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Trends in blood pressure and hypertension among older adults and oldest-old individuals in China between 2008-2018

Hypertension Research volume 46, pages 1145–1156 (2023)Cite this article

Abstract

The aim of this study was to assess the trends in blood pressure (BP) levels and the corresponding prevalence of hypertension among elderly individuals in China from 2008 to 2018. This serial cross-sectional analysis was based on data from the last four waves of the Chinese Longitudinal Healthy Longevity Survey (N = 38086). Linear regression analyses were performed to assess linear trends in mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP). Logistic regression was used to examine trends in the prevalence of hypertension across the four waves. An ordinal regression model was used to assess risk factors for BP status. From 2008 to 2018, an increase of 0.8–3.3% in BP and at least an 8.2% increase in the prevalence of hypertension were observed among older adults and oldest-old adults (aged 65–79 years and ≥ 80 years) (all Ptrend < 0.001). Furthermore, the increasing magnitude of the prevalence of hypertension in the participants aged 65–79 years was greater than that in those aged ≥ 80 years. Region, BMI and living alone were factors associated with different BP statuses. After adjustment for demographic and behavioral characteristics, an increasing trend in mean SBP and PP was found in both men and women, whereas the mean DBP increased only in men. A significant increase occurred in hypertension prevalence, SBP and PP, whereas DBP remained stable in elderly Chinese individuals from 2008 to 2018. Comprehensive strategies need to be implemented for the prevention and management of hypertension among older adults in China.

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References

  1. Brouwers S, Sudano I, Kokubo Y, Sulaica EM. Arterial hypertension. Lancet. 2021;398:249–61.

    Article  CAS  PubMed  Google Scholar 

  2. Celik T, Yuksel UC, Fici F, Celik M, Yaman H, Kilic S, et al. Vascular inflammation and aortic stiffness relate to early left ventricular diastolic dysfunction in prehypertension. Blood Press. 2013;22:94–100.

    Article  CAS  PubMed  Google Scholar 

  3. Navarro-González JF, Mora C, Muros M, García J, Donate J, Cazaña V. Relationship between inflammation and microalbuminuria in prehypertension. J Hum Hypertens. 2013;27:119–25.

    Article  PubMed  Google Scholar 

  4. Egan BM, Stevens-Fabry S. Prehypertension–prevalence, health risks, and management strategies. Nat Rev Cardiol. 2015;12:289–300.

    Article  PubMed  Google Scholar 

  5. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–e248.

    Article  PubMed  Google Scholar 

  6. Bundy JD, Mills KT, Chen J, Li C, Greenland P, He J. Estimating the Association of the 2017 and 2014 hypertension guidelines with cardiovascular events and deaths in US adults: An analysis of national data. JAMA Cardiol. 2018;3:572–81.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wang Z, Chen Z, Zhang L, Wang X, Hao G, Zhang Z, et al. Status of hypertension in China: Results from the China hypertension survey, 2012–2015. Circulation. 2018;137:2344–56.

    Article  PubMed  Google Scholar 

  8. Liu Z, Man Q, Li Y, Wang J, Zhang J, Zhao W. The relationship between prevalence of hypertension and dietary factors among the elderly aged 60 years old and over in China during 2010–2012. Chin J Preventive Med. 2018;52:622–8.

    Article  CAS  Google Scholar 

  9. Cho H, Kim JH. Secular trends in hypertension and elevated blood pressure among Korean children and adolescents in the Korea national health and nutrition examination survey 2007–2015. J Clin Hypertens. 2020;22:590–7.

    Article  Google Scholar 

  10. Ma S, Yang L, Zhao M, Xi B. Changing trends in the levels of blood pressure and prevalence of hypertension among Chinese children and adolescents from 1991 to 2015. Chin J Epidemiol. 2020;41:178–83.

    CAS  Google Scholar 

  11. Son JS, Choi S, Kim K, Kim SM, Choi D, Lee G, et al. Association of blood pressure classification in Korean young adults according to the 2017 American college of cardiology/American Heart association guidelines with subsequent cardiovascular disease events. Jama. 2018;320:1783–92.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Booth JN 3rd, Li J, Zhang L, Chen L, Muntner P, Egan B. Trends in Prehypertension and Hypertension Risk Factors in US Adults: 1999–2012. Hypertension. 2017;70:275–84.

    Article  CAS  PubMed  Google Scholar 

  13. (NCD-RisC) NCD Risk Factor Collaboration. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398:957–80.

    Article  Google Scholar 

  14. Du J, Zhu G, Yue Y, Liu M, He Y. Blood pressure and hypertension prevalence among oldest-old in China for 16 year: Based on CLHLS. BMC Geriatrics. 2019;19:248.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zeng Y. Towards deeper research and better policy for healthy aging –using the unique data of Chinese longitudinal healthy longevity survey. China Econ J. 2012;5:131–49.

    Article  Google Scholar 

  16. Zeng Y. Chinese longitudinal healthy longevity survey (1998–2012) and related research review. Sci Res Aging. 2013;1:65–72.

