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Li X, Zhang X, Gou Q, Meng Q, Chen X. Association of dietary patterns with hypertension among adults residing in Tibetan China: findings from a population-based study. Front Nutr 2025; 12:1534915. [PMID: 40181948 PMCID: PMC11966421 DOI: 10.3389/fnut.2025.1534915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 02/28/2025] [Indexed: 04/05/2025] Open
Abstract
Objectives This study aimed to investigate the dietary patterns of Tibetan residents and explore their association with the prevalence of hypertension. Methods A multi-stage, stratified, random sampling method was employed to include Tibetan residents from Luhuo County, Garze Tibetan Autonomous Prefecture, Sichuan Province, China. Dietary information was collected through face-to-face interviews using a Food Frequency Questionnaire (FFQ) consisting of 92 food items. Participants were asked to report the frequency and portion size of their consumption of each food item over the past year. The collected data were subsequently converted into average daily intake, with the 92 food items grouped into 23 distinct categories. Principal Component Analysis (PCA) was then used to identify dietary patterns. Binary logistic regression analysis was conducted to investigate the association between dietary patterns and the prevalence of hypertension, adjusting for potential confounders including age, gender, living area, education, physical activity, current smoking, current alcohol consumption, diabetes, dyslipidemia, and overweight/obesity. A P value <0.05 was considered statistically significant. Results A total of 1,262 Tibetan residents participated in the study, with an average age of 46 ± 15 years. Among them, 36.8% were male, and the prevalence of hypertension was 30.2%. Three distinct dietary patterns were identified among Tibetan residents and were subsequently named as the "Tsamba-red meat-tuber," "Rice-vegetable-fruit," and "Dairy products" patterns. After adjusting for confounding factors, individuals in the highest quartile following the "Tsamba-red meat-tuber" pattern were found to be associated with a higher prevalence of hypertension (OR = 3.04, 95% CI: 2.06-4.50; P for trend <0.001). In contrast, individuals in the highest quartile following the "Rice-vegetable-fruit" pattern were associated with a lower prevalence of hypertension (OR = 0.45, 95% CI: 0.30-0.67; P for trend <0.001). Additionally, those in the highest quartile of the "Dairy products" pattern also showed a lower prevalence of hypertension (OR = 0.58, 95% CI: 0.39-0.85; P for trend = 0.002). Conclusion The "Tsamba-red meat-tuber" pattern is associated with a higher risk of hypertension, whereas the "Rice-vegetable-fruit" and "Dairy products" patterns are associated with a lower risk of hypertension in this population.
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Affiliation(s)
- Xinran Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiling Gou
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Qingtao Meng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Adeva-Andany MM, Adeva-Contreras L, Carneiro-Freire N, Ameneiros-Rodríguez E, Vila-Altesor M, Calvo-Castro I. The impact of high altitude (hypobaric hypoxia) on insulin resistance in humans. J Physiol Biochem 2025; 81:35-55. [PMID: 40019670 DOI: 10.1007/s13105-025-01069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 01/30/2025] [Indexed: 03/01/2025]
Abstract
Exposure to hypobaric hypoxia (high altitude) diminishes systemic tissue oxygenation. Tissue hypoxia induces insulin resistance and a metabolic switch that reduces oxidative phosphorylation and glucose storage while enhancing glycolysis. Similarly to hypobaric hypoxia, insulin resistance develops in normal humans undergoing normobaric hypoxia and in patients with obstructive sleep apnea. Following acute exposure to high altitude, insulin resistance returns to baseline values upon returning to sea level or when compensatory mechanisms restore tissue oxygenation. However, insulin resistance persists in subjects unable to achieve sufficient oxygen delivery to tissues. Likewise, long-term residents at high altitude develop persistent insulin resistance when compensatory mechanisms do not attain adequate tissue oxygenation. Among these subjects, insulin resistance may cause clinical complications, such as hypertriglyceridemia, reduced HDL-c, visceral obesity, metabolic dysfunction-associated steatotic liver disease, essential hypertension, type 2 diabetes, subclinical vascular injury, cardiovascular disease, and kidney disease. Impaired tissue oxygenation allows the stabilization of hypoxia-inducible factor-1 (HIF-1), a transcription factor that modulates the transcriptional activity of a number of genes to coordinate the physiological responses to tissue hypoxia. Among them, HIF-1 downregulates PPARG, that codes peroxisome proliferator-activated receptor-gamma (PPAR-γ) and PPARGCA, that codes PPAR-γ coactivator-1α, in order to enable insulin resistance and the metabolic switch from oxidative phosphorylation toward glycolysis.
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Affiliation(s)
- María M Adeva-Andany
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, Ferrol, 15406, Spain.
| | - Lucia Adeva-Contreras
- School of Medicine, Santiago de Compostela University, Santiago de Compostela, Galicia, Spain
| | - Natalia Carneiro-Freire
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, Ferrol, 15406, Spain
| | - Eva Ameneiros-Rodríguez
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, Ferrol, 15406, Spain
| | - Matilde Vila-Altesor
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, Ferrol, 15406, Spain
| | - Isabel Calvo-Castro
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, Ferrol, 15406, Spain
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WANG JG. Chinese Guidelines for the Prevention and Treatment of Hypertension (2024 revision). J Geriatr Cardiol 2025; 22:1-149. [PMID: 40151633 PMCID: PMC11937835 DOI: 10.26599/1671-5411.2025.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2025] Open
Affiliation(s)
- Ji-Guang WANG
- Task Force of the Chinese Hypertension Guidelines; Chinese Hypertension League; Hypertension Branch of the China International Exchange and Promotive Association for Medical and Health Care; Hypertension Branch of the Chinese Geriatrics Society; Hypertension Branch of the Chinese Aging Well Association; Chinese Stroke Association; Chronic and Non-communicable Disease Control and Prevention Center of the Chinese Center for Disease Control and Prevention
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Shen Y, Jiang L, Yu J, Chen B, Liu A, Guo Y. The burden of chronic kidney disease attributable to high sodium intake: a longitudinal study in 1990-2019 in China. Front Nutr 2025; 11:1531358. [PMID: 39897530 PMCID: PMC11783680 DOI: 10.3389/fnut.2024.1531358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 12/27/2024] [Indexed: 02/04/2025] Open
Abstract
Objective Elevated sodium consumption is associated with increased risk for chronic kidney disease (CKD) and data for this disease burden attributable to high sodium intake in China from 1990 to 2019 are scarce in China. Our study aims to estimate and present the national burden of CKD attributable to high sodium intake, as well as its profile. Methods The regional disease burden data from the China Center for Food Safety Risk Assessment (CFSA) from 1990 to 2019 were compiled based on the methodology of GBD 2019. CKD burden [deaths and disability-adjusted life years (DALYs)] was quantified according to population group (age, gender) and regions categories (province, SDI). The estimated annual percentage change (EAPC) in age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) were calculated to describe long-term trends. Results Totally, the number of deaths of CKD attributable to high sodium intake reached 95,000, with DALYs amounting to 2.59 million person-years in 2019, while the trends of ASMR (EAPC: -0.31, 95%CI: -0.46, -0.17%) and ASDR (-0.33, 95%CI: -0.48, -0.18%) were down during the observation period. The age-specific numbers and rates of deaths, as well as DALYs increase with age are higher in males than in females. Significant disparities in CKD burden attributable to high sodium intake were observed across provinces and SDI regions. In both 1990 and 2019, the number of deaths and DALYs were higher in middle SDI regions, while low-middle SDI regions had highest ASMR and ASDR. The EAPC of ASDR was found to be significantly negatively correlated with the 1990 ASDR (ρ = -0.393, p = 0.024), and the EAPC of ASMR and ASDR were also significantly negatively correlated with the 2019 SDI (ASMR:ρ = -0.571, p < 0.001; ASDR:ρ = -0.368, p = 0.035). Conclusion High sodium intake accounted for a sizeable burden of disease from 1990 to 2019 in China, also presents sexual and geographic variations. Despite a slight decreasing trend exists, the absolute number increased as much as twofold, particularly among males and seniors. Targeting to reduce sodium intake remains a priority, and progress requires systematic monitoring and evaluation, particularly in middle SDI regions that are experiencing rising trends and low-middle SDI regions being susceptible to approaches.
