Modifiable risk factors including sunlight exposure and fish consumption are associated with risk of hypertension in a large representative population from Macau

Prevalence of hypertension and related risk factors in older Chinese population: a meta-analysis

Objective

Hypertension is the most challenging public health problem worldwide and seriously affects human health. To date, there are no epidemiological studies on the prevalence of and risk factors for hypertension among older people in mainland China.

Methods

We conducted a meta-analysis of the prevalence and risk factors of hypertension among the older population in mainland China. We searched Chinese and English databases for Chinese and English literature on hypertension epidemiology published between 2000 and 2022, and hypertension data among the older population were extracted from the included literature. A meta-analysis was performed using a random-effects model (I2 > 50%) with 95% confidence intervals for the forest plots. Data were processed using RevMan 5.3. Forty-nine publications (with data from 84,429 samples) met the evaluation criteria and were included in this study.

Results

We found that the total prevalence of hypertension was 47%. The total prevalence rate of the older population in China from 2000 to 2010 was 50%, and the prevalence rate from 2011 to 2021 was 45%, with no significant differences. The total prevalence in Central China was the highest (59%). There was no significant correlation between the prevalence rate of the older population, sex, and urban or rural areas.

Conclusion

Hypertension is common among the older population in China, and its control rate is low. Therefore, effective prevention and treatment measures, as well as education, should be formulated to improve the diagnosis and treatment of hypertension in the older population.

Association between sun-protective behaviors and hypertension: a cross-sectional study from National Health and Nutrition Examination Survey 2009 to 2014

BACKGROUND

In previous studies, sun-protective behaviors increased cardiovascular incidence. Our present article is to further analyze the potential relationship between sun-protective behaviors (staying in the shade, wearing long-sleeved clothing, and applying sunscreen) and hypertension.

METHOD

The present cross-sectional study evaluated 8,613 participants (aged 20-60 years) from the National Health and Nutrition Examination Survey (NHANES) obtained between 2009 and 2014. We performed multiple logistic regression analysis to examine the relationship between sun-protective behaviors and hypertension. Subgroup analysis was then performed. Multiple linear regression analysis was utilized to examine the relationship of sun-protective behaviors and each sun-protective behavior with systolic and diastolic blood pressure, stratified by sex and race.

RESULTS

A total of 8,613 participants (weighted n = 127,909,475) were applied in our study, including 1,694 hypertensive subjects. Our study demonstrated that sun-protective behaviors of the 2-3 category were associated with increased risk of hypertension, but not with higher systolic and diastolic blood pressure. In subgroup analysis, men, Mexican American, and 25 < BMI ≤ 30 who reported sun-protective behaviors (2-3) were prone to hypertension. Multiple linear regression models showed that non-Hispanic white men with sun-protective behaviors (2-3) were positively associated with systolic and diastolic blood pressure. The association between other-Hispanic men with frequent wearing long-sleeved clothing and diastolic blood pressure was positively correlated.

CONCLUSION

Sun-protective behaviors of the 2-3 category could increase the incidence of hypertension, but not increase systolic and diastolic blood pressure. We only found that non-Hispanic white men who reported sun-protective behaviors (2-3) were positively associated with systolic and diastolic blood pressure. These findings suggested that excessive sun-protective behaviors should be avoided.

Mediator or moderator? The role of obesity in the association between age at menarche and blood pressure in middle-aged and elderly Chinese: a population-based cross-sectional study

OBJECTIVE

We investigated the moderation/mediation between the age of menarche and obesity parameters in predicting blood pressure (BP) in middle-aged and elderly Chinese.

DESIGN

Our study is a population-based cross-sectional study.

SETTING

Participants in this study came from the China Health and Retirement Longitudinal Study (CHARLS).

PARTICIPANTS

The analytical sample included 4513 participants aged 45-96 years.

MAIN OUTCOME MEASUREMENTS

Data were selected from the CHARLS, a cross-sectional study. Between-group differences were evaluated using χ², t-test and one-way analysis of variance. The trend of related variables by characteristics was also tested using contrast analysis, as appropriate. Then, correlations between characteristics, moderator, mediator, and independent and dependent variables were used by Spearman's correlation test and Pearson's correlation test. Finally, the mediation analysis was performed by model 4 in PROCESS V3.3 macro for SSPSS, and moderation analysis was used by model 1 for assessment. All covariates were adjusted in the moderation or mediation models.

