Báo cáo nghiên cứu khoa học: "nghiên cứu về tình hình tăng huyết áp Tại thị xã Đông Hà, tỉnh Quảng Trị năm 2008" docx

JOURNAL OF SCIENCE, Hue University, N 0 61, 2010 STUDY OF THE HYPERTENSION SITUATION AT DONGHA TOWN, QUANGTRI PROVINCE IN 2008 Le Thi Thu Trang,Tran Kim Phung Quang Tri Health Service

JOURNAL OF SCIENCE, Hue University, N 0 61, 2010

STUDY OF THE HYPERTENSION SITUATION

AT DONGHA TOWN, QUANGTRI PROVINCE IN 2008

Le Thi Thu Trang,Tran Kim Phung

Quang Tri Health Service

SUMMARY

Hypertension has been a leading risk factor of cardiovascular disease (CDV) and a main cause of deaths from heart complications as well The prevalence rate of hypertension has been increasing throughout the world over and also in Vietnam, yet no research into this issue has ever been carried out in Quangtri An investigation named "A Study

of the hypertension situation at Dongha town, Quangtri in 2008" was conducted accordingly.The study aimed to investigate the rate of hypertension in Dongha, Quangtri and explore the relationship between hypertension and several CVD risk factors in Dongha,

Quangtri Study design: A cross-sectional investigation and analysis Subjects: 461 men and women aged ≥ 25 years residing at Dongha, Quang Tri Methods: All enrolled participants

underwent measurements of height, weight, waist and BMI calculation, blood pressure, and were quantitatively tested for a fasting venous blood glucose in the morning, and lipid components Evaluations were based on criteria issued by the WHO, NCEP ATPIII and the

Vietnam national heart association Results: The hypertension rate was 26.68% and increased

with age, the age groups of 25-34, 35-44, 45-54, 55-64 and ≥ 65 accounted for 7.5%, 15.6%, 30.3%, 38.4% and  42.5% respectively Risk factors related to hypertension included: overweight (OR = 2.19), android obesity (OR = 2.34), dyslipidemia of at least one lipid component (OR = 2.19), hypercholesterolemia (OR = 2.53), elevated plasma LDL-C (OR = 2.15), and hypertriglyceridemia (OR = 2.25) Diabetes mellitus, fasting glucose intolerance (FGI), and general raised blood glucose (BG) were all evidently correlated to hypertension The rate of hypertension in those who had elevated levels of BG (with BG ≥ 6.1mmol/l) was 41/107

= 38.3%, those who were diabetic being 23/56 = 41%, and those who suffered from FGI being

18/41 = 35.3% Conclusions: the high rate of hypertension was similar to other regions

throughout the country, and the rate obviously increased with age, overweight, android obesity, metabolic dyslipidemia, hyperglycemia, and diabetes

1 Introduction

Cardiovascular disease (CVD) is the cause of one third of all deaths in the

such as stroke, myocardial infarction, heart failure, and renal failure While lifespans, overweight and obesity have been increasing and socio-psychological events have begun to have stronger effects on people's lives, the prevalence rate of HT continued to rise in the population Moreover, although risk factors of uncontrolled HT were identified, HT itself was insufficiently managed and treated in almost all patients, thus giving rise to the high rate of cardiovascular events in the majority of treated or untreated hypertensive persons

In Vietnam, the prevalence rate of HT was 27.2% in 2008, and understanding and management of HT were to a certain extent restricted In our home province Quangtri, no investigation on HT has been carried out so far

Objectives of the study are to investigate the rate of hypertension in the population of Dongha, Quangtri and reveal the relationship between hypertension and several risk factors of CVD at Dongha, Quangtri

2 Methods

2.1 Subjects: 461 men and women aging ≥ 25 years and residing at Dongha,

Quangtri

2.2 Methods

Design: cross-sectional investigation and analysis, simple random sampling Diagnosis and classification of HT according to JNC VI All enrolled participants underwent measurements of height, weight, waist and body mass index(BMI) calculation, and were quantitatively tested for morning fasting venous blood glucose, and lipid components Evaluations were based on criteria issued by WHO, NCEP ATPIII, WPRO and the Vietnam national heart association

Collected data were statistically analysed

3 Results

3.1 Rate of hypertension

Table 1 General rate of Hypertension in Dongha to compare with other region and country