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Affiliation(s)
- Yongyao Shen
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liying Jiang
- Jiading Central Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, China
- College of Public health, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jin Yu
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bo Chen
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Aidong Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yongjin Guo
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- College of Public health, Shanghai University of Medicine & Health Sciences, Shanghai, China
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Xia Y, Pang L, Tang M, Luo Z, Ma M, Wang H, He L, Duo L, Zhu D, Pan X. Association of altitude with all-cause and cardiovascular mortality among patients with hypertension: a cohort study in Southwest China. BMC Public Health 2024; 24:3461. [PMID: 39696069 DOI: 10.1186/s12889-024-20891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 11/28/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Available evidence falls short in assessing the risk of long-term outcomes among individuals with hypertension residing at various altitudes. We aimed to investigate the association between residential altitude and the risk of all-cause and cardiovascular disease (CVD) mortality among hypertensive patients. METHODS This cohort study encompassed 67,275 hypertensive patients aged ≥35 years who participated in China's Basic Public Health Service Program in 2018. Participants were categorized into four groups based on their residence altitude: <500 m, 500-1,499 m, 1,500-2,500 m, and > 2,500 m. The associations between residential altitude and the risks of all-cause and CVD mortality were analyzed using Cox proportional hazards regression models. The dose-response relationship was performed by the restricted cubic spline with multivariable adjusted models. RESULTS Among the 67,275 hypertensive patients included in the study (mean age of 63.9 years, with 45.3% male), 8,768 deaths were recorded, of which 5,666 were attributed to CVD. Following multivariate adjustment, when compared to the group residing at altitudes < 500 m, the groups living at altitudes of 500-1,499 m, 1500-2,500 m, and > 2,500 m exhibited significantly risks of all-cause mortality [HR = 1.45 (95% CI: 1.36-1.54), 1.35 (95% CI: 1.28-1.43), and 1.41 (95% CI: 1.28-1.54), respectively] and CVD mortality [HR = 1.47 (95% CI: 1.35-1.58), 1.42 (95% CI: 1.33-1.52), and 1.46 (95% CI: 1.31-1.62), respectively]. The restricted cubic spline curves revealed a nonlinear relationship between residential altitude and all-cause and CVD mortality. The risk of mortality was higher among participants with poorly controlled blood pressure, aged 65 years and above, and living in rural areas. CONCLUSIONS This study demonstrated a significant association between long-term residential high-altitude exposure and increased risks of all-cause and CVD mortality among hypertension patients. The implications of the findings call for a prioritization of public health resource allocation and early intervention efforts, especially for those living at high altitudes and in low-income areas where hypertension is prevalent.
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Affiliation(s)
- Yu Xia
- Department of Scientific Research and Chronic Disease Management, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102, China
- School of Public Health, Kunming Medical University, Kunming, 650500, China
| | - Linhong Pang
- Department of Scientific Research and Chronic Disease Management, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102, China
| | - MingJing Tang
- Department of Scientific Research and Chronic Disease Management, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102, China
| | - Zhiling Luo
- Department of Echocardiogram, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102, China
| | - Min Ma
- Department of Scientific Research and Chronic Disease Management, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102, China
- School of Public Health, Kunming Medical University, Kunming, 650500, China
| | - Huadan Wang
- Department of Scientific Research and Chronic Disease Management, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102, China
- School of Public Health, Kunming Medical University, Kunming, 650500, China
| | - Liping He
- School of Public Health, Kunming Medical University, Kunming, 650500, China
| | - Lin Duo
- Department of Scientific Research and Chronic Disease Management, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102, China.
| | - Da Zhu
- Department of Scientific Research and Chronic Disease Management, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102, China.
| | - Xiangbin Pan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China and State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing, 100037, China.
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Wang Z, Ren Y, Liu W, Li J, Li J, Zhang C, Wang L, Zhou M, Hao J, Yin P, Ma Q. National and Subnational Trends of Mortality and Years of Life Lost Due to Stroke and Its Subtypes in Young Adults in China, 2005-2020. Neurology 2024; 103:e209982. [PMID: 39454122 PMCID: PMC11515115 DOI: 10.1212/wnl.0000000000209982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/27/2024] [Indexed: 10/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The incidence of stroke among young adults was rising globally, but the death burden of stroke in young adults in China is lacking. We aimed to examine the temporal trends in mortality and years of life lost (YLLs) caused by stroke among young adults from 2005 to 2020 across China. METHODS Based on the data from the National Mortality Surveillance System in China, we estimated the number and age-standardized rate of mortality and YLLs due to stroke and its subtypes among young adults aged 15-49 years during 2005-2020, for both China and its 31 mainland provinces. RESULTS During 2005-2020, the age-standardized mortality rate of stroke among young adults aged 15-49 years in China decreased by 21.0%, from 5.9/100,000 to 4.7/100,000, and the YLL rate decreased from 286.9/100,000 to 229.5/100,000. The age-standardized mortality rate among young adults due to intracerebral hemorrhage (ICH) showed a significant downward trend with a decrease of 26.3% while that of ischemic stroke (IS) and subarachnoid hemorrhage (SAH) decreased by 4.5% and 0.6%, respectively. In 2020, the mortality rate of ICH was 3.5 times higher than that of IS (3.3/100,000 vs 0.9/100,000) among young adults in China. The male/female ratio of age-standardized mortality rate of stroke in young adults increased from 2.0 in 2005 to 3.1 in 2020. The age-standardized mortality rate of IS and SAH in young men increased by 11.0% and 2.5%, respectively. In 2020, Tibet (18.4/100,000), Jilin (10.4/100,000), and Qinghai (8.3/100,000) were the top 3 provinces holding the highest age-standardized mortality rate due to stroke among young adults. Tibet was found to have the highest mortality rate due to ICH and SAH while that of IS was higher in northeast China. DISCUSSION In China, the death burden caused by ICH among young adults was substantially higher than that of IS. The increasing death burden of IS and SAH among young men requires special attention. Evidence-based intervention strategies are needed to improve the outcomes of stroke and alleviate the death burden due to stroke among young adults in Chinese population.
