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Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Research article

Major inducing factors of hypertensive complications and the interventions required to reduce their prevalence: an epidemiological study of hypertension in a rural population in China

Authors: Min Zhang, Yong Meng, Yongli Yang, Yancai Liu, Caiqin Dong, Jianming Xiao, Ling Zhao, Fang Li

Published in: BMC Public Health | Issue 1/2011

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Abstract

Background

The complications of hypertension cause severe health problems in rural areas in China. We (i) screened the major factors inducing hypertensive complications and provided intervention measures; and (ii) verified the efficacy of the New Rural Cooperative Medical Scheme (NRCMS; a medical insurance scheme for rural residents) for hypertension management.

Methods

A survey was conducted in the villages of Yunnan (an underdeveloped province in southwest China). The NRCMS was initiated there in 2005. Data were collected through questionnaires, physical examination, electrocardiography, as well as blood and urine tests. To detect factors inducing hypertension complications, a generalized estimating equations model was developed. Multivariable logistic regression was used to analyze influencing factors for hypertension control.

Results

Poor management of hypertension was observed in women. Being female, old, poorly educated, a smoker, ignorant of the dangerousness of hypertension, and having uncontrolled hypertension made patients more prone to hypertension complications. Combination therapy with ≥2 drugs helped control hypertension, but most rural patients disliked multidrug therapy because they considered it to be expensive and inconvenient. The NRCMS contributed little to reduce the prevalence of complications and improve control of hypertension.

