云南的农村的血压和左心室的粒量的关系

1、Association of Blood Pressure with Left Ventricular Mass in Untreated Hypertensives in Rural Yunnan Province 云南的农村的血压和左心室的粒量的关系云南的农村的血压和左心室的粒量的关系 A Akasheh, Y Wu武阳丰武阳丰, Y Li李易李易, LD Dustin, ND Wong, JM Gardin, SP Azen, RC Detrano狄家诺狄家诺. University of California, Irvine加州大学加州大学, Peking University Sch

2、ool of Public Health北京大学公共卫生学院北京大学公共卫生学院, Yunnan Province Second Peoples Hospital云南省第二人民医院云南省第二人民医院, China California Heart Watch中加心脏检查机构中加心脏检查机构 American Journal of Hypertension, 2009 China 27.5 Rural China One eigth of the worlds population 800000000 One eigth of the worlds population 八分之一 Prevale

3、nce of Hypertension in China 中国高血压的患病率中国高血压的患病率 Number of Participants Rate (%) Age-adjusted rate (%) Criteria of Diagnosis 1958-59 a 739,204 5.11 - 1979-80 b 4,012,128 7.73 7.5 W H O (1978) # 1991 c 950,356 13.57 (11.44 #) 9.4 JN C V(1993) * 2002 d 17.7 12.4 a: Proceedings of the National Cardiovas

4、cular Diseases Conference, 1959. Peoples Health Publisher, 1960, Beijing. b: Wu YK, et al: Nation-wide hypertension screening in China during 1979-1980. Chin Med J, 1982;95:101-108. c: Wu XG, et al: Prevalence and development trends of hypertension in China. Chin J Hypertension, 1995;3(Suppl.):7-13.

5、 d: the National Nutrition and Health Survey in 2002 （material for the Press Conference of the State Council Information Office） : According to national census data in 1964 and WHO diagnosis criteria in 1978. #: SBP141 mmHg or DBP91mmHg, without consideration on use of medication. *: SBP140 mmHg or

6、DBP90 mmHg or on medication in 2 weeks. Methods 方法方法 Study Sample Design:研究采样 Random cluster sampling to select 10 villages 随机抽样10村子 50 residents between the ages of 50 and 70 years from each village。每个 村子50人 490 men and women. 490人 344 available, without other confounding vascular disease (stroke,

7、MI, severe valve disease)344接受探访的（没有脑梗没有心肌梗） Methods 方法方法 Smoking, alcohol use, medication use, hypertension, hyperlipidemia, and diabetes.抽抽 烟喝酒服药高血脂糖尿病的病历烟喝酒服药高血脂糖尿病的病历 Blood pressure measured three times三次量血压三次量血压 Height and weight.身高体重身高体重 Methods 方法方法 Cardiac Ultrasound - Philips Optigo portabl

8、e ultrasound, 2-5 megahertz transducer. Parasternal long axis view.心脏超 声波（Philips Optigo)2-5MHz 探头，胸骨旁心 长轴 End-diastolic 舒张期 Inter-ventricular septal wall thickness (IST)心 室隔厚度 Left ventricular posterior wall thickness (PWT)心左室后壁厚度 Left ventricular diastolic internal diameter (LVID) 心左室内径 Four measu

9、rements each 四个测量 37 PWT = 1.6 LVID = 4.6 IST = 1.8 Devereux Formula Devereux 公式公式 LVM (g) = 0.8 x 1.04 (IST + LVID + PWT)3 - ( LVID)3 + 0.6. Methods 方法方法 Average of 3 SBP and DBP measurements. 三个收缩压和三个舒张压的测量的平均值三个收缩压和三个舒张压的测量的平均值 Average four estimates of LVM.四个心左室测量的平均值四个心左室测量的平均值 Calculate left v

10、entricular mass index: LVMI = LVM/BSA.心左室指数心左室指数 368 participants consented. 368 参与者同意参与者同意 7 excluded because of past stroke or myocardial infarction.7个中风 和心肌梗除外 9 (2.4%) excluded because of ongoing medical treatment for hypertension.9个服降压药治疗除外 8 excluded because of inadequate ultrasound images.8个超

11、声波图 像不清楚除外 344 participants not undergoing treatment for hypertension 344 名无服降压药的参与者名无服降压药的参与者 Age 年龄年龄57.8 (5.8) Males 男男48.3% BMI: 体重指数22.6kg/m2 (2.7) Present smoker 抽烟抽烟38.4 High cholesterol 高血脂高血脂0.9% Diabetes 糖尿病糖尿病1.2% SBP 收缩压收缩压130 mm Hg (26.3) DBP 舒张压舒张压 75 (12.5) LVM 心左室粒量心左室粒量(g) 138.3 g (