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Affiliation(s)
| | | | - Wei Liu
- From the Department of Neurology (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Xuanwu Hospital, Capital Medical University, Beijing; National Center for Neurological Disorders (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Beijing; Zhejiang Provincial Center for Disease Control and Prevention (W.L.), Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiamin Li
- From the Department of Neurology (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Xuanwu Hospital, Capital Medical University, Beijing; National Center for Neurological Disorders (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Beijing; Zhejiang Provincial Center for Disease Control and Prevention (W.L.), Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiameng Li
- From the Department of Neurology (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Xuanwu Hospital, Capital Medical University, Beijing; National Center for Neurological Disorders (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Beijing; Zhejiang Provincial Center for Disease Control and Prevention (W.L.), Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chen Zhang
- From the Department of Neurology (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Xuanwu Hospital, Capital Medical University, Beijing; National Center for Neurological Disorders (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Beijing; Zhejiang Provincial Center for Disease Control and Prevention (W.L.), Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lijun Wang
- From the Department of Neurology (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Xuanwu Hospital, Capital Medical University, Beijing; National Center for Neurological Disorders (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Beijing; Zhejiang Provincial Center for Disease Control and Prevention (W.L.), Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- From the Department of Neurology (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Xuanwu Hospital, Capital Medical University, Beijing; National Center for Neurological Disorders (Z.W., Y.R., Jiamin Li, Jiameng Li, C.Z., J.H., Q.M.), Beijing; Zhejiang Provincial Center for Disease Control and Prevention (W.L.), Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing, China
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Zila-Velasque JP, Grados-Espinoza P, Challapa-Mamani MR, Sánchez-Alcántara F, Cedillo-Balcázar J, Cs AD, Hernandez-Bustamante EA, Tejada-Flores J, Piano Suárez A, Pacheco-Mendoza J, Benites-Zapata VA. Prevalence of metabolic syndrome and its components according to altitude levels: a systematic review and meta-analysis. Sci Rep 2024; 14:27581. [PMID: 39528530 PMCID: PMC11555074 DOI: 10.1038/s41598-024-77928-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 10/28/2024] [Indexed: 11/16/2024] Open
Abstract
Metabolic syndrome has a multifactorial origin; however, epidemiological data correspond to populations located at sea level. It has been reported that the altitude can affected the prevalence due to physiological changes. The aim of this study is to show the global prevalence of metabolic syndrome at altitude and its components. We use four databases, all studies published up to November 2023. The prevalences from studies were meta-analyzed using a random-effects model. To assess sources of heterogeneity, subgroup analyses were performed. We included 28 studies. The number of participants was 29 195. The prevalence of metabolic syndrome was 30.3% (95% CI 22.8-38.4%). According to the altitude level, at 1500-2500 was 36.5%, 2500-3500 (21.8%), and > 3500 (30.9%), also it was higher in women (35.5%) that men (26.8%). It was observed that there is an inverse relationship between higher altitude and the prevalence of metabolic syndrome. Among its components, abdominal obesity and low HDL were present in more than 40.0%, while high blood pressure, high triglycerides and impaired glucose were present in less than 30.0%. We recommend that our results be considered for future research in populations living at altitude since they have different characteristics from populations at sea level.
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Affiliation(s)
| | | | - Mabel R Challapa-Mamani
- Red Latinoamericana de Medicina en Altitud e Investigación (REDLAMAI), Pasco, Peru
- Facultad de Ciencias de la Salud, Escuela de Medicina, Universidad César Vallejo, Trujillo, Perú
| | | | - Jamil Cedillo-Balcázar
- Red Latinoamericana de Medicina en Altitud e Investigación (REDLAMAI), Pasco, Peru
- Titulación de Medicina, Facultad de Ciencias de la Salud, Universidad Técnica Particular de Loja, Loja, Ecuador
| | - Aziz-Delgado Cs
- Red Latinoamericana de Medicina en Altitud e Investigación (REDLAMAI), Pasco, Peru
- Facultad de Medicina, Universidad de Los Andes, Trujillo, Venezuela
| | | | - Jeancarlo Tejada-Flores
- Red Latinoamericana de Medicina en Altitud e Investigación (REDLAMAI), Pasco, Peru
- Facultad de Medicina Humana, Universidad Nacional del Altiplano, Puno, Perú
| | - Antony Piano Suárez
- Red Latinoamericana de Medicina en Altitud e Investigación (REDLAMAI), Pasco, Peru
| | - Josmel Pacheco-Mendoza
- Dirección General de Investigación Desarrollo e Innovación, Universidad Científica del Sur, Lima, Peru
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Zuo X, Zhang X, Ye R, Li X, Zhang Z, Shi R, Liao H, Liu L, Yang X, Jia S, Meng Q, Chen X. Hypertension status and its risk factors in highlanders living in Ganzi Tibetan Plateau: a cross-sectional study. BMC Cardiovasc Disord 2024; 24:449. [PMID: 39182052 PMCID: PMC11344291 DOI: 10.1186/s12872-024-04102-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/07/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The updated status of hypertension and its risk factors are poorly evaluated in Tibetan highland areas. We initiated a large-scale cross-sectional survey to provide updated status of hypertension and its risk factors (especially salt intake) in the Ganzi Tibetan Plateau, China. METHODS Stratified multistage random sampling was performed to obtain a representative sample of 4,036 adult residents from 4 counties in the Ganzi Tibetan area. The whole survey population was used to present the epidemiology and risk factors of hypertension. The participants with blood and urine biochemistry data were used to analyze the relationship between salt intake parameters and hypertension. RESULTS Stratified multistage random sampling was performed to obtain a representative sample of 4,036 adult residents. The overall prevalence rate of hypertension was 33.5% (the age-adjusted prevalence rate was 28.9%). A total of 50.9% of the hypertensive patients knew their conditions; 30.1% of them received antihypertensive treatment; and 11.2% of them had their blood pressure controlled. Age, male sex, living altitude ≥ 3500 m, overweight and abdominal obesity were positively correlated with hypertension. In addition, the adjusted odds ratio (OR) for hypertension was 1.33 (95% CI: 1.01-1.74) for drinking tea with salt, and 1.51 (95% CI: 1.32-1.72) for per SD increase in the estimation of 24-hour urinary sodium excretion (e24hUSE). Furthermore, per 100mmol/day increase in e24hUSE was associated with elevation of blood pressure (+ 10.16, 95% CI: 8.45-11.87 mmHg for SBP; +3.83, 95% CI: 2.74-4.93 mmHg for DBP) in this population. CONCLUSIONS Our survey suggests a heavy disease burden of hypertension in the Ganzi Tibetan Plateau. Age, male sex, altitude of residence ≥ 3500 m, overweight, abdominal obesity, and excessive salt intake (shown as drinking tea with adding salt and a higher level of e24hUSE) all increased the risk of hypertension in this highland area.