Prevalence rate of HT at Dongha was similar to other regions in Vietnam

Table 2 Hypertension classification

(60.3%)

6244/9797

High normal: 130-139/85-89

60/461 (13%)

1260/9797

HT

(14.97%)

1346/9797 (13.8%)

> 0.05

Stage 2:

160-179/100-109

40/461 (8.68%)

555/9797 (5.7%)

< 0.005

Stage 3:  180/ 110

14/461 (3.04%)

325/9797

(100%)

9797 (100%)

Rates of HT in stages were the same as other places in Vietnam

3.2 Relationship between HT and other cardiovascular risk factors

3.2.1 Relationship between HT and anthropometric risk factors

Table 3 Gender

High normal

> 0,05

HT

Stage 2

> 0,05

Subtotal

< 0,05

HT was significantly higher in men than in women (30.5% vs 23.5%)

Table 4 Aging groups

Age

groups

(year)

BP

High normal

BP

HT

Stage 1 Stage 2 Stage 3 Subtotal

12

14 (15.6%)

(59.6%)

10 (10.1%)

16 (16.1%)

11

30 (30.3%)

(46.5%)

16 (16.2%)

19 (19.2%)

14

38 (38.4%)

14

34 (42.5%)

(60.3%)

60

40 (8.7%) 14 (3%)

OR(95%CI)

p

Rates of HT and severe HT both increased on aging

Table 5 Body mass index (BMI)

2 35.96

OR (95%CI)

p

Overweight (BMI  23) was significantly associated with HT

Table 6 Android obesity

Android obesity was significantly associated with HT

3.2.2 Relationship between HT and dyslipidemia

Table 7 At least one abnormal lipid component

OR (95%CI)

P

Dyslipidemia of at least one component was significantly associated with HT

Table 8 Elevated total cholesterolemia

P

Hypercholesterolemia was significantly associated with HT

Table 9 Elevated lower density lipoprotein – cholesterol(LDL-C)

OR (95%CI)

P

Elevated LDL-C was significantly associated with HT

Table 10 Reduced high density lipoprotein cholesterol (HDL-C)

OR (95%CI)

P

Reduced HDL-C was not a risk factor of HT

Table 11 Elevated triglyceridemia

OR (95%CI)

P

Elevated triglyceridemia was significantly associated with HT

3.3 Relationship between hypertension with elevated blood glucose

Table 12 Relationships between hypertension and diabetes (DM) and fasting glucose

intolerance (FGI)

HT

HT was significantly correlated with elevated blood glucose (DM and FGI) and DM; but not with single FGI Prevalence rates of HT in elevated blood glucose, DM and FGI persons were respectively 38.3%, 41% and 35.3%

4 Discussions

Prevalence the rate of HT in persons  25 years at Dongha (26.7%) was relatively similar to other regions in Vietnam Rates of stage-1, -2 and -3 HT were 15%, 8.7% and 3% respectively, and similar to those in Vietnamese people [5]

Gender: HT was significantly higher in men than in women (30.5% vs 23.5%),

but there was no difference between the two in each stage of classification [1], [5]

Age: The rate of HT increased on aging, and age groups of 25-34, 35-44, 45-54,

55-64 and  65 respectively accounted for 7.5%, 15.6%, 30.3%, 38.4% and 42.5% These figures were relatively similar to those in Pham Gia Khai's and Phan Long Nhon's (Binh Dinh) studies [5] The rate of severe HT, likewise, increased with age (stage-1

HT was primarily seen in those < 45 years, while stage-2 HT in those > 45 years) The rate of HT was considerably high in working age groups Especially in the still very young age group of 25-34, the rates of HT mounted up to 7.5%, not including 8.6% of which had high normal BP- which may cause injuries to target organs and progress to real HT

BMI: Overweight (BMI  23) was significantly associated with HT (OR = 3.8,

95%CI = 2.45-5.87)

Android obesity: Android obesity was also significantly associated with HT

The rate of HT in those with android obesity was 39/95 = 41.05%, while in those without android obesity 84/366 = 22.95%

Sanjay Vikrant proved in his study [10] that HT was more likely detected in obese persons than in people with normal BMI, and the higher the BMI, the higher the rate of HT

