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752
Brief report
Prevalence of hypertension and risk factors in Heilongjiang
province in 2007
FU Shi-ying, Ll Wei-min, ZHAO Yu-juan, DONG Li-hang, ZHAO Jingbo, WANG Bai-qiu,
LO Yan-jie and YANG Bao-feng
Keywords: hypertension; epidemiology; blood pressure
A
pproximately 2/ 3 of cardiovascular di seases in the
Asia-Pacific region are closely associated with
hypertension.' And statistics indicates the existence of
160 million hypertension patients in China in 2004 with
approximately I billion patients simultaneously suffering
from other cardiovascular diseases? It is evident that
hypertension control plays a crucial role in the prevention
of cardiovascular di sease. This study aimed to find the
epidemiological features of hypertension in Heilongjiang
province and to gather statistical informati on about the
prevalence and causative factors of hypertension.
METHODS
Subjects
Using the stratified chunk method, investigators of this
study completed a survey form, physical examination,
and laboratory analysis of I 0 620 participants ( 4691
males and 5929 females), who aged 15 years and above,
being permanent residents from both rural (Lanxi) and
urban area (Nangang District of Harbin) of Heilongjiang
province from January I to February 28 in 2007. The
participants were those without stress of fever, acute
infection, history of operation, trauma, etc. They were
di vided into 15-, 25-, 35- , 45- , 55- , 65-, and 2:75-year
age groups.
Protocol
The investi gators consisted of cardiologists, PhD students,
and MSc students from the First Affiliated Hospital of
Harbin Medical University as well as related physicians
from local hospitals. Following the completion of the
training program, the investigators started to investigate
the participants from both urban and rural areas.
According to a widely accepted standardized protocol as
well as quality control regulation, the investigators
measured blood pressure, height, and body weight of the
participants.
Blood pressure was measured using a mercury
sphygmomanometer under the circumstance of bright,
silence and at room temperature (about 21C), no
smoking 15 minutes before examination, and no
movement and stress 5 minutes before examination.
Systolic and diastolic pressure was measured according to
Korotkoff sounds. Specificall y, systolic pressure was
identified using a mercury sphygmomanometer when the
first sound was heard; diastolic pressure was identified
when the fifth sound disappeared. The measurement was
repeated three t imes with the average value being
calculated based on the second and third measurements.
The criteria for diagnosis of hypertension were the 2005
revised China Guidelines for the Management of
Hypertension. The accuracy rate of blood pressure was I
millimeter of mercury.
Height and body weight were measured using standard
instruments. In addition, body mass index (BMI) was a lso
assessed (BMI=weight (kg)/height
2
(m
2
) ). The criteria for
diagnosis were identified as foll ows: BMI 2:24 was
considered overweight; BMI 2:28 was considered obese.
The accuracy rate of height and body weight was 0.0 I m
and 0.1 kg respectively.
A 5-ml venous blood sample was taken from each
participant who had fasted for 8- 10 hours. Total
cholesterol (TC), tri glyceri de (TG), low density
li poprotein cholesterol (LDL-C), and hi gh density
lipoprotein cholesterol (HDL-C) were examined by the
endpoint method in the blood sample (TARGA-2000
Automatic Biochemistry Analysator, Italy).
Statistical analysis
Data were double entered and validated using Epidata
3.02 software. Categorical variables were expressed as
rates or proportions and were compared using the
chi-square test. We analyzed risk factors by the Logistic
regression model. A 2-sided P value less than 0.05 was
considered statistically significant. All the data were
analyzed by SAS 9. 1.3 statistical software package.
DOl: I 0.3 760/cma.j.issn.0366-6999.20 I 0.06.02 1
Department of Cardiology, First Affiliated Hospital of Harbin
Medical University, Harbin, Heilongjiang 150001, China (Fu SY.
Li WM, Zhao YJ and Dong LH)
Cardiovascular lnslirute, Harbin Medical Univ.ersity, Harbin,
Heilongjiang 150001, China (Wang BQ. LO YJ and Yang BF)
Public Heallh College of Harbin Medical University, Harbin,
Heilongji ang 150001, China (Zhao JB)
Correspondence to: Or. ZHAO Yu-juan, Department of Cardiology,
First Affiliated Hospital of Harbin Medical University, Harbin.
Heilongjiang 150001, China (Tel: 86- 13845 104322. Fax:
86-451-53643907. Email: zhaoyujuan2008@yahoo.cn)

/
Chinese Medica/Journa/2010; 123(6):752-755 753
Tabl e I. Prevalence of hypertension in Heilongjiang province in 2007
Toll!
Male Totill
Groups
Rural area Urban area
Mille Female Totill Male Female Total
Nonnal (n) 1716 1993 3709 1323 23SI 3674 3039 7313
Hyp<neMioo (n) 823 740 IS63 829 84S 1674 16S2 ISIS 3237
Total(n) 2S39 2733 S272 2lS2 3196 S348 4691 S929 10 620
Prevalence (Y) 32.41 27.01 29.6S 3I .S2 26.44 31.30 3S.22 26.73 30.41
Adjusled prevalence (Y,) 31.24 21.36 2S.69
x'- 87.3164, p <0.0001.