12、40.4) 收缩压 心左室粒量指数心左室粒量指数 心左室粒量指数心左室粒量指数 舒张压 血压种类 心左室粒量指数心左室粒量指数 LVMI and Blood Pressure (SBP and DBP) Adjusting for Covariates (age, gender, BMI) 心左室粒量指数和血压条件共变量（年龄性别心左室粒量指数和血压条件共变量（年龄性别BMI) Coefficient (SE) p Model 1 SBP （收缩压）（收缩压）0.379 (0.043) 0.0001 Age 0.322 (0.195) 0.10 BMI 0.904 (0.411) 0.03 M

13、ale Gender 5.890 (2.179) 0.007 Model 2 DBP （舒张压）（舒张压）0.714 (0.092) 0.0001 Age 0.653 (0.194) 0.0008 BMI 0.854 (0.424) 0.04 Male Gender 4.447 (2.228) 0.05 Conclusions 定论定论 High prevalence of untreated HTN (30%) in rural Yunnan。云南省的农村的高 血压的患病率很高 Strong Linear Relationship between blood pressure and LV

14、Mass. 血压和心 左室的关系很大 Untreated diastolic blood pressure may have a greater effect on LV mass. 未经治疗的舒张压的影响比收缩压更大 Public health implications of uncontrolled blood pressure in rural China are substantial.未经治疗的血压的公共卫生的意味是实效 Salt in China 1.46 million metric tons per year 2.Double production and increase i

15、n imports in past 20 years; Plans to continue increase. 3.Now higher than the US production 4.Industry monopoly by government 5.More consumed in North than South Salt Production in China So salt production and increased disease incidence increase together with time. So what? Systolic Blood Pressure

16、Sodium ExcretionCheng (2006) So blood pressure increases with salt consumption. So what? Systolic Blood Pressure Sodium Excretion CVD and Salt in China 1. Increasing together 2. Geographically related 3. Mechanism? 4. Does decreasing salt ingestion decrease risk in China? Why is salt bad for you? In

17、crease in blood pressure due to fluid retention and deleterious renal-endocrine effects. Independent effect on Left Ventricular Mass. Does decreasing salt ingestion decrease risk? The China Salt Substitute Study Collaborative Group. (2007). Preliminary Data from Survey of Hypertension and LV Mass in

18、 Yunnan Farmers 173 men and 188 women. Mean age was 57.7 +/- 5.7 years. Prevalence of Hypertension 32% Untreated Hypertension: 96% Preliminary Data from Yunnan Farmers Yunnan Farmers 1. Much untreated hypertension in Yunnan 2. strong relationship between blood pressure and LV mass 3. A lot of scatte

19、r in above relationship suggest other factors influence LV mass 4. Salt? Salt and Left Ventricular Mass Fogarty International Research Collaboration Grant. Hypothesis: Salt LV mass Disease Incidence Understanding the problem is the first step to a solution. 认识问题是第一步解决认识问题是第一步解决 Research and Teaching

20、 24 谢谢 Planned Research and Teaching MESA China Pilot Study MESA 中国试验研究 Untreated Hypertension and its Consequences in Rural China. 在中国农村未曾治疗过的高血压及其后果。 Medical Students Summer in Yunnan. 医学系学生暑期在云南。 27 Daibu Township, Yunnan (2008) 30-39 years 40-49 years 50-59 years 60-69 years 70 years or older Ch

21、i- square p-value Men2/9 (22.2%) 3/9 (33.3%) 10/35 (28.6%) 4/21 (19.1%) 2/4 (50%) 0.72 Women0/9 (0%) 3/12 (25%) 12/40 (30%) 10/19 (52.6%) 0/2 (0%) 0.05 Heart Disease USA vs. China 4 Yearly Heart Disease Deaths in USA 1900 - 2000 CCU Defibrillator Preventive Cardiology CABGPCI 11. thousand s 4 12. US

22、A China Projected Yearly Heart Disease Deaths in USA and CHina 1900 to 2050 WHO statistic s Projectin g forward Mission of the China California Heart Watch 中加心脏健康检查中加心脏健康检查 Encourage the use of non-invasive imaging to study cardiovascular epidemiology in China. 鼓励使用非侵入性成像在中国研究心血管病流行病 学。 Establish trans-national educational exchange to allow American medical students to study in developing areas of China. 建立跨国家的教育交流，并让美国医科学生在中国 发展这个领域中的研究。 Methods 方法方法 Study Sample Design:研究采样 Random cluster sampling to select 10 villages 随机抽样10村子 50 residents between the ages of 50 and 70 years from ea