Risk factors for prehypertension and their interactive effect: a cross- sectional survey in China

Abstract

BackgroundIndividuals with prehypertension are at higher risk of developing hypertension and cardiovascular diseases, while the interaction between factors may aggravate prehypertension risk. Therefore, this study aimed to evaluate the risk factors for prehypertension in Chinese middle-aged and elderly adults, and explore the potentially interactive effect of evaluated factors.MethodsAll the participants that came from a community based cross-sectional survey were investigated in Bengbu, China, by being interviewed with a questionnaire. Body mass index (BMI), Waist circumference (WC) and lipid accumulation product (LAP) that reflect participants’ obesity were also calculated. In addition, logistic regression model was applied to explore the risk factors of prehypertension, followed by the assessment of the interactive effects between risk factors on prehypertension by the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (SI).ResultsA total of 1777 participants were enrolled in this study, among which the prevalence of normtension, prehypertension and hypertension were 41.70%, 33.93% and 24.37% respectively. According to the multivariate logistic regression analysis, age (OR: 1.01, 95%CI: 1.00–1.02), smoking (OR: 1.67, 95%CI: 1.22–2.29), family history of cardiovascular diseases (OR: 1.52, 95%CI: 1.14–2.02), general obesity (OR: 1.51, 95%CI: 1.15–1.97) and LAP (OR: 2.58, 95%CI: 1.76–3.80) were all defined as the major factors that significantly related with the risk of prehypertension. When identifying prehypertension risk, the receiver-operating characteristics (ROC) curves (AUC) analysis indicated that LAP performed better than BMI in males (Z = 2.05, P = 0.03) and females (Z = 2.12, P = 0.03), but was superior to WC only in females (Z = 2.43, P = 0.01). What is more, there were significant interactive effects of LAP with family history of cardiovascular diseases (RERI: 1.88, 95%CI: 0.25–3.51; AP: 0.44, 95%CI: 0.20–0.69; SI: 2.37, 95%CI: 1.22–4.60) and smoking (RERI: 1.99, 95%CI: 0.04–3.93; AP: 0.42, 95%CI: 0.17–0.67; SI: 2.16, 95%CI: 1.68–4.00) on prehypertension risk. The value of AP (0.40, 95%CI: 0.03–0.77) also indicated a significant interaction between family history of cardiovascular diseases and smoking on prehypertension.ConclusionPrehypertension is currently prevalent in Chinese adults. This study indicated that age, family history of cardiovascular diseases, smoking, general obesity and LAP were significantly related with prehypertension risk. Furthermore, interactive effects on risk of prehypertension had been demonstrated in this study as well, which would help researchers to build strategy against prehypertension more comprehensively and scientifically.Electronic supplementary materialThe online version of this article (10.1186/s12872-018-0917-y) contains supplementary material, which is available to authorized users.

Interaction of lipid accumulation product and family history of hypertension on hypertension risk: a cross-sectional study in the Southern Chinese population

“…The interaction in females is not statistically significant, but their synergistic effect is obvious. The synergistic effect between family history of hypertension and LAP on the hypertension risk is demonstrated in our study as well as in other studies 21 40. Visceral obesity and family history of hypertension may result in increased BP through some unknown mechanisms.…”

“…However, Gao et al found that the performance of LAP is superior to that of BMI in male Mongolians23; these findings may be due to the apparently lower prevalence of high TG in female Mongolians than in male Mongolians (13.20% vs 23.10%, p<0.05), and the facts might disturb the association between LAP and hypertension in female Mongolians. Several studies find the superiority of LAP over BMI for detection of hypertension and prehypertension in both genders 21 37 40. However, in the present study, we also found that LAP performs better than BMI in females.…”

“…Notably, hypertriglyceridaemic waist (HTGW) is also calculated based on the combination of TG and WC. However, LAP, as a continuous indicator, is superior to reflect visceral fat than HTGW,38 a discontinuous indicator 21. Therefore, LAP is used as a visceral obesity indicator in this study.…”

“…Additionally, several cross-sectional studies conducted in Japan,19 India14 and Brazil indicate that LAP significantly associated with cardiovascular disease and is a better indicator than BMI for identifying cardiovascular risk 13 20. A few national studies have investigated the association between LAP and hypertension in China, and all of them are conducted in Northern China, including Bengbu,21 Beijing22 and Inner Mongolia 23. With a vast territory, China has a tremendous difference between South and North.…”

Hypertension and prehypertension: prevalence and associated factors in Gabonese Youth and Adolescents

“…Even though family history of hypertension and a regular consumption of tobacco and/or alcohol did not increase the risk of prehypertension among the study participants, other studies report a positive correlation between these different factors [32,39,45]. Thus, the public health policy makers should emphasize the ght against tobacco and alcohol consumption, which remains a priority in the youth population.…”