中国高血压人群中H型高血压的比率和特征及与美国人群的比较

doi:10.19723/j.issn.1671-167X.2022.05.033

Abstract

Abstract:

Objective: To study the rate and characteristics of H-type hypertension in Chinese hypertensive population, and to compare them with the relevant data from the United States. Methods: Observational studies on the prevalence of H-type hypertension in Chinese population published before April 30, 2022 were searched in several Chinese and English databases (PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Databases, and Chinese Biome-dical Literature Database). Study selection, date extraction and quality evaluation were conducted. Random effect model was used to estimate the rate of H-type hypertension in hypertensive patients and the pooled prevalence of H-type hypertension. Stratified analysis was used to explore the distribution characteristics of H-type hypertension in China. We made meta-regression to search the source of heterogeneity. The National Health and Nutrition Examination Survey (NHANES) population from 1999 to 2006 in the United States was divided into four stages according to the time of data collection. Basic information of the participants was acquired from the database and the rate and prevalence of H-type hypertension analyzed. Results: This study was finally comprised of 33 studies, involving 78 470 patients with hypertension, among whom 59 842 patients were with H-type hypertension. The rate of H-type hypertension in hypertensive population in China was 73.1% (95%CI: 69.3%-76.9%, I²=99.4%, P < 0.001), and the prevalence of H-type hypertension in general population was 26.9% (95%CI: 21.1%-32.8%, I²=99.8%, P < 0.001). In the stratified analysis, the rate of H-type hypertension was higher among the elderly over 65 years, males, ethnic minorities, and residents in the inland, western, northern, and rural areas. During the decade from 2011 to 2020, the rate of H-type hypertension in China declined slowly (2011-2013: 79.2% vs. 2014-2016: 70.4% vs. 2017-2020: 66.6%, P < 0.001). Meta-regression showed that area was the source of heterogeneity. The rate of H-type hypertension in the United States increased over time, reaching a high value in 2003-2004 and then declining in 2005-2006. The rate of H-type hypertension in hypertensive patients and the prevalence of H-type hypertension in general population in the United States was lower than that in China. Conclusion: Although the rate of H-type hypertension in Chinese hypertensive patients has a downtrend, it still far exceeds that in the United States, especially in the elderly, males, ethnic minorities, and residents in the inland, western, northern, and rural areas. Understanding the epidemiology of H-type hypertension provides scientific evidence for further prevention of cardiovascular and cerebrovascular diseases.

Key words: H-type hypertension, Characteristics, China, Risk assessment, Risk factors

CLC Number:

R544.1

Zhe LIANG,Fang-fang FAN,Yan ZHANG,Xian-hui QIN,Jian-ping LI,Yong HUO. Rate and characteristics of H-type hypertension in Chinese hypertensive population and comparison with American population[J].Journal of Peking University (Health Sciences), 2022, 54(5): 1028-1037.

Figures/Tables 11

Figure 1

Table 1

Basic characteristics of studies on the prevalence of H-type hypertension in China"