RESULTS

In the correlation analysis, body mass index (BMI) and waist circle (WC) level were positively correlated with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in women (BMI and DBP: r=0.221, p<0.001; WC and DBP: r=0.183, p<0.001; BMI and SBP: r=0.129, p<0.001; WC and SBP: r=0.177, p<0.001). Age of menarche was negatively correlated with DBP (r=-0.060, p<0.001). However, the age of menarche was not significantly correlated with SBP (r=-0.014, p=0.335). In the moderator analysis, after controlling for the potential confounders, the interaction term of obesity parameters×age of menarche was not significant for predicting either DBP (BMI: B=0.0260, SE=0.0229, p=0.2556, 95% CI -0.0189 to 0.071; WC: B=0.0099, SE=0.0074, p=0.1833, 95% CI -0.0047 to 0.0244) or SBP (BMI: B=0.0091, SE=0.0504, p=0.8561, 95% CI -0.0897 to 0.108; WC: B=-0.0032, SE=0.0159, p=0.8427, 95% CI -0.0343 to 0.028). All correlations were significant correlation between age of menarche, obesity parameters and BP except the path of the menarche age→SBP (with the addition of the BMI indicator: β=-0.0004, B=-0.0046, p=0.9797, 95% CI -0.3619 to 0.3526; with the addition of the WC indicator: β=0.0004, B=0.0044, p=0.9804, 95% CI -0.3439 to 0.3526) in crude model. In general, after controlling for potential confounders, BMI (DBP: β=-0.0471, B= -0.2682, p=0.0021, 95% CI -0.4388 to -0.0976; SBP: β=-0.0515, B=-0.6314, p<0.001, 95% CI -0.9889 to -0.2739) and WC (DBP: β=-0.0474, B= -0.2689, p<0.001, 95% CI -0.4395 to -0.0984; SBP: β=-0.0524, B=-0.6320, p<0.001, 95% CI -0.9832 to -0.2807) partly mediated the relationship between age of menarche and BP.

CONCLUSIONS

The interaction term of obesity parameters×age of menarche was not significant for predicting either DBP or SBP in women. Moreover, obesity parameters partly mediated the relationship between the age of menarche and BP.

The effect of ultraviolet irradiation compared to oral vitamin D supplementation on blood pressure of nursing home residents with dementia

Background

Observational studies have reported an inverse association between ultraviolet (UV) radiation and hypertension. The aim of this study was to assess differences in blood pressure changes between persons with dementia receiving UV light versus vitamin D (VD) supplementation.

Methods

Post-hoc analysis of randomized controlled trial data concerning nursing home residents with dementia (N = 61; 41 women, mean age 84.8 years). The participants received half-body UV irradiation, twice weekly over 6 months, at one standard erythema dose (UV group, n = 22) or 5600 international units of cholecalciferol once a week (VD group, n = 39). Short-term effects were evaluated after 1 month and long-term effects after 3 and 6 months. Differences in blood pressure changes were assessed using linear mixed models.

Results

With the VD group as a reference, the estimated difference in mean change of systolic blood pressure was − 26.0 mmHg [95% confidence interval (CI) -39.9, − 12.1, p = .000] at 1 month, 4.5 mmHg (95% CI -6.8, 15.9, p = 0.432) at 3 months, and 0.1 (95% CI -14.1, 14.3, p = 0.83) at 6 months. The estimated difference in diastolic blood pressure was − 10.0 mmHg (95% CI -19.2, − 0.7, p = 0.035) at 1 month, 3.6 mmHg (95% CI -4.1, 11.2, p = 0.358) at 3 months, and 2.7 (95% CI -6.8, 12.1, p = 0.580) at 6 months.

Conclusions

UV light had only a short-term effect but not a long-term effect on blood pressure reduction compared to VD use in this sample of normotensive to mild hypertensive nursing home residents with dementia. Future studies will be needed to determine the effect of UV light in different samples of the population and especially in a population with hypertension.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02538-7.

Combined Effect of Famine Exposure and Obesity Parameters on Hypertension in the Midaged and Older Adult: A Population-Based Cross-Sectional Study

OBJECTIVES

Undernutrition early in life may increase the incidence of adverse effects on adult health. The relations between undernutrition and obesity parameters (body mass index (BMI) and WC (waist circle)) and hypertension were often contradictory. Our study is aimed at identifying the combined effects of famine exposure and obesity parameters on hypertension in middle-aged and older Chinese.

DESIGN

A population-based cross-sectional study. Setting. Data were selected from the China Health and Retirement Longitudinal Study Wave2011 (CHARLS Wave2011). Participants. The sample included 12945 individuals aged 45 to 96. Main Outcome Measurements. The study analyzed data from 12945 middle-aged and older Chinese selected from CHARLS Wave2011. Differences between baseline characteristics and famine exposure/BMI levels/WC levels were evaluated using the t-, Chi-square- (χ 2-), and F-test. Then, the difference in the prevalence of hypertension between baseline characteristics was estimated by the t- and χ 2-test. Finally, multivariable-adjusted logistic regression models were used to explore the associations of famine exposure and obesity parameters with odds of prevalence of hypertension.