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Affiliation(s)
- Xianghao Zuo
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Xin Zhang
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Runyu Ye
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Xinran Li
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Zhipeng Zhang
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Rufeng Shi
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Hang Liao
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Lu Liu
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Xiangyu Yang
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Shanshan Jia
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Qingtao Meng
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China.
| | - Xiaoping Chen
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China.
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Song Y. Establishment of a Risk Prediction Model for Metabolic Syndrome in High Altitude Areas in Qinghai Province, China: A Cross-Sectional Study [Letter]. Diabetes Metab Syndr Obes 2024; 17:2707-2708. [PMID: 39050618 PMCID: PMC11268714 DOI: 10.2147/dmso.s486379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024] Open
Affiliation(s)
- Yanyan Song
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
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10
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Roman-Lazarte V, Angela Roman L, Moncada-Mapelli E, Uribe-Cavero LJ, Luz Marcelo-Armas M. Clinical manifestations and complications of preeclampsia and eclampsia in populations residing at high altitudes and very high altitudes: A scoping review. Pregnancy Hypertens 2024; 36:101119. [PMID: 38461671 DOI: 10.1016/j.preghy.2024.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/15/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Preeclampsia and eclampsia are conditions that affect gestation, characterized by high blood pressure and direct organ damage, while geographical altitude directly affects cardiovascular physiology. The aim of this review is to identify the clinical manifestations and complications of preeclampsia in pregnant women at high and very high altitudes. METHODS A scoping review was conducted to assess the objective. A systematic search was performed on Pubmed, Web of Science, Embase, Scopus, Scielo, and Lilacs. Studies including pregnant women with preeclampsia or eclampsia at high altitudes and very high altitudes were included, excluding non-citable documents. Results were summarized in tables based on bibliographic data, methodological aspects, and key findings. RESULTS Eight documents meeting the inclusion and exclusion criteria were obtained. Seven studies focused on populations in Latin America, with the highest geographical altitude being 4380 m above sea level in the city of Cerro de Pasco, Peru. One report suggests a higher admission rate to the Intensive Care Unit and a higher frequency of HELLP syndrome. Functional cardiovascular changes were also observed. CONCLUSIONS There are few studies directly evaluating pregnant populations at high altitudes and very high altitudes experiencing preeclampsia and eclampsia. Complications may be more frequent at high altitudes and very high altitudes with clinically unobservable cardiovascular changes.
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Affiliation(s)
| | - Luz Angela Roman
- Sociedad Científica de Estudiantes de Medicina Daniel Alcides Carrion, Universidad Nacional Daniel Alcides Carrion, Cerro de Pasco, Peru
| | | | - Leonardo J Uribe-Cavero
- Sociedad Científica de Estudiantes de Medicina de Ica, Facultad de Medicina Humana, Universidad Nacional San Luis Gonzaga de Ica, Ica, Perú
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11
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Zhao ML, Lu ZJ, Yang L, Ding S, Gao F, Liu YZ, Yang XL, Li X, He SY. The cardiovascular system at high altitude: A bibliometric and visualization analysis. World J Cardiol 2024; 16:199-214. [PMID: 38690218 PMCID: PMC11056872 DOI: 10.4330/wjc.v16.i4.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/14/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND When exposed to high-altitude environments, the cardiovascular system undergoes various changes, the performance and mechanisms of which remain controversial. AIM To summarize the latest research advancements and hot research points in the cardiovascular system at high altitude by conducting a bibliometric and visualization analysis. METHODS The literature was systematically retrieved and filtered using the Web of Science Core Collection of Science Citation Index Expanded. A visualization analysis of the identified publications was conducted employing CiteSpace and VOSviewer. RESULTS A total of 1674 publications were included in the study, with an observed annual increase in the number of publications spanning from 1990 to 2022. The United States of America emerged as the predominant contributor, while Universidad Peruana Cayetano Heredia stood out as the institution with the highest publication output. Notably, Jean-Paul Richalet demonstrated the highest productivity among researchers focusing on the cardiovascular system at high altitude. Furthermore, Peter Bärtsch emerged as the author with the highest number of cited articles. Keyword analysis identified hypoxia, exercise, acclimatization, acute and chronic mountain sickness, pulmonary hypertension, metabolism, and echocardiography as the primary research hot research points and emerging directions in the study of the cardiovascular system at high altitude. CONCLUSION Over the past 32 years, research on the cardiovascular system in high-altitude regions has been steadily increasing. Future research in this field may focus on areas such as hypoxia adaptation, metabolism, and cardiopulmonary exercise. Strengthening interdisciplinary and multi-team collaborations will facilitate further exploration of the pathophysiological mechanisms underlying cardiovascular changes in high-altitude environments and provide a theoretical basis for standardized disease diagnosis and treatment.
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Affiliation(s)
- Mao-Lin Zhao
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Zhong-Jie Lu
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Li Yang
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Sheng Ding
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Feng Gao
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Yuan-Zhang Liu
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Xue-Lin Yang
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Xia Li
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Si-Yi He
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China.