Conclusions

The present study suggested that the NRCMS needs to be reformed to concentrate on early intervention in hypertension and to concentrate on women. To increase hypertension control in rural areas in China, compound products containing effective and inexpensive drugs (and not multidrug therapy) are needed.
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Literature
1.
go back to reference Murray CJ, Lopez AD: Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997, 349 (9061): 1269-1276. 10.1016/S0140-6736(96)07493-4.CrossRefPubMed Murray CJ, Lopez AD: Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997, 349 (9061): 1269-1276. 10.1016/S0140-6736(96)07493-4.CrossRefPubMed
2.
go back to reference The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med. 1997, 157 (21): 2413-2446. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med. 1997, 157 (21): 2413-2446.
3.
go back to reference Gu D, Reynolds K, Wu X, Chen J, Duan X, Muntner P, Huang G, Reynolds RF, Su S, Whelton PK, et al: Prevalence, awareness, treatment, and control of hypertension in china. Hypertension. 2002, 40 (6): 920-927. 10.1161/01.HYP.0000040263.94619.D5.CrossRefPubMed Gu D, Reynolds K, Wu X, Chen J, Duan X, Muntner P, Huang G, Reynolds RF, Su S, Whelton PK, et al: Prevalence, awareness, treatment, and control of hypertension in china. Hypertension. 2002, 40 (6): 920-927. 10.1161/01.HYP.0000040263.94619.D5.CrossRefPubMed
4.
go back to reference Wu X, Duan X, Gu D, Hao J, Tao S, Fan D: Prevalence of hypertension and its trends in Chinese populations. Int J Cardiol. 1995, 52 (1): 39-44. 10.1016/0167-5273(95)02443-Z.CrossRefPubMed Wu X, Duan X, Gu D, Hao J, Tao S, Fan D: Prevalence of hypertension and its trends in Chinese populations. Int J Cardiol. 1995, 52 (1): 39-44. 10.1016/0167-5273(95)02443-Z.CrossRefPubMed
5.
go back to reference Wang Z, Wu Y, Zhao L, Li Y, Yang J, Zhou B: Trends in prevalence, awareness, treatment and control of hypertension in the middle-aged population of China, 1992-1998. Hypertens Res. 2004, 27 (10): 703-709. 10.1291/hypres.27.703.CrossRefPubMed Wang Z, Wu Y, Zhao L, Li Y, Yang J, Zhou B: Trends in prevalence, awareness, treatment and control of hypertension in the middle-aged population of China, 1992-1998. Hypertens Res. 2004, 27 (10): 703-709. 10.1291/hypres.27.703.CrossRefPubMed
9.
go back to reference Xu Y, Zhang X, Zhu X: Medical financial assistance in rural china: policy design and implementation. Studies in HSO8P. 2008, 23: 295-317. Xu Y, Zhang X, Zhu X: Medical financial assistance in rural china: policy design and implementation. Studies in HSO8P. 2008, 23: 295-317.
10.
go back to reference 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003, 21 (6): 1011-1053. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003, 21 (6): 1011-1053.
11.
go back to reference Zhang W, Tian X: Application of generalized estimating equations in analysis of multiple response. Chinese J Health Stat. 2004, 21 (3): 139-141. Zhang W, Tian X: Application of generalized estimating equations in analysis of multiple response. Chinese J Health Stat. 2004, 21 (3): 139-141.
12.
go back to reference Kearney PM, Whelton M, Reynolds K, Whelton PK, He J: Worldwide prevalence of hypertension: a systematic review. J Hypertens. 2004, 22 (1): 11-19. 10.1097/00004872-200401000-00003.CrossRefPubMed Kearney PM, Whelton M, Reynolds K, Whelton PK, He J: Worldwide prevalence of hypertension: a systematic review. J Hypertens. 2004, 22 (1): 11-19. 10.1097/00004872-200401000-00003.CrossRefPubMed
13.
go back to reference Wang Y, Wang QJ: The prevalence of prehypertension and hypertension among US adults according to the new joint national committee guidelines: new challenges of the old problem. Arch Intern Med. 2004, 164 (19): 2126-2134. 10.1001/archinte.164.19.2126.CrossRefPubMed Wang Y, Wang QJ: The prevalence of prehypertension and hypertension among US adults according to the new joint national committee guidelines: new challenges of the old problem. Arch Intern Med. 2004, 164 (19): 2126-2134. 10.1001/archinte.164.19.2126.CrossRefPubMed
15.
go back to reference Shi W, Chongsuvivatwong V, Geater A, Zhang J, Zhang H, Brombal D: The influence of the rural health security schemes on health utilization and household impoverishment in rural China: data from a household survey of western and central China. Int J Equity Health. 2010, 9: 7-10.1186/1475-9276-9-7.CrossRefPubMedPubMedCentral Shi W, Chongsuvivatwong V, Geater A, Zhang J, Zhang H, Brombal D: The influence of the rural health security schemes on health utilization and household impoverishment in rural China: data from a household survey of western and central China. Int J Equity Health. 2010, 9: 7-10.1186/1475-9276-9-7.CrossRefPubMedPubMedCentral
16.
