficiência Cardíaca/diagnóstico por imagem , Volume Sistólico , Trombose/diagnóstico por imagem , Função Ventricular Esquerda , Corticosteroides/uso terapêutico , Anticoagulantes/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Fármacos Cardiovasculares/uso terapêutico , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Humanos , Imunossupressores/uso terapêutico , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Trombose/complicações , Trombose/tratamento farmacológico , Trombose/fisiopatologia , Fatores de Tempo , Resultado do TratamentoRESUMO
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 130âmmHg or DBP at least 80âmmHg. 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 36â352 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 20âmmHg increase) and DBP (per 10âmmHg increase) are independently associated with the risk of stroke incidence [SBP, hazard ratioâ=â1.277, 95% confidence interval (95% CI), 1.217-1.340, Pâ<â0.001; DBP, hazard ratioâ=â1.138, 95% CI, 1.090-1.189, Pâ<â0.001]. CONCLUSION: Our study revealed that the ideal BP for a population with BMI less than 24âkg/m was less than 130/80âmmHg, whereas the ideal BP for BMI at least 24âkg/m was less than 120/80âmmHg. The sensitivity analyses between BMI less than 25âkg/m and BMI at least 25âkg/m showed similar findings. This finding provides more accurate primary prevention strategies based on various BMI populations.
Assuntos
Pressão Sanguínea , Índice de Massa Corporal , Hipertensão/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , American Heart Association/organização & administração , Cardiologia/normas , China/epidemiologia , Análise por Conglomerados , Feminino , Humanos , Hipertensão/fisiopatologia , Incidência , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prevenção Primária , Modelos de Riscos Proporcionais , Estudos Prospectivos , Risco , Acidente Vascular Cerebral/fisiopatologia , Estados UnidosRESUMO
BACKGROUND: To investigate the status of hypertension and related risk factor disparities between urban and rural areas of northeast China. METHODS: A multi-stage, stratified, and cluster random sampling method was used to conduct the cross-sectional survey in Liaoning Province in 2017-2019. Finally, included 18,796 participants (28.9% urban, 71.1% rural) aged ≥40 years. The prevalence and control rate of hypertension were estimated based on Chinese hypertension guidelines and the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. RESULTS: The mean age of the population was 60.4±9.9 years, and 61.0% were women. The overall prevalence of hypertension was 56.8%. Compared to urban areas, hypertension was more prevalent, but the awareness, treatment, and control rates were lower in rural areas (59.2 vs 50.2, 52.5% vs 47.0%, 46.9% vs 34.9%, and 11.4% vs 3.7%, P<0.001, respectively). Multivariate regression analysis identified that the lack of exercise (odds ratio (OR), 1.24; 95% confidence interval (CI), 1.10-1.38) in rural areas, whereas overweight/obesity (OR, 2.01; 95% CI, 1.79-2.27) and alcohol consumption (OR, 1.20; 95% CI, 1.01-1.41) in urban areas were specific risk factors for hypertension, besides common risk factors. Under the 2017 ACC/AHA guidelines, the prevalence of hypertension was 80.6% (urban 76.6%, rural 82.2%), increased 1.4-fold compared with the current Chinese guidelines, with increased rates of 27.9% in urban areas and 25.7% in rural areas. CONCLUSION: A highly diverse prevalence for hypertension was found between urban and rural areas in northeast China. Region-specific strategies targeting the prevention and management of hypertension should be highlighted.