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12
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Jiang L, Shen W, Wang A, Fang H, Wang Q, Li H, Liu S, Shen Y, Liu A. Cardiovascular Disease Burden Attributable to High Sodium Intake in China: A Longitudinal Study from 1990 to 2019. Nutrients 2024; 16:1307. [PMID: 38732554 PMCID: PMC11085757 DOI: 10.3390/nu16091307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/21/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Overconsumption of sodium has been identified as a key driving factor for diet-related cardiovascular diseases (CVDs). China, being a country bearing a hefty burden of CVD, has a large population with diverse cultural traditions and ethnic beliefs, which complicates the patterns of dietary sodium intake, necessitating a systematic investigation into the profile of the high sodium intake (HSI)-related burden of CVD within its subregions. This study aims to estimate the evolving patterns of HSI-induced CVD burden across China from 1990 to 2019. METHODS The methodology used in the Global Burden of Disease Study was followed to assess deaths and disability-adjusted life years (DALYs) by age, sex, region, and socio-demographic index (SDI). The estimated annual percentage change (EAPC) was calculated to quantify the secular changes in the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR). RESULTS In 2019, 0.79 million deaths and 1.93 million DALYs of CVD were attributed to HSI, an increase of 53.91% and 39.39% since 1990, respectively. Nevertheless, a downward trend in ASMR (EAPC: -1.45, 95% CI: -1.55, -1.35) and ASDR (EAPC: -1.61, 95% CI: -1.68, -1.53) was detected over time. ASMR and ASDR were higher for males, individuals aged ≥60 years, and regions with low-middle SDI. A markedly negative association between the EAPC in both ASMR and ASDR and the SDI was found in 2019 (ρ = -0.659, p < 0.001 and ρ = -0.558, p < 0.001, respectively). CONCLUSIONS The HSI-induced CVD burden is gender-, age-, and socioeconomic-dependent. Integrated and targeted strategies for CVD prevention are anticipated in the future throughout China.
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Affiliation(s)
- Liying Jiang
- Jiading Central Hospital, Shanghai University of Medicine & Health Sciences, Shanghai 201899, China;
- Department of Prevention Medicine, College of Public Health, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
| | - Wanying Shen
- Department of Epidemiology, School of Public Health, Nantong University, Nantong 226019, China; shenwanying-@outlook.com
| | - Anqi Wang
- Graduate School, Shanghai University of Traditional & Chinese Medicine, Shanghai 201203, China;
| | - Haiqin Fang
- Department of Nutrition Division I, China National Center for Food Safety Risk Assessment, Beijing 100022, China; (H.F.); (Q.W.); (H.L.); (S.L.)
| | - Qihe Wang
- Department of Nutrition Division I, China National Center for Food Safety Risk Assessment, Beijing 100022, China; (H.F.); (Q.W.); (H.L.); (S.L.)
| | - Huzhong Li
- Department of Nutrition Division I, China National Center for Food Safety Risk Assessment, Beijing 100022, China; (H.F.); (Q.W.); (H.L.); (S.L.)
| | - Sana Liu
- Department of Nutrition Division I, China National Center for Food Safety Risk Assessment, Beijing 100022, China; (H.F.); (Q.W.); (H.L.); (S.L.)
| | - Yi Shen
- Department of Epidemiology, School of Public Health, Nantong University, Nantong 226019, China; shenwanying-@outlook.com
| | - Aidong Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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13
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Li Y, Yu B, Yin L, Li X, Nima Q. Long-term exposure to particulate matter is associated with elevated blood pressure: Evidence from the Chinese plateau area. J Glob Health 2024; 14:04039. [PMID: 38483442 PMCID: PMC10939114 DOI: 10.7189/jogh.14.04039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Background Ambient air pollution could increase the risk of hypertension; however, evidence regarding the relationship between long-term exposure to particulate matter and elevated blood pressure in plateau areas with lower pollution levels is limited. Methods We assessed the associations of long-term exposure to particulate matter (PM, PM1, PM2.5, and PM10) with hypertension, diastolic blood pressure (DBP), systolic blood pressure (SBP) and pulse pressure (PP) in 4.235 Tibet adults, based on the baseline of the China multi-ethnic cohort study (CMEC) in Lhasa city, Tibet from 2018-19. We used logistic regression and linear regression models to evaluate the associations of ambient PM with hypertension and blood pressure, respectively. Results Long-term exposure to PM1, PM2.5, and PM10 is positively associated with hypertension, DBP, and SBP, while negatively associated with PP. Among these air pollutants, PM10 had the strongest effect on hypertension, DBP, and SBP, while PM2.5 had the strongest effect on PP. The results showed for hypertension odds ratio (OR) = 1.99; 95% confidence interval (CI) = 1.58, 2.51 per interquartile range (IQR) μg/m3 increase in PM1, OR = 1.93; 95% CI = 1.55, 2.40 per IQR μg/m3 increase in PM2.5, and OR = 2.12; 95% CI = 1.67, 2.68 per IQR μg/m3 increase in PM10. Conclusions Long-term exposure to ambient air pollution was associated with an increased risk of hypertension, elevated SBP and DBP levels, and decreased PP levels. To reduce the risk of hypertension and PP reduction, attention should be paid to air quality interventions in plateau areas with low pollution levels.
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Affiliation(s)
- Yajie Li
- Tibet Centre for Disease Control and Prevention, Lhasa, Tibet Autonomous Region, China
| | - Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University – Hong Kong Polytechnic University, Chengdu, China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Li Yin
- Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, China
- Clinical Medical Research Center, Panzhihua Central Hospital, Panzhihua, China
- Dali University, Dali, China
| | - Xianzhi Li
- Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, China
- Clinical Medical Research Center, Panzhihua Central Hospital, Panzhihua, China
- Dali University, Dali, China
| | - Qucuo Nima
- Tibet Centre for Disease Control and Prevention, Lhasa, Tibet Autonomous Region, China
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14
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Liu X, Yang C, Zhang X, Ye R, Li X, Zhang Z, Jia S, Sun L, Meng Q, Chen X. Association between hemoglobin concentration and hypertension risk in native Tibetans at high altitude. J Clin Hypertens (Greenwich) 2024; 26:17-23. [PMID: 37724706 PMCID: PMC10795086 DOI: 10.1111/jch.14726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Previous studies examining the association between hemoglobin concentration and hypertension have yielded inconsistent results. There is still a lack of evidence regarding the association between hemoglobin concentration and hypertension risk in native Tibetans at high altitude. We performed this cross-sectional study in Luhuo County of Ganzi Tibetan Autonomous Prefecture (average altitude of 3500 m). In this study, we enrolled 1547 native Tibetans. The association between hemoglobin concentration and hypertension risk was examined by multivariate binary logistic regression and smooth curve fitting. Native Tibetans with hypertension had significantly higher hemoglobin concentrations than those without hypertension (165.9 ± 21.5 g/L vs. 157.7 ± 19.2 g/L, P < 0.001). An increase in hemoglobin concentration of 1 g/L was associated with hypertension (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.02) after confounder adjustment. The highest hemoglobin concentration group (exceeding 173 g/L) was associated with an increased hypertension risk compared with the bottom quartile of hemoglobin concentration (OR 2.39, 95% CI 1.48-3.85). Hemoglobin concentration (per 1 g/L change) exceeding 176 g/L was significantly associated with an increased hypertension risk (OR 1.04, 95% CI 1.03-1.06). Additionally, high-altitude polycythemia significantly increased the hypertension risk compared with a normal hemoglobin concentration (OR 2.92, 95% CI 1.25-6.86). A similar result was observed for mild polycythemia (OR 1.74, 95% CI 1.29-2.34). In conclusion, hemoglobin concentration was associated with hypertension risk in native Tibetans. When the hemoglobin concentration exceeded a certain value (approximately 176 g/L), the risk of hypertension was significantly increased.