Dyslipidemia: Dyslipidemia was significantly associated with HT The rate of

HT in those with dyslipidemia of at least one component was 30%, while in others with normal lipid levels 16.5%

The rate of HT in those with hypercholesterolemia was 58/146 = 39.7%, while

in the others with normal cholesterolemia it was 65/315 = 20.6% Kaplan M.N suggested that cholesterolemia was often elevated in hypertensive persons, for hypercholesterolemia evidently injures the intima-dependent vasodilatory mechanism [7]

Rates of HT in those with and without elevated LDL-C were 40/102 = 39.2% and 83/359 = 23.1%, respectively

Reduced HDL-C was not a risk factor of HT Rates of HT in those with and without reduced HDL-C were approximately the same (31.3% vs 27.2%, respectively)

Rates of HT in groups with hypertriglyceridemia and with normal

triglyceridemia were 78//225 = 34.7% and 45/336 = 13.4% respectively

Diabetes mellitus and fasting glucose intolerance: Fasting blood glucose

levels  6.1mmol/l were significantly associated with HT The rate of HT in those with fasting blood glucose levels  6.1mmol/l was 41/107 = 38.3%, in diabetics being 23/56

= 41%, in those with FGI being 18/41 = 35.3% Sanjay Vikrant [10] and Kaplan M.N [7] supposed that insulin resistance and elevated blood glucose were related to HT The NHANES III study reported 71% of diabetics had HT [7]

5 Conclusions

5.1 Rate of HT was 26.68%

5.2 Rates of HT in age groups of 25-34, 35-44, 45-54, 55-64 and  65 respectively accounted for 7.5%, 15.6%, 30.3%, 38.4% and 42.5%

5.3 Risk factors associated with HT: Overweight (OR=3.8, 95%CI = 2.45-5.87, p<0.001), android obesity (OR = 2.34, 95%CI=1.46-3.37, p < 0.001), Dyslipidemia of

at least one component (OR = 2.19, 95%CI= 1.3-3.71, p < 0.005), hypercholesterolemia (OR = 2.53 95%CI = 1.66-3.87, p < 0,001), elevated LDL-C (OR = 2.15, 95%CI

=1.35-3.4, p < 0.005) and hypertriglyceridemia (OR = 2.25, 95%CI = 1.48-3.43, p < 0.001)

5.4 DM, elevated blood glucose of  6.1 mmol/l were obviously associated with

HT and rates of HT in these two circumstances were 41% and 38.3%, respectively

REFERENCES

1 Tran Van Huy, Truong Tan Minh (2004), Epidemiology of main cardiovascular

risk factors in adults in Khanh Hoa province, Journal of Vietnam Cardiology, No

37/2004, 580-596

2 Huynh Van Minh, Pham Gia Khai, Nguyen Huy Dung, ,(2008), Vietnam heart

association recommendation on diagnosis, treatment and prevention of hypertension in adults, Recommendations on cardiovascular and metabolic

diseases, 235-294

3 Huynh Van Minh, Đoan Phuoc Thuoc, , (2008), Epidemiological features of

metabolic syndrome in the Thua Thien-Hue population and in high risk subjects,

Practical medicine, No 616-617, 594-609

4 Phan Long Nhon (2007), Study on hypertension situation in adults in northern

Binh Dinh province, Journal of Vietnam Cardiology, No 47, Aug 2007, 31-38

5 Pham Gia Khai (2008), Epidemiology of hypertension in Vietnam, Reported at

6 Burt VL, Whelton P, Roccella EJ, , (1995) Prevalence of hypertension in the

US adult population Results from the third National Health and Nutrition Examination Survey, Hypertension, 1995 mar:25(3):305-13

7 Kaplan MN, System Hypertension: Mechanism and diagnosis, Heart disease -

chapter 37, 2005

8 Lip G.Y.H, Hall J.E, Comprehensive Hypertension, Mosby Elsevier, (2007)

9 The Joint National Committee, The seventh report of the Joint National

Committee on Prevention, Detection, Evaluation, and Treatment of high blood pressure, (2004)

10 Vikrant S, Tiwari SC, Essential Hypertension - pathogenesis and

pathophysiology, Journal, Indian Academy of Clinical Medicine vol.2, No.3:

2001, 140-161