Study	Year of publication	Year of data colleetion	Population source	Area	Region	Setting	Nationality	No. of hypertension cases	Mean age/years	No. of H-type hypertension cases	Rate of H-type hypertension	Quality evaluation
Chai 2016^[10]	2016	2014.6-2014.8	Community	Coast	Eastern	Rural and urban	Han	1662	64.51±11.42	1137	68.41%	10
Chang 2017^[11]	2017	2012.7-2013.8	Community	Coast	Northeast	Rural	Han	3392	58.01	2943	86.76%	9
Chen 2016a^[12]	2016	2010.5-2013.5	Physical examination	Inland	Northern	Rural and urban	Han	4759	NR	3543	74.45%	8
Chen 2016b^[13]	2016	2015	Community	Coast	Eastern	Rural and urban	Han	568	NR	281	49.47%	8
Gong 2019^[14]	2019	2016.1-2018.5	Physical examination	Inland	Northern	Rural and urban	Han	1608	NR	1331	82.77%	5
Cuo 2015^[15]	2015	2011-2012	Community	Inland	Western	Rural	Minority	811	NR	712	87.79%	8
Guo 2021^[16]	2021	2012.3-2015.7	Community	Coast	Southern	Rural and urban	Han	4077	50.5±5.5	1926	47.24%	9
Kong 2013^[17]	2013	2011.12-2012.1	Community	Coast	Eastern	Rural and urban	Han	1895	66.45 +8.83	1489	78.58%	10
Li 2014^[18]	2014	2012.6-2012.12	Community	Coast	Southern	Rural and urban	Minority	2832	60.83	2126	75.07%	7
Li 2015^[19]	2015	2013.3-2013.5	Community	Coast	Northeast	Rural and urban	Han	681	NR	475	69.75%	9
Li 2016^[20]	2016	2013.11-2014.3	Community	Coast	Eastern	Rural and urban	Han	604	NR	448	74.17%	7
Liang 2012^[21]	2012	2009.12-2011.5	Community	Inland	Northern	Rural and urban	Han	221	NR	207	93.67%	9
Liu 2016^[22]	2016	2015.1-2016.1	Community	Coast	Eastern	Rural and urban	Han	656	57.8±11.2	380	57.93%	7
Liu 2018^[23]	2018	2016.6-2016.9	Community	Inland	Northern	Rural	Han	1473	63.78+8.92	1223	83.03%	7
Ma 2016^[24]	2016	2014.1-2015.12	Community	Coast	Eastern	Rural and urban	Han	975	69.47+10.35	571	58.56%	6
Pan 2015^[25]	2015	NR	Community	Coast	Eastern	Rural and urban	Han	1208	63.92	857	70.94%	6
Pang 2014^[26]	2014	2011.5-2012.11	Community	Inland	Western	Rural	Minority	402	NR	352	87.56%	9
Pu 2017^[27]	2017	2016.1-2017.2	Community	Inland	Southwest	Urban	Han	1145	NR	687	60.00%	7
Qian 2021^[28]	2021	2019.7-2020.4	Community	Coast	Eastern	Rural and urban	Han	22731	68.9±8.6	18151	79.85%	9
Qin 2017^[5]	2017	2008.5-2013.8	Community	Coast	Eastern	Rural and urban	Han	10783	59.85	8592	79.68%	10
Song 2016^[29]	2016	2015.3-2015.10	Community	Inland	Northern	Rural	Han	860	69.39	834	96.98%	6
Sun 2019^[30]	2019	2011.12-2012.4	Community	Inland	Northern	Rural and urban	Han	2671	NR	2120	79.37%	6
Tan 2018^[31]	2018	2017.3-2018.3	Physical examination	Inland	Central	Rural and urban	Han	1849	52.51	1395	75.45%	5
Wang 2018^[32]	2018	2014.3-2017.3	Community	Coast	Eastern	Urban	Han	574	63.3±12.2	421	73.34%	7
Wang 2022^[33]	2022	2019.4-2019.6	Community	Coast	Eastern	Rural and urban	Han	368	64.08	131	35.60%	7
Wu 2016^[34]	2016	2013.1-2014.10	Physical examination	Inland	Southwest	Rural and urban	Han	1496	NR	1376	91.98%	5
Zhang 2016^[35]	2016	2013.9-2013.12	Community	Coast	Eastern	Rural and urban	Han	1636	NR	1439	87.96%	10
Zhang 2020^[36]	2020	NR	Community	Inland	Central	Rural and urban	Han	1395	58.28±12.00	1208	86.59%	7
Zhou 2019^[37]	2019	2017.9-2017.12	Community	Coast	Eastern	Rural and urban	Han	1082	73.2±7.9	904	83.55%	8
Zhou 2020^[38]	2020	2019.1-2019.3	Community	Coast	Eastern	Rural and urban	Han	908	65.53±10.63	373	41.08%	8
Zhu 2013^[39]	2013	2011.5-2012.5	Physical examination	Coast	Eastern	Rural and urban	Han	221	NR	95	42.99%	7
Zhu 2018^[40]	2018	2015.1-2016.6	Community	Coast	Eastern	Rural and urban	Han	1795	NR	1242	69.19%	9
Zou 2017^[41]	2017	2015	Physical examination	Coast	Eastern	Rural and urban	Han	1132	NR	873	77.12%	6

