Hypertension subtype and risk of cardiovascular disease in Chinese adults

Abstract

Background: We examined the relationship between hypertension subtype and cardiovascular disease incidence and mortality in Chinese adults.

Methods and results: We conducted a prospective cohort study in a nationally representative sample of 169 871 Chinese men and women aged >or=40 years. Data on systolic (SBP) and diastolic blood pressure (DBP) and other variables were obtained at a baseline examination in 1991 with the use of standard protocols. Follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4%. Hypertension subtypes were defined as combined systolic and diastolic hypertension (SBP >or=140 and DBP >or=90 mm Hg), isolated systolic hypertension (SBP >or=140 and DBP <90 mm Hg), isolated diastolic hypertension (SBP <140 and DBP >or=90 mm Hg), and 2 categories of treated hypertension (SBP <140 and DBP <90 mm Hg or SBP >or=140 and/or DBP >or=90 mm Hg). After participants with missing BP values were excluded, 169 577 adults were included in the analyses. Compared with normotensives, relative risks (95% CIs) of cardiovascular disease incidence and mortality were 2.73 (2.60 to 2.86) and 2.53 (2.39 to 2.68) for combined systolic and diastolic hypertension, 1.78 (1.69 to 1.87) and 1.68 (1.58 to 1.78) for isolated systolic hypertension, 1.59 (1.43 to 1.76) and 1.45 (1.27 to 1.65) for isolated diastolic hypertension, 2.01 (1.64 to 2.48) and 1.61 (1.28 to 2.03) for treated hypertension with SBP <140 and DBP <90 mm Hg, and 3.37 (3.07 to 3.69) and 2.88 (2.60 to 3.19) for treated hypertension with SBP >or=140 and/or DBP >or=90 mm Hg, respectively, after adjustment for important covariables.

Conclusions: Our results indicate that all hypertension subtypes are associated with significantly increased risk of cardiovascular disease in Chinese adults. Primary prevention of hypertension should be a public health priority in the Chinese population.

Figure 1

Map of China with participating provinces highlighted.

Figure 2

Flow chart of participant recruitment and derivation of the population used in the final analysis.

Figure 3

Relative risk (95% confidence interval) of cardiovascular disease, coronary heart disease, and stroke incidence among those aged <60 and ≥ 60 years, after adjustment for baseline age, sex, education, cigarette smoking, alcohol consumption, physical inactivity, body-mass index, geographic region, urbanization and time-dependent history of diabetes.

Figure 3

Relative risk (95% confidence interval) of cardiovascular disease, coronary heart disease, and stroke incidence among those aged <60 and ≥ 60 years, after adjustment for baseline age, sex, education, cigarette smoking, alcohol consumption, physical inactivity, body-mass index, geographic region, urbanization and time-dependent history of diabetes.

Figure 3

Relative risk (95% confidence interval) of cardiovascular disease, coronary heart disease, and stroke incidence among those aged <60 and ≥ 60 years, after adjustment for baseline age, sex, education, cigarette smoking, alcohol consumption, physical inactivity, body-mass index, geographic region, urbanization and time-dependent history of diabetes.

Figure 4

Relative risk (95% confidence interval) of cardiovascular disease, coronary heart disease, and stroke mortality among those aged <60 and ≥60 years, after adjustment for baseline age, sex, education, cigarette smoking, alcohol consumption, physical inactivity, body-mass index, geographic region, urbanization and time-dependent history of diabetes.

Figure 4

Relative risk (95% confidence interval) of cardiovascular disease, coronary heart disease, and stroke mortality among those aged <60 and ≥60 years, after adjustment for baseline age, sex, education, cigarette smoking, alcohol consumption, physical inactivity, body-mass index, geographic region, urbanization and time-dependent history of diabetes.

Figure 4

Relative risk (95% confidence interval) of cardiovascular disease, coronary heart disease, and stroke mortality among those aged <60 and ≥60 years, after adjustment for baseline age, sex, education, cigarette smoking, alcohol consumption, physical inactivity, body-mass index, geographic region, urbanization and time-dependent history of diabetes.