Impact of urbanisation and altitude on the incidence of, and risk factors for, hypertension
Impact of urbanisation and altitude on the incidence of, and risk factors for, hypertension
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DOI：
10.1136/heartjnl-2016-310347
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发表时间：
2017-06-01
期刊：
影响因子：
5.7
通讯作者：
Jaime Miranda, J.
中科院分区：
文献类型：
--
作者：
Bernabe-Ortiz, Antonio;Carrillo-Larco, Rodrigo M.;Jaime Miranda, J.
关于低收入和中等收入国家高血压负担的大多数数据来自横断面调查，而不是纵向研究。我们估计了四个不同城市化程度和海拔的研究地点的高血压发病率和危险因素。方法采用在秘鲁城市、半城市和农村地区进行的CRONICAS队列研究的数据。参与者的年龄分层和性别分层随机样本取自每个站点可获得的最新人口普查。高血压定义为收缩压>= 140 mm Hg，或舒张压>= 90 mm Hg，或自我报告医生诊断和当前治疗。暴露是研究地点和海拔以及可改变的危险因素。使用广义线性模型估计发病率、发病率比（IRRs）、95% ci和人群归因分数（paf）。结果分析了3237名参与者的信息，平均年龄55.8 （SD +/- 12.7）岁，男性48.4%。总体基线高血压患病率为19.7% （95% CI 18.4%至21.1%）。总共记录了375例新的高血压病例，包括5266人年的随访，发病率为7.12 (95% CI 6.44 - 7.88) / 100人年。与高度城市化地区相比，来自半城市地区的个体高血压风险更高（IRR= 1.76; 95% CI 1.39至2.23）；然而，那些来自高海拔地区的人风险较低（IRR= 0.74; 95% CI 0.58 ~ 0.95）。肥胖是高血压的主要危险因素，PAF在12.5% - 42.4%之间，因研究地点不同而差异很大。结论：我们的研究结果表明，高血压的发展具有异质性，这取决于城市化和地点海拔。
Background Most of the data regarding the burden of hypertension in low-income and middle-income countries comes from cross-sectional surveys instead of longitudinal studies. We estimated the incidence of, and risk factors for, hypertension in four study sites with different degree of urbanisation and altitude.Methods Data from the CRONICAS Cohort Study, conducted in urban, semiurban and rural areas in Peru, was used. An age-stratified and sex-stratified random sample of participants was taken from the most updated census available in each site. Hypertension was defined as systolic blood pressure >= 140 mm Hg, or diastolic blood pressure >= 90 mm Hg, or self-report physician diagnosis and current treatment. The exposures were study site and altitude as well as modifiable risk factors. Incidence, incidence rate ratios (IRRs), 95% CIs and population- attributable fractions (PAFs) were estimated using generalised linear models.Results Information from 3237 participants, mean age 55.8 (SD +/- 12.7) years, 48.4% males, was analysed. Overall baseline prevalence of hypertension was 19.7% (95% CI 18.4% to 21.1%). A total of 375 new cases of hypertension were recorded, including 5266 person-years of follow-up, with an incidence of 7.12 (95% CI 6.44 to 7.88) per 100 person-years. Individuals from semiurban site were at higher risk of hypertension compared with highly urbanised areas (IRR= 1.76; 95% CI 1.39 to 2.23); however, those from high-altitude sites had a reduced risk (IRR= 0.74; 95% CI 0.58 to 0.95). Obesity was the leading risk factor for hypertension with a great variation according to study site with PAF ranging from 12.5% to 42.4%.Conclusions Our results suggest heterogeneity in the progression towards hypertension depending on urbanisation and site altitude.