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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (5): 1028-1037. doi: 10.19723/j.issn.1671-167X.2022.05.033

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

Zhe LIANG1,Fang-fang FAN1,Yan ZHANG1,Xian-hui QIN2,Jian-ping LI1,Yong HUO1,*()   

  1. 1. Department of Cardiology, Peking University First Hospital; Institute of Cardiovascular Disease, Peking University First Hospital; Beijing 100034, China
    2. Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
  • Received:2022-06-08 Online:2022-10-18 Published:2022-10-14
  • Contact: Yong HUO E-mail:huoyong@263.net.cn
  • Supported by:
    the National Key Research and Development Program of China(2021YFC2500500);the National Key Research and Development Program of China(2021YFC2500501);the Key Laboratory of Molecular Cardiovascular Sciences (Peking University), and the Ministry of Education and NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides (Peking University)

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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

Figure 1

Flow diagram of literature identification and screening CNKI, China National Knowledge Infrastructure; CBM, China Biology Medicine; Hcy, homocysteine; AHRQ, Agency for Healthcare Research and Quality."

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

Figure 2

Forest plot of the rate of H-type hypertension in hypertensive population in China Weight are from random-effects model."

Figure 3

Forest plot of the prevalence of H-type hypertension in general population in China Weight are from random-effects model."

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
I2 P
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

Figure 4

Regional distribution of the rate of H-type hypertension in China"

Table 3

Baseline characteristics of the NHANES population in the United States"

Characteristic Year of data collection P value
1999-2000 2001-2002 2003-2004 2005-2006
No. of participants 3 829 4 307 4 098 4 051
Mean age/years, ˉx±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), ˉx±s 28.0±0.2 28.0±0.2 28.2±0.2 28.6±0.2 < 0.001
SBP/mmHg, ˉx±s 124.3±0.8 123.6±0.5 123.5±0.5 123.0±0.5 0.030
DBP/mmHg, ˉx±s 73.1±0.4 72.7±0.4 71.6±0.3 70.7±0.4 < 0.001
Hcy/(μmol/L), ˉx±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

Figure 5

Comparison of the rate of H-type hypertension between China and the United States A, China; B, the United States."

Table 4

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

Variables No. of studies No. of hypertension cases Univariate Multivariate
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

Figure 6

Publication bias of studies on the rate of H-type hypertension in China"

Figure 7

Sensitivity analysis of studies on the rate of H-type hypertension in China"

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