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Affiliation(s)
- Xueting Liu
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Changqiang Yang
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Xin Zhang
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Runyu Ye
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Xinran Li
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Zhipeng Zhang
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Shanshan Jia
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Lirong Sun
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Qingtao Meng
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Xiaoping Chen
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
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15
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Dou L, Shi Z, Cuomu Z, Zhuoga C, Li C, Dawa Z, Li S. Health-related quality of life and its changes of the Tibetan population in China: based on the 2013 and 2018 National Health Services Surveys. BMJ Open 2023; 13:e072854. [PMID: 37984958 PMCID: PMC10660197 DOI: 10.1136/bmjopen-2023-072854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE Health-related quality of life (HRQoL) was an important health outcome measure for evaluating an individual's overall health status. However, there was limited in the literature on HRQoL and its long-term changes of the Tibetan population. This study aimed to assess HRQoL of Tibetan and its changes over time, and explore the differences in HRQoL for residents at different altitudes. DESIGN Data for the cross-sectional study were extracted from the fifth and sixth waves of the National Health Services Surveys which were conducted in 2013 and 2018. A multistage stratified cluster random sampling strategy was used to select representative participants. SETTING Tibet Autonomous Region in China. PARTICIPANTS This study recruited 14 752 participants in 2013 and 13 106 participants in 2018, and after excluding observations with missing values for key variables, 10 247 in 2013 and 6436 in 2018 were included in the study analysis. PRIMARY AND SECONDARY OUTCOME MEASURES The EQ-5D-3L was used to measure participants' HRQoL. RESULTS The mean health state utility scores of the participants were 0.969±0.078 and 0.966±0.077 in 2013 and 2018, respectively. Pain/discomfort was the most frequently prevalent issue reported in 18.1% and 17.9% of the participants in 2013 and 2018, respectively. Tibetans living 3500-4000 m altitude had the best HRQoL. Age, sex, employment status, educational attainment, chronic disease and weekly physical exercise were influencing factors associated with HRQoL. CONCLUSIONS The HRQoL of the Tibetan population was lower than the general Chinese population, and decreased over time between 5 years. There were differences in HRQoL among Tibetan at different altitudes, with residents living at 3500-4000 m having the best quality of life. More attention should be paid to those Tibetans who are older, female, unemployed and without formal education.
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Affiliation(s)
- Lei Dou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
| | - Zhao Shi
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
| | - Zhaxi Cuomu
- Medical College of Tibet University, Lhasa, China
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, China
| | - Cidan Zhuoga
- Medical College of Tibet University, Lhasa, China
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, China
| | - Chaofan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
| | - Zhaxi Dawa
- Medical College of Tibet University, Lhasa, China
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
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Duo D, Duan Y, Zhu J, Bai X, Yang J, Liu G, Wang Q, Li X. New strategy for rational use of antihypertensive drugs in clinical practice in high-altitude hypoxic environments. Drug Metab Rev 2023; 55:388-404. [PMID: 37606301 DOI: 10.1080/03602532.2023.2250930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Abstract
High-altitude hypoxic environments have critical implications on cardiovascular system function as well as blood pressure regulation. Such environments place patients with hypertension at risk by activating the sympathetic nervous system, which leads to an increase in blood pressure. In addition, the high-altitude hypoxic environment alters the in vivo metabolism and antihypertensive effects of antihypertensive drugs, which changes the activity and expression of drug-metabolizing enzymes and drug transporters. The present study reviewed the pharmacodynamics and pharmacokinetics of antihypertensive drugs and its effects on patients with hypertension in a high-altitude hypoxic environment. It also proposes a new strategy for the rational use of antihypertensive drugs in clinical practice in high-altitude hypoxic environments. The increase in blood pressure on exposure to a high-altitude hypoxic environment was mainly dependent on increased sympathetic nervous system activity. Blood pressure also increased proportionally to altitude, whilst ambulatory blood pressure increased more than conventional blood pressure, especially at night. High-altitude hypoxia can reduce the activities and expression of drug-metabolizing enzymes, such as CYP1A1, CYP1A2, CYP3A1, and CYP2E1, while increasing those of CYP2D1, CYP2D6, and CYP3A6. Drug transporter changes were related to tissue type, hypoxic degree, and hypoxic exposure time. Furthermore, the effects of high-altitude hypoxia on drug-metabolism enzymes and transporters altered drug pharmacokinetics, causing changes in pharmacodynamic responses. These findings suggest that high-altitude hypoxic environments affect the blood pressure, pharmacokinetics, and pharmacodynamics of antihypertensive drugs. The optimal hypertension treatment plan and safe and effective medication strategy should be formulated considering high-altitude hypoxic environments.
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Affiliation(s)
- Delong Duo
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
- Qinghai Provincial People's Hospital, Xining, China
| | - Yabin Duan
- Qinghai University Affiliated Hospital, Xining, China
| | - Junbo Zhu
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Xue Bai
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Jianxin Yang
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Guiqin Liu
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Qian Wang
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Xiangyang Li
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
- State Key Laboratory of Plateau Ecology and Agriculture, Qinghai University, Xining, China
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17
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Zila-Velasque JP, Soriano-Moreno DR, Medina-Ramirez SA, Ccami-Bernal F, Castro-Diaz SD, Cortez-Soto AG, Esparza Varas AL, Fernandez-Morales J, Olortegui-Rodriguez JJ, Pelayo-Luis IP, Zafra-Tanaka JH. Prevalence of hypertension in adults living at altitude in Latin America and the Caribbean: A systematic review and meta-analysis. PLoS One 2023; 18:e0292111. [PMID: 37824544 PMCID: PMC10569637 DOI: 10.1371/journal.pone.0292111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE The objective of this systematic review and meta-analysis was to assess the prevalence of hypertension in populations living at altitude in Latin America and the Caribbean. METHODS We conducted a systematic search from January 1, 2000 to January 10, 2023 in Web of Science (WoS)/Core Collection, WoS/Medline, WoS/Scielo, Scopus, PubMed and Embase databases. We included studies that assessed the prevalence of hypertension in altitude populations (>1500 m.a.s.l.) and these were meta-analyzed using a random-effects model. To assess the sources of heterogeneity, we performed subgroup and meta-regression analyses. RESULTS Thirty cross-sectional studies (117 406 participants) met the inclusion criteria. Studies used different cut-off points. The prevalence of hypertension in the studies that considered the cut-off point of ≥ 140/90 mmHg in the general population was 19.1%, ≥ 130/85 mmHg was 13.1%, and ≥ 130/80 mmHg was 43.4%. There was a tendency for the prevalence of hypertension to be higher in men. In meta-regression analyses, no association was found between altitude, mean age, year of publication, risk of bias and prevalence of hypertension. CONCLUSION The prevalence of hypertension in the altitude population of Latin America and the Caribbean is lower than that reported in populations living at sea level and lower than other altitude populations such as Tibetans. PROSPERO CRD42021275229.