Tabl e 2. Comparison prevalence in different gender and age sroups in Heilongjiang province in 2007
Age (years)
Male Female x'
p
Normal !!!!!!2 Total Prevalence(%! Normal Total (%! values values
<2S 1092 79 1171 6.7S 1261 26 1287 2.02 33.4907 <0.0001
25- 462 74 S36 13.11 467 II 4IS 3.71 31.64S3 <0.0001
35- soo 226 726 31.13 942 203 114S 17.73 4S. I4S8 <0. 0001
45- 471 S31 1009 S2.63 1020 S04 IS24 33.07 96.0720 <0.0001
ss- 331 406 737 55.09 471 506 977 51.79 1. 8342 0.1756
6S- 141 267 41 S 64.34 141 272 420 64.76 0.0614 0.8980
2:75 28 69 97 71.13 3S S6 91 61.S4 1.9403 0.1636
Total 3039 16S2 4691 3S.22 4344 ISIS S929 26.13 81.9472 <0.0001
Table 3. Logistic regression analysis of hypertension contributing factors in 2007
II ems Freedom P SE Wald x' values P values OR(95%CD
Constant
DMI
Gender
I - 6.2428 0.5636 122.7102 <0.0001
0.66SS 0.0775 73.7686 <0.0001 1.94S ( 1. 671- 2.264)
1.912 (1.268-2.882)
1.757 (1.397-2.210)
1.669 ( 1.497-1.861)
1.390 ( 1.1 58-1.661)
1.184 ( 1.103-1.270!
0.648 1 0.2094 9.S781 0.0020
TG increase
Age
O. S635 0. 1170 23.1962 <0.0001
HDL-C de<rease
Fam1ly hrpenensive history
RESULTS
0.5123
0.3291
0.1616
O.OS55
0.0930
0.03S9
In II 216 participants we investigated (aged 15 years and
above, pennanent residents in both rural and urban areas
of these regions), 10 620 (4691 males and 5929 females)
responded with a rate of 94.69%. Those who lost to
follow-up included the parti ci pants going out for jobs,
going to colleges, traveling or refusing examination.
Hypertension prevalence in Heilongjiang province in
2007 is shown in Table I. The prevalence of hypertension
in urban and rurar areas was 31.30% and 29.65%
respectively. The prevalence of hypertension in this
province was 30.48% (adjusted prevalence was 25.69%).
The prevalence of hypertension in males was higher than
in females in both urban and rural areas. The comparison
of our results with the national database suggested that
Heilongjiang province is a region with a high prevalence
of hypertension (i.e., prevalence of hypertension in this
region was 25.69%), significantl y higher than the average
( 18.81%) in China in 2004.
As indicated in Table 2, the prevalence of hypertension
increased progressively with age accompanied by a trend
of earlier onset age. Data demonstrated that the prevalence
of hypertension was higher in males before the age of 55
years (P <0. 000 I); whereas, among the people older than
55 years, the prevalence in females increased rapidly. This
was not different in the prevalence of hypertension in
participants aged 65 years and over (P >0.05).
The prevalence of hypertension varied among participants
85.2653
12. SISI
22.0454
<0.0001
0.0004
<0.0001
with different professions. In this investi gation, fanners
and service staff had the lowest prevalence; whereas,
office staff had the highest prevalence. Technical
professionals possessed a median prevalence of
hypertension. The prevalence of hypertension for the
office staff was as high as 41.67%, suggesting that they
should be a target populati on for hypertension prevention
and treatment.
Using the Logistic model, we analyzed hypertension-
related factors and ident ified BMl (OR 1.945), gender
(OR 1.912), increased TG (OR 1.757), age (OR 1.669),
decreased HDL-C (OR 1.390), and genetic history (OR
1.184) as the contributing risk factors for hypertension in
Heilongj iang province (Table 3). Hypertension prevalence
(59.64%) in participants with BMI >28 was much higher
than that of part icipants with BMI between 24 and 28
(38.06%, P <0.0001) and BMl <24 (17.52%, P <0.0001).
In this investigation, hypertension prevalence was found
to be related to education background. The highest
prevalence was identified in the uneducated population
(45.44%). People with primary school education had a
relatively high prevalence (34.81 %) of hypertension. The
lowest prevalence (1 8.15%) was found in people with
undergraduate education. The part ici pants graduating
from high schools and technical schools had an
intennediate prevalence.
The prevalence of hypertension was higher in alcoholic
participants in comparison with the non-alcoholic group
(P <0.0 I) and gradually increased with the rise of alcohol

uptake. Furthermore, we discovered that diastol ic
pressure was significantly elevated (5 mmHg higher than
the non-alcoholic group, P <0.01} at an alcohol uptake of
1.1 - 1.5 kg/month. When alcohol uptake increased to 3.0
kg/month, diastolic pressure was 9.7 mmHg higher than
that in the non-alcoholic group (P <0.0 I). Participants
with a history of smoking in this investigation had a
hi gher prevalence (40. 19%) of hypertension in cont rast to
the general prevalence (25.69%, P <0.01). However, our
results indicated that daily cigarette consumption was not
correlated with the prevalence of hypertension.