RESULTS

Among the 12945 participants, 1548 (11.96%) participants had been exposed to the Chinese famine during the fetal group, whereas 5101 (39.41%) participants and 4362 (33.70%) participants had been exposed to the famine during childhood and adolescence/adult group, respectively. Regarding the participants with BMI levels, 3746 (28.94%) were overweight, and 1465 (11.32%) were obese, whereas 5345 (41.29%) of the participants with WC levels were obese, respectively. Furthermore, 1920 (31.17%) had hypertension in males and 2233 (32.91%) in females. In multivariable-adjusted models, famine exposure and obesity parameters were related with prevalence of hypertension independently in total populations ((1) model threec, famine exposure with prevalence of hypertension: the fatal-exposed vs. no-exposed group (OR1.27; 95% CI 1.08, 1.49); childhood-exposed vs. no-exposed group (OR1.64; 95% CI 1.44, 1.87); the adolescence/adult-exposed vs. no-exposed group (OR3.06; 95% CI 2.68, 3.50); P for trend < 0.001; (2) model threee, famine exposure with prevalence of hypertension: the fatal-exposed vs. no-exposed group (OR1.25; 95% CI 1.06, 1.47); childhood-exposed vs. no-exposed group (OR1.52; 95% CI 1.34, 1.73); the adolescence/adult-exposed vs. no-exposed group (OR2.66; 95% CI 2.33, 3.03); P for trend < 0.001; (3) model threeg, BMI levels with prevalence of hypertension: overweight vs. normal (OR1.75; 95% CI 1.60, 1.91); obesity vs. normal (OR2.79; 95% CI 2.48, 3.15); P for trend < 0.001; (4) WC levels with prevalence of hypertension: overweight vs. normal (OR1.42; 95% CI 1.36, 1.48)). When stratified by sex, results in both males and females were mostly similar to those in the total population. In general, interaction analysis in the multivariable-adjusted model, compared with the combination of normal BMI/WC levels and no-exposed famine group, all groups trended towards higher odds of prevalence of hypertension (the greatest increase in odds, adolescence/adult-exposed group with obesity in BMI levels: (OR8.13; 95% CI 6.18, 10.71); adolescence/adult-exposed group with obesity in WC levels: (OR6.36; 95% CI 5.22, 7.75); P for interaction < 0.001). When stratified by sex, the results in both males and females were also similar to those in the total population.

CONCLUSION

Our data support a strongly positive combined effect of famine exposure and obesity parameters on hypertension in middle-aged and elderly Chinese.

Individual and combined association analysis of famine exposure and serum uric acid with hypertension in the mid-aged and older adult: a population-based cross-sectional study

Background

Malnutrition in early life may affect health in later life. The associations between malnutrition and serum uric acid (SUA) and hypertension were inconsistent. The present study aimed to investigate the individual and combined association between famine exposure and serum uric acid and hypertension in middle-aged and older Chinese.

Methods

Data were selected from the China Health and Retirement Longitudinal Study (CHARLS) Wave2011. The analytic sample included 9368 individuals aged 45 to 90. Differences between baseline characteristics and famine exposure/SUA level were evaluated using the Chi-square test, t-test, and F-test. Then, the differences in the prevalence of hypertension between characteristic groups was also estimated by the Chi-square and t-test. Finally, multivariable-adjusted logistic regression models examined association of famine exposure and serum uric acid with odds of prevalence of hypertension.

Results

A total of 9368 individuals were enrolled in the study, 4366 (46.61%) and 5002 (53.39%) were male and female, respectively. Among males, 459 (10.51%) had been exposed to the Chinese famine during the fetal stage, whereas 1760 (40.31%) and 1645 (37.68%) had been exposed to the famine during childhood and adolescence/adult stage, respectively. Among females, 635 (12.69%) had been exposed to the Chinese famine during the fetal stage, whereas 1988 (39.74%) and 1569 (31.37%) had been exposed to the famine during childhood and adolescence/adult stage, respectively. Regarding the participants with SUA level measurements, 290 (6.64%) reported having Hyperuricemia (HUA) in males and 234 (4.68%) in the females. Furthermore, 1357 (31.08%) reported having hypertension in male and 1619 (32.37%) in the female. In multivariable-adjusted model, famine exposure and serum uric acid were associated with prevalence of hypertension independently in total populations [(1) Model four^d, fatal exposed group vs non-exposed group: 1.25 (95% CI 1.03, 1.52); childhood-exposed group vs non-exposed group:1.60 (95% CI 1.37, 1.87); adolescence/adult exposed group vs non-exposed group: 2.87 (95% CI 2.44, 3.37), P for trend < 0.001; (2) Model four ^e, high vs normal:1.73 (95% CI 1.44, 2.08)]. When stratified by sex, the results in both males and females were similar to those in the total population. In general, interaction analysis in the multivariable-adjusted model, compared with the combination of normal SUA level and no-exposed famine stage, all groups trended towards higher odds of prevalence of hypertension [the greatest increase in odds, adolescence/adult exposed stage and high SUA level in total participants: OR4.34; 95%CI 3.24, 5.81; P for interaction < 0.001]. When stratified by sex, the results in both males and females were also similar to those in the total population.

Conclusion

Our data support a strongly positive individual and combined association of famine exposure and serum uric acid with hypertension in middle-aged and elderly Chinese.