Table 1

Figure 2

Figure 3

Table 2

Stratified analysis for the rate of H-type hypertension in China"

Subgroups	No. of studies	No. of hypertension cases	Pooled rate/%	Heterogeneity		P for comparison
Subgroups	No. of studies	No. of hypertension cases	Pooled rate/%	I²	P	P for comparison
Demographic characteristics
Mean age/years	18					< 0.001
< 65	12	30 269	70.1 (62.9-77.4)	99.5%	< 0.001
≥65	6	28 451	73.2 (62.6-83.7)	99.7%	< 0.001
Gender	23					< 0.001
Male	23	29 896	81.8 (77.9-85.7)	99.3%	< 0.001
Female	23	32 328	62.8 (56.8-68.7)	99.2%	< 0.001
Nationality	33					< 0.001
Han	30	74 425	72.1 (68.0-76.1)	99.5%	< 0.001
Minority	3	4 045	83.4 (74.0-92.8)	98.1%	< 0.001
Study characteristics
Year of publication	33					< 0.001
2012-2015	8	8 271	76.2 (69.6-82.7)	98.1%	< 0.001
2016-2018	17	35 359	74.5 (69.5-79.5)	99.3%	< 0.001
2019-2022	8	34 840	67.1 (56.7-77.6)	99.7%	< 0.001
Year of data collection	31					< 0.001
2011-2013	12	30 304	79.2 (75.6-82.8)	98.3%	< 0.001
2014-2016	11	15 298	70.4 (58.8-82.0)	99.7%	< 0.001
2017-2020	8	30 265	66.6 (58.2-75.0)	99.3%	< 0.001
No. of hypertension cases	33					< 0.001
< 1 000	13	7 849	66.9 (55.1-78.8)	99.5%	< 0.001
≥1 000	20	70 621	76.9 (73.1-80.8)	99.3%	< 0.001
Population source	33					< 0.001
Community	27	67 405	72.8 (68.4-77.1)	99.5%	< 0.001
Physical examination	6	11 065	74.7 (66.9-82.4)	99.0%	< 0.001
Geographical distributions
Area	33					< 0.001
Inland	12	18 690	83.3 (77.8-88.8)	99.1%	< 0.001
Coast	21	59 780	67.2 (62.4-72.0)	99.4%	< 0.001
Region	33					< 0.001
Northern	6	11 592	85.0 (76.8-93.2)	99.4%	< 0.001
Northeast	2	4 073	78.3 (61.7-95.0)	98.8%	< 0.001
Eastern	17	48 798	66.7 (62.3-71.2)	99.1%	< 0.001
Central	2	3 244	81.0 (70.1-92.0)	98.5%	< 0.001
Southern	2	6 909	61.2 (33.9-88.4)	99.8%	< 0.001
Southwest	2	2 641	76.0 (44.7-100.0)	99.7%	< 0.001
Western	2	1 213	87.7 (85.9-89.6)	0.0%	0.909
Setting	33					< 0.001
Rural	5	6 938	88.5 (82.8-94.1)	98.3%	< 0.001
Urban	2	1 719	66.6 (53.5-79.7)	96.9%	< 0.001
Rural and urban	26	69 813	70.6 (66.6-74.7)	99.4%	< 0.001

