Associations between age, cohort, and urbanization with SBP and DBP in China

Abstract

Objective Little is known about whether large-scale environmental changes, such as those seen with urbanization, are differentially associated with systolic versus diastolic blood pressure, and whether those changes vary by birth cohort. Methods We used data from the China Health and Nutrition Survey, a population-based cohort study of Chinese adults (n=18,976; ages 18–70y) seen a maximum of 7 times over 1991–2009. We used hierarchical multivariable linear models to simultaneously estimate systolic and diastolic blood pressure as correlated outcomes over time, accounting for their physiologic, time-varying correlation. Main exposure variables were urbanicity, age, and birth cohort. Over 18 years of modernization, median systolic and diastolic blood pressure increased by 10 and 7 mm Hg, respectively. Results Our hierarchical model results suggest greater temporal increases in systolic and particularly diastolic blood pressure at lower versus higher urbanicity. At the same chronological age, for a 10-year difference in birth cohort (i.e., born in 1980s versus 1970s) the adjusted mean diastolic blood pressure was ~3mm Hg higher for the later birth cohort (p<0.001). Pulse pressure (calculated as model-predicted systolic minus diastolic blood pressure) was also higher at low versus high urbanicity. Conclusions These results suggest increased susceptibility of diastolic blood pressure (and thus peripheral vascular resistance) to environmental change, particularly in younger Chinese adults. Because diastolic blood pressure more strongly predicts cardiovascular disease risk in younger adulthood, hypertension-related health burden in China may increase over time.

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

“…In 54 countries high SBP is actually declining, while its increase in China is now well documented in a series of population-based surveys. 25 , 26 , 27 Tackling rising SBP is a global concern, but this is particularly important in those locations where rates are increasing. In view of the effect of the risk and the large array of available, effective interventions, health systems and the global health community need to mobilise increased resources and policy attention to tackle this problem.…”

Circulating ErbB3/HER3 Levels are Associated with Increased Risk of Hypertension with Overweight: A Cross-Sectional Study

“…Another study reported that environmental exposures to drinking, smoking were associated with adult hypertension in Japanese population [23]. Remarkably，DBP has increased sensitivity to environmental changes, and more strongly predicts cardiovascular disease risk in younger Chinese adulthood [24]. In the present study, BMI both in males and in drinking population and UA in males presented negatively correlations with ErbB3.…”

Association of Body Fat Mass and Fat Distribution With the Incidence of Hypertension in a Population‐Based Chinese Cohort: A 22‐Year Follow‐Up

“…Hypertension is a major public health problem worldwide and the greatest attributable risk factor for death 1. As a major modifiable risk factor for cardiovascular disease, hypertension accounts for ≈45% of global cardiovascular disease morbidity and mortality,2 which corresponds to ≈7 million deaths each year 3, 4, 5.…”