Low sun exposure habits is associated with a dose-dependent increased risk of hypertension: a report from the large MISS cohort

In prospective observational cohort studies, increasing sun exposure habits have been associated with reduced risk of cardiovascular mortality. Our aim was to assess possible observational mechanisms for this phenomenon. A written questionnaire was answered by 23,593 women in the year 2000 regarding risk factors for melanoma, including factors of possible interest for hypertension, such as detailed sun exposure habits, hypertension, marital status, education, smoking, alcohol consumption, BMI, exercise, and chronic high stress. Hypertension was measured by the proxy "use of hypertension medication" 2005-2007, and high stress by "need of anti-depressive medication". Sun exposure habits was assessed by the number of `yes' to the following questions; Do you sunbath during summer?, During winter vacation?, Do you travel south to sunbath?, Or do you use sun bed? Women answering 'yes' on one or two questions had moderate and those answering 'yes' on three or four as having greatest sun exposure. The main outcome was the risk of hypertension by sun exposure habits adjusted for confounding. As compared to those women with the greatest sun exposure, women with low and moderate sun exposure were at 41% and 15% higher odds of hypertension (OR 1.41, 95% CI 1.3‒1.6, p < 0.001 and OR 1.15, 95% CI 1.1‒1.2, p < 0.001), respectively. There was a strong age-related increased risk of hypertension. Other risk factors for hypertension were lack of exercise (OR 1.36), a non-fair phenotype (OR 1.08), chronic high stress level (OR 1.8), and lack of university education (OR 1.3). We conclude that in our observational design sun exposure was associated with a dose-dependent reduced risk of hypertension, which might partly explain the fewer deaths of cardiovascular disease with increasing sun exposure.

Effects of intact and hydrolysed blue whiting proteins on blood pressure and markers of kidney function in obese Zucker fa/fa rats

PURPOSE

To investigate the effects of diets containing intact or hydrolysed proteins from blue whiting (Micromesistius poutassou) on the development of high blood pressure and markers of kidney function in obese Zucker fa/fa rats which are prone to develop hypertension and renal failure.

METHODS

Male rats were fed isocaloric diets containing either intact blue whiting whole meal (BW-WM), blue whiting protein hydrolysate prepared with Alcalase^® (BW-HA) or blue whiting protein hydrolysate prepared with Protamex^® (BW-HP) as 1/3 of total protein with the remaining 2/3 as casein, or casein as sole protein source (control group). Blood pressure was measured at Day 0 and Day 32. Rats were housed in metabolic cages for 24 h for collection of urine in week 4. After 5 weeks, rats were euthanized and blood was drawn from the heart. The renin and angiotensin-converting enzyme (ACE) inhibition capacities for casein and blue whiting proteins were measured in vitro.

RESULTS

The blood pressure increase was lower in rats fed diets containing blue whiting proteins when compared to the control group, whereas markers of kidney function were similar between all groups. The three blue whiting proteins inhibited renin activity in vitro, whereas casein had no effect. The in vitro ACE inhibition was similar for casein, BW-WM and BW-HP proteins, whereas BW-HA protein was less potent.

CONCLUSION

Blue whiting protein feeding attenuated the blood pressure increase in obese Zucker fa/fa rats, possibly mediated through the renin-angiotensin system and without affecting markers of kidney function.

Sleep duration is associated with vitamin D deficiency in older women living in Macao, China: A pilot cross-sectional study

Chinese women are known to have both a high prevalence of metabolic syndrome (MetS) and vitamin D deficiency (serum 25-hydroxyvitamin D (25OHD) <50 nmol/l). Associations between sleep duration and circulating 25OHD have recently been reported but, to our knowledge, these associations have not been studied in older Chinese populations. We thus investigated whether sleep duration was associated with vitamin D status in a population from Macao, China, and whether sleep duration modified the association between MetS and vitamin D deficiency. In 207 older (>55 years) Macanese, anthropometry, blood samples and validated questionnaires, including sleep duration and cardiovascular risk factors, were simultaneously collected. On multivariable categorical analyses, those women, not men, who had short sleep duration (≤6 hours (h)) were at a 2-fold risk for vitamin D deficiency (both <50 nmol/L and <37 nmol/L; OR = 1.94, 95%CI 1.29–2.92; OR = 2.05, 95%CI 1.06–3.98, respectively) and those who had longer sleep duration (>8 h) were 3-fold more likely to have vitamin D deficiency (OR = 3.07, 95%CI 1.47–6.39; OR = 2.75, 95%CI 1.08–7.00, respectively) compared to those with normal sleep duration (6–8 h). Both women and men with MetS were 2-fold more likely to have vitamin D deficiency (women: OR = 2.04, 95%CI 1.31–3.17; OR = 2.15, 95%CI 1.11–4.17, respectively; men: OR = 2.01, 95%CI 1.23–3.28; OR = 2.04, 95%CI 1.00–4.29, respectively). Moreover, women with both short sleep duration and MetS had an increased risk of vitamin D deficiency (OR = 3.26, 95%CI 1.10–9.64). These associations were not found in those with longer sleep. Men with longer sleep and MetS had a 5-fold risk of vitamin D deficiency (OR = 5.22; 95%CI 2.70–10.12). This association was non-significant for men with shorter sleep. We conclude that both short and long sleep duration were associated with vitamin D deficiency in older Chinese women. Further research is needed in larger cohorts or with intervention studies to further examine the associations between reduced sleep, metabolic syndrome and vitamin D deficiency.

Association of sun and UV exposure with blood pressure and cardiovascular disease: A systematic review

BACKGROUND

Ecological studies show that sun or ultraviolet (UV) exposure have inverse associations with blood pressure (BP) and cardiovascular disease (CVD). Although sunlight is the primary source of vitamin D, recent meta-analyses of clinical trials have not reported a beneficial effect from vitamin D supplementation on BP or CVD. Sunlight may have beneficial effects independent of vitamin D. We carried out a systematic review to appraise the extent and quality of the evidence from human studies.