go back to reference Hao Y, Wu Q, Zhang Z, Gao L, Ning N, Jiao M, Zakus D: The impact of different benefit packages of Medical Financial Assistance Scheme on health service utilization of poor population in rural China. BMC Health Serv Res. 2010, 10: 170-10.1186/1472-6963-10-170.CrossRefPubMedPubMedCentral Hao Y, Wu Q, Zhang Z, Gao L, Ning N, Jiao M, Zakus D: The impact of different benefit packages of Medical Financial Assistance Scheme on health service utilization of poor population in rural China. BMC Health Serv Res. 2010, 10: 170-10.1186/1472-6963-10-170.CrossRefPubMedPubMedCentral
17.
go back to reference Marques-Vidal P, Ruidavets JB, Cambou JP, Ferrieres J: Trends in hypertension prevalence and management in Southwestern France, 1985-1996. J Clin Epidemiol. 2000, 53 (12): 1230-1235. 10.1016/S0895-4356(00)00245-6.CrossRefPubMed Marques-Vidal P, Ruidavets JB, Cambou JP, Ferrieres J: Trends in hypertension prevalence and management in Southwestern France, 1985-1996. J Clin Epidemiol. 2000, 53 (12): 1230-1235. 10.1016/S0895-4356(00)00245-6.CrossRefPubMed
18.
go back to reference Muntner P, Gu D, Wu X, Duan X, Wenqi G, Whelton PK, He J: Factors associated with hypertension awareness, treatment, and control in a representative sample of the chinese population. Hypertension. 2004, 43 (3): 578-585. 10.1161/01.HYP.0000116302.08484.14.CrossRefPubMed Muntner P, Gu D, Wu X, Duan X, Wenqi G, Whelton PK, He J: Factors associated with hypertension awareness, treatment, and control in a representative sample of the chinese population. Hypertension. 2004, 43 (3): 578-585. 10.1161/01.HYP.0000116302.08484.14.CrossRefPubMed
19.
go back to reference Puras A, Sanchis C, Artigao LM, Divison JA: Prevalence, awareness, treatment, and control of hypertension in a Spanish population. Eur J Epidemiol. 1998, 14 (1): 31-36. 10.1023/A:1007483916158.CrossRefPubMed Puras A, Sanchis C, Artigao LM, Divison JA: Prevalence, awareness, treatment, and control of hypertension in a Spanish population. Eur J Epidemiol. 1998, 14 (1): 31-36. 10.1023/A:1007483916158.CrossRefPubMed
20.
go back to reference Sun Z, Zheng L, Wei Y, Li J, Zhang X, Liu S, Xu C, Zhao F, Dong G, Hu D, et al: The prevalence of prehypertension and hypertension among rural adults in Liaoning province of China. Clin Cardiol. 2007, 30 (4): 183-187. 10.1002/clc.20073.CrossRefPubMed Sun Z, Zheng L, Wei Y, Li J, Zhang X, Liu S, Xu C, Zhao F, Dong G, Hu D, et al: The prevalence of prehypertension and hypertension among rural adults in Liaoning province of China. Clin Cardiol. 2007, 30 (4): 183-187. 10.1002/clc.20073.CrossRefPubMed
21.
go back to reference Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA, Wright AD, Turner RC, Holman RR: Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000, 321 (7258): 412-419. 10.1136/bmj.321.7258.412.CrossRefPubMedPubMedCentral Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA, Wright AD, Turner RC, Holman RR: Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000, 321 (7258): 412-419. 10.1136/bmj.321.7258.412.CrossRefPubMedPubMedCentral
22.
go back to reference Collins R, MacMahon S: Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull. 1994, 50 (2): 272-298.PubMed Collins R, MacMahon S: Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull. 1994, 50 (2): 272-298.PubMed
23.
go back to reference Ruilope LM, Campo C, Rodriguez-Artalejo F, Lahera V, Garcia-Robles R, Rodicio JL: Blood pressure and renal function: therapeutic implications. J Hypertens. 1996, 14 (11): 1259-1263. 10.1097/00004872-199611000-00001.CrossRefPubMed Ruilope LM, Campo C, Rodriguez-Artalejo F, Lahera V, Garcia-Robles R, Rodicio JL: Blood pressure and renal function: therapeutic implications. J Hypertens. 1996, 14 (11): 1259-1263. 10.1097/00004872-199611000-00001.CrossRefPubMed
24.
go back to reference Khan N, Chockalingam A, Campbell NR: Lack of control of high blood pressure and treatment recommendations in Canada. Can J Cardiol. 2002, 18 (6): 657-661.PubMed Khan N, Chockalingam A, Campbell NR: Lack of control of high blood pressure and treatment recommendations in Canada. Can J Cardiol. 2002, 18 (6): 657-661.PubMed
25.
26.
go back to reference Mancia G, Parati G, Borghi C, Ghironzi G, Andriani E, Marinelli L, Valentini M, Tessari F, Ambrosioni E: Hypertension prevalence, awareness, control and association with metabolic abnormalities in the San Marino population: the SMOOTH study. J Hypertens. 2006, 24 (5): 837-843. 10.1097/01.hjh.0000222752.67572.61.CrossRefPubMed Mancia G, Parati G, Borghi C, Ghironzi G, Andriani E, Marinelli L, Valentini M, Tessari F, Ambrosioni E: Hypertension prevalence, awareness, control and association with metabolic abnormalities in the San Marino population: the SMOOTH study. J Hypertens. 2006, 24 (5): 837-843. 10.1097/01.hjh.0000222752.67572.61.CrossRefPubMed
27.