    Google Scholar 

  17. Hardy ST, Urbina EM. Blood Pressure in Childhood and Adolescence. Am J Hypertens. 2021;34:242–9.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Zhou B. Coorperative Meta-Analysis Group Of China Obesity Task Force. Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population. Chin J Epidemiol. 2002;23:5–10.

    Google Scholar 

  19. National Bureau of Statistics. Tabulation on the popultion census of the people’s republic of China. 2010 http://www.stats.gov.cn/tjsj/pcsj/rkpc/6rp/indexch.htm.

  20. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: A systematic analysis of population-based studies from 90 countries. Circulation. 2016;134:441–50.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Zhang M, Wu J, Zhang X, Hu C, Zhao Z, Chun L, et al. Prevalence and control of hypertension in adults in China, 2018. Chin J Epidemiol. 2021;42:1780–9.

    CAS  Google Scholar 

  22. Chen J Analysis of hypertension status and its related factors on the elderly in China–Based on CHARLS 2015 data. Nanjing University Of Posts And Telecommunications. 2020.

  23. Wang J, Zhang L, Wang F, Liu L, Wang H, China National Survey of Chronic Kidney Disease Working Group. Prevalence, awareness, treatment, and control of hypertension in China: Results from a national survey. Am J Hypertens. 2014;27:1355–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Levine BS, Kannel WB. Coronary heart disease risk in people 65 years of age and older. Prog Cardiovasc Nurs. 2003;18:135–40.

    Article  PubMed  Google Scholar 

  25. Kim BJ, Han JM, Kang JG, Kim BS, Kang JH. Association between cotinine-verified smoking status and hypertension in 167,868 Korean adults. Blood Press. 2017;26:303–10.

    Article  PubMed  Google Scholar 

  26. Alomari MA, Al-Sheyab NA. Cigarette smoking lowers blood pressure in adolescents: The Irbid-TRY. Inhalation Toxicol. 2016;28:140–4.

    Article  CAS  Google Scholar 

  27. Li G, Wang H, Wang K, Wang W, Dong F, Qian Y, et al. The association between smoking and blood pressure in men: A cross-sectional study. BMC Public Health. 2017;17:797.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cavusoglu Y, Timuralp B, Us T, Akgün Y, Kudaiberdieva G, Gorenek B, et al. Cigarette smoking increases plasma concentrations of vascular cell adhesion molecule-1 in patients with coronary artery disease. Angiology. 2004;55:397–402.

    Article  PubMed  Google Scholar 

  29. Halperin RO, Gaziano JM, Sesso HD. Smoking and the risk of incident hypertension in middle-aged and older men. Am J Hypertens. 2008;21:148–52.

    Article  PubMed  Google Scholar 

  30. Khan JR, Biswas RK, Islam MM. Relationship between blood pressure and BMI in young adult population: a national-level assessment in Bangladesh. Br J Nutr. 2021;128:1–8.

    Google Scholar 

  31. Neter JE, Stam BE, Kok FJ, Grobbee DE, Geleijnse JM. Influence of weight reduction on blood pressure: A meta-analysis of randomized controlled trials. Hypertension. 2003;42:878–84.

    Article  CAS  PubMed  Google Scholar 

  32. Gandotra C, Basam M, Mahajan A, Ngwa J, Ortega G, Tran D, et al. Characteristics and resolution of hypertension in obese African American bariatric cohort. Sci Rep. 2021;11:1683.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Youn JC, Kim C, Park S, Lee SH, Kang SM, Choi D, et al. Adiponectin and progression of arterial stiffness in hypertensive patients. Int J Cardiol. 2013;163:316–9.

    Article  PubMed  Google Scholar 

  34. Gan T, Yang J, Jiang L, Gao Y Living alone and cardiovascular outcomes: a meta-analysis of 11 cohort studies. Psychol, Health Med. 2021:1–13. https://doi.org/10.1080/13548506.2021.1975784.

  35. National Academies of Sciences, Engineering, and Medicine, Division of Behavioral and Social Sciences and Education, Health and Medicine Division, Board on Behavioral, Cognitive, and Sensory Sciences, Board on Health Sciences Policy, Committee on the Health and Medical Dimensions of Social Isolation and Loneliness in Older Adults. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System Washington (DC): National Academies Press (US).

  36. OʼSúilleabháin PS, Gallagher S, Steptoe A. Loneliness, living alone, and all-cause mortality: The role of emotional and social loneliness in the elderly during 19 years of follow-up. Psychosom Med. 2019;81:521–6.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Cederbom S, Rydwik E, Söderlund A, Denison E, Frändin K, Wågert PVH. A behavioral medicine intervention for older women living alone with chronic pain - a feasibility study. Clin Interventions Aging. 2014;9:1383–97.

    Article  Google Scholar 

  38. Franklin SS. Ageing and hypertension: The assessment of blood pressure indices in predicting coronary heart disease. J Hypertens Suppl. 1999;17:S29–36.