METHODS

Observational and interventional studies that measured sun or UV exposure, along with BP or CVD, were selected after searching databases.

RESULTS

Identified studies could not be combined quantitatively in meta-analysis because of different exposure measures. Solar exposure was inversely associated with BP in 3 out of 4 cross-sectional publications, and with CVD and/or total mortality in 5 out of 6 publications of cohort studies. Two of the cohort studies reported inverse associations between sun exposure and CVD, after adjusting for serum 25-hydroxyvitamin D. Five clinical trials with an appropriate control group were identified, the outcome being BP. Two trials compared UVB with UVA (as control), with only one finding a significant reduction in BP (after 6 weeks). Three trials compared short-term UVA exposure (<30 min) with placebo (or crossover control), of which two reported short-term lowering of BP.

CONCLUSION

This review has identified a small body of evidence that suggests sun exposure protects against high BP and CVD, but further research is required to determine if this is independent of vitamin D.

Cod Residual Protein Prevented Blood Pressure Increase in Zucker fa/fa Rats, Possibly by Inhibiting Activities of Angiotensin-Converting Enzyme and Renin

Hypertension is the leading risk factor for cardiovascular disease, and prevention of high blood pressure through diet and lifestyle should be a preferred approach. High intake of fish is associated with lower blood pressure, possibly mediated through the proteins since peptides with angiotensin-converting enzyme (ACE) inhibiting capacities have been identified in fish skin, backbone, and fillet. The effects of cod meals made from residual materials and fillet on blood pressure were investigated in obese Zucker fa/fa rats which spontaneously develop high blood pressure. Rats were fed diets containing water-soluble (stickwater) or water-insoluble (presscake) fractions of protein-rich meals from cod residual materials (head, gut, backbone with muscle residuals, skin, trimmings) or fillet. Rats were fed diets containing 25% of total protein from cod meal and 75% of protein from casein, or casein as the sole protein source (control group) for four weeks. Results show that a diet containing residual presscake meal with high gut content prevented blood pressure increase, and this cod residual meal also showed the strongest in vitro inhibitions of ACE and renin activities. In conclusion, a diet containing water-insoluble proteins (presscake meal) with high gut content prevented increase in blood pressure in obese Zucker fa/fa rats.

A Dietary Pattern of Higher Fish, Egg, Milk, Nut, Vegetable and Fruit, and Lower Salt Intake Correlates With the Prevalence and Control of Hypertension

BACKGROUND

The effects of food on the prevalence and control of hypertension are unclear. We aimed to investigate whether a dietary pattern of higher fish, egg, milk, nut, vegetable and fruit consumption, and lower salt intake was associated with hypertension in China.

METHODS

A total of 15,303 subjects were recruited from September 2012 to December 2014. Groups with (n = 1,604) and without (n = 13,660) hypertension were formed for a case-control study. The hypertensive participants were classified into the controlled blood pressure (BP) subgroup (n = 397) and the uncontrolled BP subgroup (n = 1,207). Data on the average weekly intake of fish, eggs, milk, nuts, vegetables, fruit, and salt in the past year were collected. Higher intake was defined as greater than or equal to median food intake.

RESULTS

Higher fish, egg, milk, nut, vegetable, and fruit intake correlated with lower hypertension prevalence, and fish and fruit intake were the strongest associated factors. Meanwhile, higher fruit intake, the highest quartile of egg or milk intake, and the lowest quartile of salt intake correlated with better BP control. Furthermore, the dietary pattern was associated with lower hypertension prevalence (odds ratio [OR]: 0.88, 95% confidence interval [CI]: 0.84-0.92; P < 0.001) and better BP control (OR: 1.11, 95% CI: 1.03-1.21; P = 0.011). However, the dietary pattern did not correlate with BP control after excluding fruit intake.

CONCLUSIONS

The dietary pattern correlated with lower hypertension prevalence and better BP control, and its association with BP control might be driven by higher fruit consumption.

Prevalence and distribution of hypertension and related risk factors in Jilin Province, China 2015: a cross-sectional study

OBJECTIVE

This study aimed to investigate the prevalence and distribution of hypertension and its related factors in Jilin province, China.

DESIGN

A cross-sectional study in four cities and four rural counties in Jilin as part of a national Chinese study.

PARTICIPANTS AND SETTING

A total of 15 206 participants who were ≥15 years old and were selected using a stratified multistage random sampling method.

MAIN OUTCOME MEASURES

The prevalence of hypertension.

RESULTS

The prevalence of hypertension in Jilin province was 24.7%. Moreover, the prevalence of hypertension increased with age in both sexes, and was higher in men than in women. The modifiable factors that were associated with hypertension were body mass index, smoking and alcohol drinking. The risk factors identified are similar to those in southern China, except smoking, which has no association with hypertension prevalence in the South.

CONCLUSIONS

Age, sex, body mass index, smoking and alcohol drinking were risk factors of hypertension. Control of these related risk factors, especially smoking, may be helpful in the treatment and management of hypertension in Jilin province.