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Affiliation(s)
- J. Pierre Zila-Velasque
- Facultad de Medicina Humana, Universidad Nacional Daniel Alcides Carrion, Pasco, Peru
- Red Latinoamericana de Medicina en Altitud e Investigacion (REDLAMAI), Pasco, Peru
| | - David R. Soriano-Moreno
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru
| | - Sebastian A. Medina-Ramirez
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru
| | - Fabricio Ccami-Bernal
- Facultad de Medicina, Universidad Nacional de San Agustin de Arequipa, Arequipa, Peru
| | - Sharong D. Castro-Diaz
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru
| | - Andrea G. Cortez-Soto
- Sociedad Científica de Estudiantes de Medicina de Ica, Universidad Nacional San Luis Gonzaga, Ica, Peru
| | - Analis L. Esparza Varas
- Universidad Nacional de Trujillo, La Libertad, Peru
- Sociedad científica de estudiantes de medicina de la Universidad Nacional de Trujillo, Trujillo, Peru
| | - Jared Fernandez-Morales
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru
| | - Juan J. Olortegui-Rodriguez
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru
| | - Isabel P. Pelayo-Luis
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru
- Escuela de Enfermería, Universidad Peruana Unión, Lima, Peru
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Li Y, Li J, Nima Q. Associations of socioeconomic status and obesity with hypertension in tibetan adults in a Chinese plateau area. BMC Public Health 2023; 23:1840. [PMID: 37735642 PMCID: PMC10515255 DOI: 10.1186/s12889-023-15864-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/10/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Previous studies have identified that socioeconomic status (SES) and obesity are associated with hypertension. However, their interaction on hypertension risk has not yet been assessed. METHODS The study used data from 6,069 Tibetan residents in Chengguan District in Lhasa, the Chinese Tibetan autonomous region's capital, based on a cohort study conducted from May 2018 to September 2019 in five provinces in southwest China. We used logistic regression models to assess the complex relations of SES and obesity with hypertension. RESULTS Compared with individuals of high SES, low and moderate SES were positively associated with high risk of hypertension. SES and obesity have significant additive interaction on hypertension (general obesity by BMI: RERI = 1.33, P < 0.001; abdominal obesity by WC: RERI = 0.76, P < 0.001; abdominal obesity by WHtR: RERI = 0.96, P < 0.001). In people from the low and moderate SES segments, obesity was linked to an increased risk of hypertension, but the correlations were stronger in people from the moderate SES category. Compared with people of high SES and non obese, those with moderate SES and obesity had a higher risk of hypertension, and ORs were 4.38 (2.80, 6.84) for general obesity by BMI, 3.38 (2.05, 5.57) for abdominal obesity by WC, and 3.18 (1.57, 6.42) for abdominal obesity by WHtR. CONCLUSION There is an independent and additive interaction effect of obesity and SES on the risk of hypertension. People with obesity, especially those of moderate and low SES, should reduce weight and waist circumference, and pay more attention to blood pressure. Moreover, the government, health administration departments, and society should prioritize improving the socioeconomic status of the Tibetan population and addressing risk factors like obesity.
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Affiliation(s)
- Yajie Li
- Tibet Center for Disease Control and Prevention, 21 North linkuo Road, Lhasa, Tibet, China
| | - Jianbo Li
- Wuzhong District Center for Disease Control and Prevention, Suzhou City, China
| | - Qucuo Nima
- Tibet Center for Disease Control and Prevention, 21 North linkuo Road, Lhasa, Tibet, China.
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19
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Zhou E, Lei R, Tian X, Liu C, Guo J, Jin L, Jin H, Wang S, Cao L, Zhuoma C, Wang J, Luo B, Hu J. Association between salt sensitivity of blood pressure and the risk of hypertension in a Chinese Tibetan population. J Clin Hypertens (Greenwich) 2023; 25:453-462. [PMID: 37120829 PMCID: PMC10184482 DOI: 10.1111/jch.14663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 05/02/2023]
Abstract
Epidemiological studies have confirmed salt sensitivity as a crucial risk factor for the development of hypertension. However, few studies have investigated the association between salt sensitivity of blood pressure (SSBP) and hypertension in Chinese Tibetan population. Therefore, we conducted a cross-sectional study based on a Tibetan population to evaluate the association between SSBP and the risk of hypertension. Seven hundred and eighty-four participants with hypertension and 645 participants without hypertension were included from five villages in Tibetan Autonomous Region of Gannan during 2013-2014. The assessment of salt sensitivity (SS) and non-salt sensitivity (NSS) was performed according to mean arterial pressure (MAP) changes by the modified Sullivan's acute oral saline load and diuresis shrinkage test (MSAOSL-DST). Logistic regression models and restricted cubic models were used to examine the association between SSBP and hypertension. There were 554 (70.5%) salt-sensitive participants with hypertension and 412 (63.9%) salt-sensitive participants without hypertension in this study. Compared with individuals with NSS, individuals with SS had a significantly increased risk of hypertension, and the multiple-adjusted odds ratios were 2.582 with 95% confidence interval of 1.357-4.912. Furthermore, a significant linear trend was found between MAP changes and hypertension. Subgroup analyses showed significant and stronger associations between SSBP and the risk of hypertension in the older (age ≥ 55 years old), males and participants who took exercise less than 1 time per week. Our results suggest that SS is associated with an increased risk of hypertension in Tibetan population, indicating a need for clinicians dealing with SSBP to decrease the risk of hypertension.