Table 2

Figure 4

Table 3

Figure 5

Table 4

Figure 6

Figure 7

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Characteristic	Year of data collection				P value
Characteristic	1999-2000	2001-2002	2003-2004	2005-2006	P value
No. of participants	3 829	4 307	4 098	4 051
Mean age/years, ${\bar x}$±s	46.3±0.4	47.0±0.5	46.8±0.5	47.3±0.7	0.089
Male, n (%)	1 903 (49.2)	2 156 (48.6)	2 083 (49.3)	2 087 (49.1)	0.886
Ethnicity, n (%)					0.446
Mexain American	1 030 (7.0)	867 (6.2)	796 (7.2)	787 (7.7)
Other Hispanic	246 (8.1)	177 (5.7)	116 (3.3)	122 (3.4)
Non-Hispanic white	1 726 (70.7)	2 337 (74.3)	2 213 (73.6)	2 071 (73.0)
Non-Hispanic black	720 (10.3)	795 (9.7)	803 (10.8)	918 (10.9)
Other race	107 (4.0)	131 (4.1)	170 (5.2)	153 (5.1)
BMI/(kg/m²), ${\bar x}$±s	28.0±0.2	28.0±0.2	28.2±0.2	28.6±0.2	< 0.001
SBP/mmHg, ${\bar x}$±s	124.3±0.8	123.6±0.5	123.5±0.5	123.0±0.5	0.030
DBP/mmHg, ${\bar x}$±s	73.1±0.4	72.7±0.4	71.6±0.3	70.7±0.4	< 0.001
Hcy/(μmol/L), ${\bar x}$±s	8.3±0.1	8.9±0.1	9.2±0.1	8.5±0.1	< 0.001
Hypertension, n (%)	1 686 (35.2)	1 836 (36.1)	1 925 (39.1)	1 716 (37.8)	0.258
H-type hypertension, n (%)	562 (10.0)	770 (13.4)	925 (16.2)	641 (12.3)	< 0.001

Rate and characteristics of H-type hypertension in Chinese hypertensive population and comparison with American population

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Variables	No. of studies	No. of hypertension cases	Univariate			Multivariate
Variables	No. of studies	No. of hypertension cases	Coefficient	95%CI	P value	Coefficient	95%CI	P value
Demographic characteristics
Mean age	18	58 720	0.005	-0.008 to 0.019	0.444
Male/Female	25	66 290	-0.063	-0.143 to 0.017	0.123
Nationality	33
Han	30	74 425	Reference
Minority	3	4 045	0.115	-0.071 to 0.301	0.226
Study characteristics
Year of publication	33	78 470	-0.018	-0.040 to 0.004	0.112
Year of data collection	31	75 867	-0.024	-0.046 to -0.001	0.038	-0.017	-0.038 to 0.004	0.118
No. of hypertension cases	33	78 470	4.67×10^-6	-8.63×10^-6 to 1.8×10^-5	0.491
Population source	33
Community	27	67 405	-0.016	-0.158 to 0.126	0.825
Physical examination	6	11 065	Reference
Geographical distributions
Area	33
Inland	12	18 690	0.162	0.063 to 0.260	0.001	Reference
Coast	21	59 780		Reference		-0.120	-0.232 to -0.008	0.035
Region	33
Northern	6	11 592	-0.026	-0.259 to 0.206	0.823
Northeast	2	4 073	-0.094	-0.378 to 0.191	0.519
Eastern	17	48 798	-0.212	-0.424 to 0.001	0.051
Central	2	3 244	-0.067	-0.351 to 0.218	0.646
Southern	2	6 909	-0.265	-0.550 to 0.019	0.067
Southwest	2	2 641	-0.116	-0.401 to 0.168	0.423
Western	2	1 213		Reference
Setting	33
Rural	5	6 938		Reference		0.125	-0.112 to 0.363	0.301
Urban	2	1 719	-0.218	-0.460 to 0.025	0.078	Reference
Rural and urban	26	69 813	-0.179	-0.320 to -0.038	0.013	0.026	-0.180 to 0.232	0.805

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