Anti-hypertensive drugs and skin cancer risk: a review of the literature and meta-analysis

INTRODUCTION

Several anti-hypertensive drugs have photosensitizing properties, however it remains unclear whether long-term users of these drugs are also at increased risk of skin malignancies. We conducted a literature review and meta-analysis on the association between use of anti-hypertensive drugs and the risk of cutaneous melanoma and non-melanoma skin cancer (NMSC).

METHODS

We searched PubMed, EMBASE, Google Scholar and the Cochrane Library, and included observational and experimental epidemiological studies published until February 28th, 2017. We calculated summary relative risk (SRR) and 95% confidence intervals (95% CI) through random effect models to estimate the risk of skin malignancies among users of the following classes of anti-hypertensive drugs: thiazide diuretics, angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), calcium channel blockers (CCB) and β-blockers. We conducted sub-group and sensitivity analysis to explore causes of between-studies heterogeneity, and assessed publication bias using a funnel-plot based approach.

RESULTS

Nineteen independent studies were included in the meta-analysis. CCB users were at increased skin cancer risk (SRR 1.14, 95% CI 1.07-1.21), and β-blockers users were at increased risk of developing cutaneous melanoma (SRR 1.21, 95% CI 1.05-1.40), with acceptable between-studies heterogeneity (I2 < 50%). There was no association between thiazide diuretics, ACEi or ARB use and skin cancer risk. We found no evidence of publication bias affecting the results.

CONCLUSION

Family doctors and clinicians should inform their patients about the increased risk of skin cancer associated with the use of CCB and β-blockers and instruct them to perform periodic skin self-examination. Further studies are warranted to elucidate the observed associations.

Hypertension and other cardiovascular risk factors are associated with vitamin D deficiency in an urban Chinese population: A short report

There is debate concerning the association of 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) with cardiovascular disease (CVD) risk factors. As both hypertension and vitamin D deficiency are increasingly important public health concerns in China, we investigated these associations in 566 Macao residents. The aim was to investigate the association of serum 25OHD and PTH concentrations with CVD risk factors (hypertension, high pulse rate, abnormal blood lipids). The data were stratified by age, sex, and blood pressure (BP) medication use. Multiple linear regression analyses were performed to assess associations, adjusting for appropriate confounders. Lower 25OHD concentrations were significantly associated with higher systolic BP (SBP) mmHg (β=-0.07), diastolic BP (DBP) mmHg (β=-0.06) and pulse rate beats/min (β=-0.12), lower high-density lipoprotein (HDL) concentrations nmol/L (β=10.51) and higher triglycerides (TG) nmol/L (β=-2.38). However, the inverse associations with lower 25OHD for higher SBP, DBP, pulse rate and TG were much stronger in those using BP medications, in those who were older, and in females. Higher PTH concentrations were significantly associated with higher low-density lipoprotein (LDL) nmol/L (β=0.77) in the total population and with higher SBP mmHg (β=0.08) in males and those who were older (β=0.09). In conclusion, our major new finding is that lower 25OHD is associated with higher BP especially in those who use BP medications. These results might explain past discrepancies in findings regarding the association of BP and vitamin D and suggest that prospective studies and randomized control trials, in otherwise healthy Chinese populations taking blood pressure medications, are needed to confirm these cross-sectional results.

Vitamin D and hypertension: Prospective study and meta-analysis

OBJECTIVES

The study sought to determine the link between vitamin D concentrations and incident hypertension in prospective study and meta-analysis.

METHODS

The study was embedded in the Kailuan Study, a population-based cohort of adults that contains underground miners. In 2012, we studied 2,456 men and women free of prevalent hypertension, age 21 to 67 at baseline. Serum 25-hydroxyvitamin D was measured from previously frozen baseline samples using ELISA (Enzyme-Linked ImmunoadSorbent Assay). We use the logistic regression analysis to estimate the odd radio (ORs) 95% confidence intervals (CIs) for 25-hydroxyvitamin D [25(OH)D] concentrations with incident hypertension. To help place our new data in context, we conducted a systemic review and meta-analysis of previous prospective reports of vitamin D and hypertension.

RESULTS

During a median follow-up of 2 years, 42.6% of the cohort (n = 1047) developed hypertension. Compared with the 25-hydroxyvitamin D >30ng/ml, 25-hydroxyvitamin D <20 ng/ml was associated with a greater hypertension risk (OR: 1.225 [95% CI: 1.010 to 1.485] p = 0.04), although the association was attenuated and not statistically significant after adjusting for potential confounders (OR: 1.092 [95% CI: 0.866 to 1.377] p = 0.456). This meta-analysis included seven prospective studies for 53,375 participants using adjusted HR founded a significant association between vitamin D deficiencies and incident hypertension (HRs = 1.235 (95% CI: 1.083 to 1.409, p = 0.002)).

CONCLUSION

Lower serum 25-hydroxyvitamin D concentrations were not associated with a greater risk of incident hypertension. More research is needed to further determine the role of 25-hydroxyvitamin D in hypertension prevention and therapy.