Fami ly history was identified as one of the important
factors contributing to hypert ension. We found that
parti cipants with a hi story of maternal hypertension had a
higher prevalence (37.88%) than those wi thout a history
(3 1.93%, P <0.0001), suggesting a role of hereditary
predisposition in the development of hypertension.
This investigation revealed that the hypertension
awareness rate was 48.9%, treatment rate 25.33% and
control rate 4.32%.
DISCUSSION
In the present investigation, we found the epidemiological
characteristics of hypertension and its risk factors in
Heilongjiang province.
In comparison with the national survey in 2004/ the
prevalence of hypertension in Heilongjiang province was
higher than the average level in China. Hence,
Heilongjiang province could be considered a high-risk area
of hypertension. The harsh climate and diet in this region
may be primary factors for the high prevalence of
hypertension. Consumption of salt has also been
universally accepted as a risk factor for hypertension.
5
The
average daily salt uptake for residents in Heilongj iang
province was 17-18 gld, which was significantly higher
than the average level in China,
4
suggesting thai bigh salt
uptake may be another reason for the high prevalence of
hypertension in Heilongjiang province.
The present investigation revealed that the prevalence of
hypertension in Heilongjiang province has reached
25.69"/o. Hypertension in the younger population may be
due to the combined effects of heredity, abnormal
metabolism, and an unhealthy lifestyle. These factors act
synergisticall y, causing eleva.tion of blood pressure,
endothelial dysfunction, cardiac remodeling, abnormal
metabolism, and destruction of organ function, eventually
leading to cardiovascul ar events.
6
The prevalence of hypertension was significantly hi gher
in male than in female participants before the age of 55
years. However the prevalence in female participants
rapidly increased after the age of 55 years, and the
difference of hypertension prevalence between the two
genders disappeared in participants older than 65 years.
This may be associated with the protective effect of
estrogen on the cardiovascular system and that of
unhealthy lifestyle of the male population such as
drinking and smok ing
7
Alcohol consumption was also found to be positively
correlated with diastolic pressure. This correlation was
not altered in those who received anti-hypertension drug
treatment.
8
It has been established that alcohol funct ions
to reduce the risk of coronary disease through increasing
serum concentration of HDL, suppressing inflammation
and altering the sensitivity of insulin. Consequently,
rather than complete abstinence from alcohol,
hypertension patients could drink appropriately and avoid
massive drinking, which normall y leads to the sudden
elevati on of blood pressure. S m o k i n ~ is another
independent risk factor for hypertension. The current
investigation revealed that the prevalence of hypertension
in the population with a history of smoking was
significantly higher than the general prevalence.
The present investigation showed the hi ghest prevalence
in participants who dropped out of primary schools. The
prevalence of hypertension was also high in the
population with only primary school education. The
population with undergraduate education had the lowest
prevalence. The participants graduating from high schools
and technical schools had an intermediate prevalence.
The overall less occurrence of risk factors such as
unbalal)ced diet, obesity, smoking, alcoholism, and lack
of education may be the main reason for the observed
lower prevalence of hypertension in this population.
10
In this investigation, government and business executi ves
were found to have a high risk factor for hypertension,
wit h a prevalence of 41.67%. This phenomenon may be
associated with a faster occupati onal pace, mental stress,
unhealthy lifestyle and diet, and lack of exercise.
11
This investigation also demonstrated that the prevalence
of hypertension in the population with a 28 or above BMI
reached 59.64%, indicati ng that hi gher BMI is a high ri sk
factor for hypertension. Although the mechanisms
underlying abdominal fat-causing hypertension remain
unclear, they may be associated with abnormal
endothelial function, renal damage, and activation of the
sympathetic nervous system and renin-angiotensin
system.
12
By multi-linear analysis, we also identified a
correlation between hypertension and increased TG and
reduced HDL. We also found that the prevalence of
hypertension is higher in the popul ation with maternal
hypertension history than that in the population without.
Awareness, treatment,. and control rate of hypertension
are tightly linked to patients' prognosis. In the present
investigation, awareness, treatment, and control rates
were found lower than the average levels reported in
China and in USA.
13

14
In conclusion, Heilongjiang province is the "high-risk"

region for hypertension and shoul d be considered an
important target area for nation-wide hypertension
prevention and treatment.
Acknowledgements: We thank Ll Bin from lhe Heahh Departmenl
of Heilongjiang Province, ZHOU Jin from the Firs! Affiliated
Hospilal of Harbin Medical Univcrsily, HU Wei-fang from lhe
Hcahh Departmenl of Nangang Dislrict of Harbin, QU Gui-rong
and ZHOU Guang-wei from the Ninth Hospilal of Nangang
Dislricl of Harbin for their conlribulion and financial support. We
are al so graleful to the I 00 graduale Sludents and relaled doelors
involved in the project for their hard work.
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(Received December / 6, 2009)
Edited by WANG Mou-yue