    CAS  PubMed  Google Scholar 

  39. Robles NR, Macias JF. Hypertension in the elderly. Cardiovasc Hematol Agents Medicinal Chem. 2015;12:136–45.

    Article  Google Scholar 

  40. Klassen SA, Joyner MJ, Baker SE. The impact of ageing and sex on sympathetic neurocirculatory regulation. Semin Cell Developmental Biol. 2021;116:72–81.

    Article  CAS  Google Scholar 

  41. Lu Y, Pechlaner R, Cai J, Yuan H, Huang Z, Yang G, et al. Trajectories of Age-Related Arterial Stiffness in Chinese Men and Women. J Am Coll Cardiol. 2020;75:870–80.

    Article  PubMed  Google Scholar 

  42. Amery A, Fagard R, Guo C, Staessen J, Thijs L. Isolated systolic hypertension in the elderly: an epidemiologic review. Am J Med. 1991;90:64s–70s.

    Article  CAS  PubMed  Google Scholar 

  43. Samargandy S, Matthews KA, Brooks MM, Barinas-Mitchell E, Magnani JW, Janssen I, et al. Arterial Stiffness Accelerates Within 1 Year of the Final Menstrual Period: The SWAN Heart Study. Arteriosclerosis, thrombosis. Vasc Biol. 2020;40:1001–8.

    Article  CAS  Google Scholar 

  44. Avolio AP, Kuznetsova T, Heyndrickx GR, Kerkhof PLM, Li JKJ. Arterial flow, pulse pressure and pulse wave velocity in men and women at various ages. Adv Exp Med Biol. 2018;1065:153–68.

    Article  PubMed  Google Scholar 

  45. Fleg JL, Strait J. Age-associated changes in cardiovascular structure and function: a fertile milieu for future disease. Heart Fail Rev. 2012;17:545–54.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Cox ER, Brown WJ, Gajanand T, Bailey TG, Gomersall SR, Chachay VS, et al. Effects of fitness and fatness on age-related arterial stiffening in people with type 2 diabetes. Clin Obes. 2022;12:e12519.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Boutouyrie P, Chowienczyk P, Humphrey JD, Mitchell GF. Arterial stiffness and cardiovascular risk in hypertension. Circulation Res. 2021;128:864–86.

    Article  CAS  PubMed  Google Scholar 

  48. Safar ME. Arterial stiffness as a risk factor for clinical hypertension. Nat Rev Cardiol. 2018;15:97–105.

    Article  PubMed  Google Scholar 

  49. Li JKJ, Zhu Y, O’Hara D, Khaw K. Allometric hemodynamic analysis of isolated systolic hypertension and aging. Cardiovasc Eng (Dordr, Neth). 2007;7:135–9.

    Article  Google Scholar 

  50. Acelajado MC, Hughes ZH, Oparil S, Calhoun DA. Treatment of resistant and refractory hypertension. Circulation Res. 2019;124:1061–70.

    Article  CAS  PubMed  Google Scholar 

  51. Sierra C. Hypertension in older adults. Hipertension Riesgo Vasc. 2017;34:26–29.

    Article  Google Scholar 

  52. Kleipool EEF, Rozendaal ES, Mahadew SKN, Kramer MHH, Born BJHVD, Serné EH, et al. The value of ambulatory blood pressure measurement to detect masked diastolic hypotension in older patients treated for hypertension. Age Ageing. 2021;50:1229–35.

    Article  PubMed  Google Scholar 

  53. Nagai M, Ohkubo T, Murakami Y, Takashima N, Kadota A, Miyagawa N, et al. Secular trends of the impact of overweight and obesity on hypertension in Japan, 1980–2010. Hypertens Res. 2015;38:790–5.

    Article  PubMed  Google Scholar 

  54. The Ministry of Health, Labour, and Welfare. The Results of the 2019 National Health and Nutrition Survey in Japan. https://www.mhlw.go.jp/content/10900000/000687163.pdf.

  55. Miura K. Epidemiology and prevention of hypertension in Japanese: How could Japan get longevity? EPMA J. 2011;2:59–64.

    Article  PubMed  PubMed Central  Google Scholar 

  56. (NCD-RisC) NCD Risk Factor Collaboration. Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys. Lancet (Lond, Engl). 2019;394:639–51.

    Article  Google Scholar 

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Acknowledgements

We are grateful for the data provided by the Chinese Longitudinal Healthy Longevity Survey (CLHLS) team. We would also like to acknowledge all the elderly individuals who participated in the survey.

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Authors and Affiliations

  1. School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China

    Siyue Tan, Dong Liu, Yuyi Zhang, Shengnan Li, Ke Zhang & Hui Zuo

  2. Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China

    Hui Zuo

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Tan, S., Liu, D., Zhang, Y. et al. Trends in blood pressure and hypertension among older adults and oldest-old individuals in China between 2008-2018. Hypertens Res 46, 1145–1156 (2023). https://doi.org/10.1038/s41440-023-01183-4

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