The consumption of fish cooked by different methods was related to the risk of hyperuricemia in Japanese adults: A 3-year follow-up study

BACKGROUND AND AIMS

Fish consumption is a recognized risk factor for elevated serum uric acid (UA) levels, hyperuricemia, and gout. However, the relationship between the consumption of fish cooked by different methods and the risk of hyperuricemia is unclear. Therefore, we aimed to investigate the relationship between the consumption of fish cooked by different methods and the risk of hyperuricemia in Japanese adults.

METHODS AND RESULTS

A 3-year follow-up study was conducted with 424 Japanese adults aged 29-74 years. Fish consumption was assessed using a validated self-administered dietary history questionnaire, and hyperuricemia was defined as serum UA ≥7 mg/dL in men and ≥6 mg/dL in women or the use of any anti-gout treatment. During the 3-year follow-up period, we documented 30 newly diagnosed cases of hyperuricemia. After adjusting for potential confounders, multivariate logistic regressions analysis revealed a significant positive relationship between the risk of hyperuricemia and raw (sashimi and sushi) or roasted fish consumption, but not boiled or fried fish consumption. The odds ratios (95% CI) for hyperuricemia with increasing raw fish consumption were 1.00 (reference), 2.51 (0.85, 7.39), and 3.46 (1.07, 11.14) (P for trend: 0.036). Similarly, the odds ratios (95% CI) with increasing roasted fish consumption were 1.00 (reference), 3.00 (0.75, 11.89), and 5.17 (1.30, 20.62) (P for trend: 0.018).

CONCLUSION

This 3-year follow-up study showed that the consumption of raw or roasted fish, but not boiled or fried fish, was related with a higher risk of hyperuricemia in Japanese adults.

Dietary Features and Blood Pressure among 18-88-Year-Old Residents in an Island Population in China

OBJECTIVES

Dietary recommendations to reduce blood pressure (BP) have been widely disseminated and residents who live on islands have unique dietary characteristics. Here, we identified associations between dietary intake and BP levels among island residents in China.

DESIGN

Cross-sectional study.

SETTING

The Changhai islands, which is an important island county in China.

PARTICIPANTS

A total of 876 residents, 18-88 years old, of Changhai county.

MEASUREMENTS

Dietary intake and BP measurements were assessed using standardized questionnaires and protocols, respectively. Dietary intake was compared across BP categories and linear regression analyses were performed between dietary intake and systolic blood pressure (SBP) and diastolic blood pressure (DBP).

RESULTS

Participants previously diagnosed with hypertension consumed less salt than those with undiagnosed high BP (p < 0.01). After exclusion of participants previously diagnosed with hypertension, salt and meat consumption were positively and linearly associated with both SBP (p < 0.01 and < 0.001, respectively) and DBP (p = 0.03 and < 0.01, respectively), whereas consumption of marine products was inversely associated with SBP (p = 0.047). Mixed edible oil and edible oil consumption were associated with SBP (p < 0.01) and DBP (p = 0.021), respectively. In the multiple linear regression model, meat intake was positively associated with both SBP and DBP (β = 0.139, p < 0.001; β = 0.066, p = 0.047, respectively), whereas consumption of marine products was inversely associated with SBP (β = -0.102, p <0.001), while mixed edible oil was associated with SBP (β = 0.062, p = 0.03).

CONCLUSION

Adherence to nutritional recommendations can be improved among hypertensive patients, even those aware of their conditions. In the general island population, eating habits regarding salt, meat, edible oil consumption, and use of mixed edible oil increased the risk of hypertension onset, whereas marine products were found to decrease this risk.

Fish, Long-Chain n-3 PUFA and Incidence of Elevated Blood Pressure: A Meta-Analysis of Prospective Cohort Studies

Results from prospective cohort studies on fish or long-chain (LC) n-3 polyunsaturated fatty acid (PUFA) intake and elevated blood pressure (EBP) are inconsistent. We aimed to investigate the summary effects. Pertinent studies were identified from PubMed and EMBASE database through October 2015. Multivariate-adjusted risk ratios (RRs) for incidence of EBP in the highest verses the bottom category of baseline intake of fish or LC n-3 PUFA were pooled using a random-effects meta-analysis. Over the follow-up ranging from 3 to 20 years, 20,497 EBP events occurred among 56,204 adults from eight prospective cohort studies. The summary RR (SRR) was 0.96 (95% CI: 0.81, 1.14; I² = 44.70%) for fish in four studies, and 0.73 (95% CI: 0.60, 0.89; I² = 75.00%) for LC n-3 PUFA in six studies (three studies for biomarker vs. three studies for diet). Circulating LC n-3 PUFA as biomarker was inversely associated with incidence of EBP (SRR: 0.67; 95% CI: 0.55, 0.83), especially docosahexaenoic acid (SRR: 0.64; 95% CI: 0.45, 0.88), whereas no significant association was found for dietary intake (SRR: 0.80; 95% CI: 0.58, 1.10). The present finding suggests that increased intake of docosahexaenoic acid to improve its circulating levels may benefit primary prevention of EBP.