go back to reference Pavlik VN, Hyman DJ: How well are we managing and monitoring high blood pressure?. Curr Opin Nephrol Hypertens. 2003, 12 (3): 299-304. 10.1097/00041552-200305000-00012.CrossRefPubMed Pavlik VN, Hyman DJ: How well are we managing and monitoring high blood pressure?. Curr Opin Nephrol Hypertens. 2003, 12 (3): 299-304. 10.1097/00041552-200305000-00012.CrossRefPubMed
28.
go back to reference Poggi L, Chamontin B, Lang T, Menard J, Chevalier H, Gallois H, Cremier O: [Prevalence, treatment and control of hypertension in family practice patients in France during 1994]. Arch Mal Coeur Vaiss. 1996, 89 (8): 1075-1080.PubMed Poggi L, Chamontin B, Lang T, Menard J, Chevalier H, Gallois H, Cremier O: [Prevalence, treatment and control of hypertension in family practice patients in France during 1994]. Arch Mal Coeur Vaiss. 1996, 89 (8): 1075-1080.PubMed
29.
go back to reference Primatesta P, Poulter NR: Improvement in hypertension management in England: results from the Health Survey for England 2003. J Hypertens. 2006, 24 (6): 1187-1192. 10.1097/01.hjh.0000226210.95936.bc.CrossRefPubMed Primatesta P, Poulter NR: Improvement in hypertension management in England: results from the Health Survey for England 2003. J Hypertens. 2006, 24 (6): 1187-1192. 10.1097/01.hjh.0000226210.95936.bc.CrossRefPubMed
30.
go back to reference Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, et al: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003, 289 (19): 2560-2572. 10.1001/jama.289.19.2560.CrossRefPubMed Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, et al: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003, 289 (19): 2560-2572. 10.1001/jama.289.19.2560.CrossRefPubMed
31.
go back to reference Volpe M, Junren Z, Maxwell T, Rodriguez A, Gamboa R, Gomez-Fernandez P, Ortega-Gonzalez G, Matadamas N, Rodriguez F, et al: Comparison of the blood pressure-lowering effects and tolerability of Losartan- and Amlodipine-based regimens in patients with isolated systolic hypertension. Clin Ther. 2003, 25 (5): 1469-1489. 10.1016/S0149-2918(03)80133-9.CrossRefPubMed Volpe M, Junren Z, Maxwell T, Rodriguez A, Gamboa R, Gomez-Fernandez P, Ortega-Gonzalez G, Matadamas N, Rodriguez F, et al: Comparison of the blood pressure-lowering effects and tolerability of Losartan- and Amlodipine-based regimens in patients with isolated systolic hypertension. Clin Ther. 2003, 25 (5): 1469-1489. 10.1016/S0149-2918(03)80133-9.CrossRefPubMed
32.
go back to reference Allemann Y, Fraile B, Lambert M, Barbier M, Ferber P, Izzo JL: Efficacy of the combination of amlodipine and valsartan in patients with hypertension uncontrolled with previous monotherapy: the Exforge in Failure after Single Therapy (EX-FAST) study. J Clin Hypertens (Greenwich). 2008, 10 (3): 185-194. 10.1111/j.1751-7176.2008.07516.x.CrossRef Allemann Y, Fraile B, Lambert M, Barbier M, Ferber P, Izzo JL: Efficacy of the combination of amlodipine and valsartan in patients with hypertension uncontrolled with previous monotherapy: the Exforge in Failure after Single Therapy (EX-FAST) study. J Clin Hypertens (Greenwich). 2008, 10 (3): 185-194. 10.1111/j.1751-7176.2008.07516.x.CrossRef
33.
go back to reference Neutel JM, Saunders E, Bakris GL, Cushman WC, Ferdinand KC, Ofili EO, Sowers JR, Weber MA: The efficacy and safety of low- and high-dose fixed combinations of irbesartan/hydrochlorothiazide in patients with uncontrolled systolic blood pressure on monotherapy: the INCLUSIVE trial. J Clin Hypertens (Greenwich). 2005, 7 (10): 578-586. 10.1111/j.1524-6175.2004.04720.x.CrossRef Neutel JM, Saunders E, Bakris GL, Cushman WC, Ferdinand KC, Ofili EO, Sowers JR, Weber MA: The efficacy and safety of low- and high-dose fixed combinations of irbesartan/hydrochlorothiazide in patients with uncontrolled systolic blood pressure on monotherapy: the INCLUSIVE trial. J Clin Hypertens (Greenwich). 2005, 7 (10): 578-586. 10.1111/j.1524-6175.2004.04720.x.CrossRef
34.
go back to reference Patel A, MacMahon S, Chalmers J, Neal B, Woodward M, Billot L, Harrap S, Poulter N, Marre M, Cooper M, et al: Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet. 2007, 370 (9590): 829-840. 10.1016/S0140-6736(07)61303-8.CrossRefPubMed Patel A, MacMahon S, Chalmers J, Neal B, Woodward M, Billot L, Harrap S, Poulter N, Marre M, Cooper M, et al: Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet. 2007, 370 (9590): 829-840. 10.1016/S0140-6736(07)61303-8.CrossRefPubMed
Metadata
Title
Major inducing factors of hypertensive complications and the interventions required to reduce their prevalence: an epidemiological study of hypertension in a rural population in China
Authors
Min Zhang
Yong Meng
Yongli Yang
Yancai Liu
Caiqin Dong
Jianming Xiao
Ling Zhao
Fang Li
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-301

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