Associations between CLCNKA_B tag SNPs with essential hypertension and interactions between genetic and environmental factors in an island population in China

OBJECTIVE

Essential hypertension (EH) is known as the result from the interaction of environmental and genetic factors. We selected tag SNPs of CLCNKA_B genes as gene markers, to elucidate the relationship between CLCNKA_B and EH, and to determine the possible interaction among tag SNPs and dietary factors in island of China.

METHODS

A case-control study was conducted in Changshan islands of China, blood samples of 806 participants were genotyped, and the general characteristics and dietary habits of them were collected. Unconditional logistic regression (ULR) was used to assess the effects of CLCNKA_B tag SNPs and dietary factors on EH. Generalized multifactor dimensionality reduction (GMDR) was used to test gene-environment interaction for EH risk.

RESULTS

Four SNPs were identified as the tag SNPs of CLCNKA_B. Recessive model for rs5253 and rs2275166 were marginal associated with the decrease risk of EH (OR = 0.36, 95% CI = 0.12-1.07 for rs5253; OR = 0.40, 95% CI = 0.16-1.05 for rs2275166). In GMDR, the five-factor interaction model of rs1010069, salt, marine products, meat and edible oil consumption was the best model, with a maximum CVC of 10/10 and a TBA of 0.638 (p = 0.001). In ULR, compared with subjects carried wild genotypes and null dietary risk factor, those with three or more dietary risk factors and mutation genotypes had 5.90-fold EH risk (95% CI:2.24-15.53).

CONCLUSION

Though the single loci of tag SNPs of CLCNKA_B are not enough to significantly increase the EH susceptibility, the combination of CLCNKA tag SNP, salt, marine products, meat and edible oil consumption is associated with elevated risk.

Vitamin D status and hypertension: a review

Vitamin D is a steroid prohormone synthesized in the skin following ultraviolet exposure and also achieved through supplemental or dietary intake. While there is strong evidence for its role in maintaining bone and muscle health, there has been recent debate regarding the role of vitamin D deficiency in hypertension based on conflicting epidemiological evidence. Thus, we conducted a scoping systematic literature review and meta-analysis of all observational studies published up to early 2014 in order to map trends in the evidence of this association. Mixed-effect meta-analysis was performed to pool risk estimates from ten prospective studies (n=58,262) (pooled risk for incident hypertension, relative risk [RR] =0.76 (0.63–0.90) for top vs bottom category of 25-hydroxyvitamin D [25OHD]) and from 19 cross-sectional studies (n=90,535) (odds ratio [OR] =0.79 (0.73–0.87)). Findings suggest that the better the assessed quality of the respective study design, the stronger the relationship between higher 25OHD levels and hypertension risk (RR =0.67 (0.51–0.88); OR =0.77 (0.72–0.89)). There was significant heterogeneity among the findings for both prospective and cross-sectional studies, but no evidence of publication bias was shown. There was no increased risk of hypertension when the participants were of older age or when they were vitamin D deficient. Younger females showed strong associations between high 25OHD levels and hypertension risk, especially in prospective studies (RR =0.36 (0.18–0.72); OR =0.62 (0.44–0.87)). Despite the accumulating evidence of a consistent link between vitamin D and blood pressure, these data are observational, so questions still remain in relation to the causality of this relationship. Further studies either combining existing raw data from available cohort studies or conducting further Mendelian analyses are needed to determine whether this represents a causal association. Large randomized controlled trials are also needed to determine whether vitamin supplementation may be beneficial in the prevention or the treatment of hypertension.

Vitamin D and parathyroid hormone status in a representative population living in Macau, China

Associations between documented sun-exposure, exercise patterns and fish and supplement intake and 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) were investigated in a random household survey of Macau residents (aged 18-93). Blood samples (566) taken in summer were analyzed for 25OHD and PTH. In this Chinese population, 55% were deficient (25OHD <50nmol/L: median (interquartile range)=47.7 (24.2) nmol/L). Vitamin D deficiency was greatest in those aged <50 years: median (interquartile range)=43.3 (18.2) nmol/L, females: median (interquartile range)=45.5 (19.4) nmol/L and those with higher educational qualifications: median (interquartile range)=43.1 (18.7) nmol/L. In the total Macau population, statistically significant (p<0.01) modifiable associations with lower 25OHD levels were sunlight exposure (β=0.06), physical activity (PA) (measured as hours(hrs)/day: β=0.08), sitting (measured as hrs/day β=-0.20), intake of fish (β=0.08) and calcium (Ca) supplement intake (β=0.06) [linear regression analysis adjusting for demographic risk factors]. On similar analysis, and after adjustment for 25OHD, the only significant modifiable associations in the total population with PTH were sitting (β=-0.17), Body Mass Index (β=0.07) and Ca supplement intake (β=-0.06). In this Macau population less documented sun exposure, fish and Ca supplement intake and exercise were associated with lower 25OHD levels, especially in the younger population, along with the interesting finding that more sitting was associated with both lower 25OHD and high PTH blood levels. In conclusion, unlike findings from Caucasian populations, younger participants were significantly more vitamin D deficient, in particular highly educated single females. This may indicate the desire of young females to be pale and avoid the sun. There are also big differences in lifestyle between the older generation and the younger, in particular with respect to sun exposure and PA. This article is part of a Special Issue entitled '17th Vitamin D Workshop'.