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Affiliation(s)
- Erkai Zhou
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ruoyi Lei
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaoyu Tian
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ce Liu
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jingzhe Guo
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Limei Jin
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Hua Jin
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Shuxia Wang
- Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Liangjia Cao
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Cao Zhuoma
- People's Hospital of Xiahe County, Gannan Tibetan Autonomous Prefecture, Lanzhou, Gansu, China
| | - Jianzhong Wang
- School of Tibetan Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Bin Luo
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jihong Hu
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
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20
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Liu G, Xu Q, Sun M, Xiao R. Factors associated with the elasticity of asymptomatic carotid plaques in hypertension Tibetan population. Vascular 2023; 31:304-311. [PMID: 34875918 DOI: 10.1177/17085381211060938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS Hypertension is a major risk factor for coronary, cerebrovascular, and the greatest cause of stroke. Half of stroke events are the result of cerebrovascular atherosclerosis, including carotid plaques. It is of major importance to detect which plaques are vulnerable, even though not yet ruptured. Due to the particularity of the Tibetan population, this study evaluated the elasticity of asymptomatic carotid plaques in Tibetan hypertension patients using shear wave elastography (SWE) and explored associated risk factors. METHODS A total of 91 Tibetan patients were divided into normotension, grade 1-2, and grade 3 hypertension groups based on the level of blood pressure. All subjects underwent common duplex ultrasonic examination and SWE evaluation for carotid plaques. Elasticity of carotid plaque was assessed by Young's modulus. RESULTS The final analysis included 126 plaques as representative plaques according to Total Plaque Risk Score. The mean and maximum Young's modulus in the grade 3 hypertension group were smaller, and more plaques with irregularity surface compared with the other two groups (p < 0.05). Multivariate regression analysis showed drinking butter tea (β = -0.220, p = 0.009; β = -0.240, p = 0.004, respectively) was the independent factor associated with mean and maximum Young's modulus. CONCLUSIONS SWE is feasible for measurement of Young's modulus of carotid plaques. Plaques in the grade 3 hypertension group were more likely to become vulnerable ones. In hypertension Tibetan patients, drinking butter tea was an independent factor associated with mean and maximum Young's modulus of asymptomatic carotid plaque.
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Affiliation(s)
- Guyue Liu
- Department of Ultrasound, Chengdu Office Hospital of Tibet Autonomous Region People's Government, Chengdu, China
| | - Qing Xu
- Department of Ultrasound, Chengdu Office Hospital of Tibet Autonomous Region People's Government, Chengdu, China
| | - Min Sun
- Department of Ultrasound, Chengdu Office Hospital of Tibet Autonomous Region People's Government, Chengdu, China
| | - Rong Xiao
- Department of Ultrasound, Chengdu Office Hospital of Tibet Autonomous Region People's Government, Chengdu, China
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21
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Peng W, Jian W, Li T, Malowany M, Tang X, Huang M, Wang Y, Ren Y. Disparities of obesity and non-communicable disease burden between the Tibetan Plateau and developed megacities in China. Front Public Health 2023; 10:1070918. [PMID: 36703857 PMCID: PMC9873242 DOI: 10.3389/fpubh.2022.1070918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Abstract
Background Non-communicable diseases (NCDs) including risk factors, e.g., obesity, are the major causes of preventable deaths in China, yet NCD disparities in China remain under-studied. Objective This study aimed to compare the determinants and burden of NCDs within four selected provinces in mainland China: the least developed Qinghai-Tibet Plateau group (PG, Tibetan Autonomous Region [TAR] and Qinghai Province) and most developed megacity group (MCG, Shanghai, and Beijing). Methods Studies, reports, and other official sources with comparable data for NCD burden and related determinants for the four provinces were searched. Geographic, demographic, socioeconomic, and dietary characteristics and selected health indicators (e.g., life expectancy) were extracted from the China Statistical Yearbook and China Health Statistics Yearbook. Data on NCD burdens were extracted from the National Chronic Disease and Risk Factor Surveillance Study and other nationally representative studies. Results The overall NCD mortality rates and prevalence of metabolic risk factors including obesity, hypertension, and diabetes in mainland China have increased in the past 20 years, and this trend is expected to continue. The PG had the highest level of standardized mortality rates (SMRs) on NCDs (711.6-896.1/100,000, 6th/6-level); the MCG had the lowest (290.6-389.6/100,000, 1st/6-level) in mainland China. The gaps in SMRs were particularly high with regard to chronic respiratory diseases (PG 6th/6-level, MCG 1st/6-level) and cardiovascular diseases (6th/6 and 4th/6 in TAR and Qinghai; 1st/6-level and 2nd/6-level in Shanghai and Beijing). In contrast, the prevalence rates of obesity, hypertension, and diabetes were generally higher or comparable in MCG compared to PG. Diabetes prevalence was particularly high in MCG (5th/5-level, 13.36-14.35%) and low in PG (1st/5-level, 6.20-10.39%). However, awareness, treatment, and control of hypertension were poor in PG. Additionally, PG had much lower and severely inadequate intakes of vegetables, fruits, and dairy products, with additional indicators of lower socioeconomic status (education, income, etc.,) compared with MCG. Conclusion Evidence showed large disparities in NCD burden in China's provinces. Socioeconomic disparity and dietary determinants are probably the reasons. Integrated policies and actions are needed.
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Affiliation(s)
- Wen Peng
- Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University, Xining, China,Qinghai Provincial Key Laboratory of Traditional Chinese Medicine Research for Glucolipid Metabolic Diseases, Medical College, Qinghai University, Xining, Qinghai, China,Wen Peng ✉
| | - Wenxiu Jian
- Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University, Xining, China
| | - Tiemei Li
- Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University, Xining, China
| | - Maureen Malowany
- Faculty of Medicine, Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem—Hadassah Medical Organization, Jerusalem, Israel
| | - Xiao Tang
- Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University, Xining, China
| | - Mingyu Huang
- Medical College, Qinghai University, Xining, China
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Yanming Ren
- Medical College, Qinghai University, Xining, China,*Correspondence: Yanming Ren ✉
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22
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Shu J, Fei W, Zhang J, Li F, Hao Y, Ding Z, Tseyang, Drolma, Ji S, Zhao W, Hu Y, Sun W, Huang Y, Zhao Y, Zhang W. Cerebral small-vessel disease at high altitude: A comparison of patients from plateau and plain. Front Neurol 2023; 14:1086476. [PMID: 36970535 PMCID: PMC10034167 DOI: 10.3389/fneur.2023.1086476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/20/2023] [Indexed: 03/29/2023] Open
Abstract
Background and purpose Cerebral small-vessel disease (CSVD) is prevalent worldwide and one of the major causes of stroke and dementia. For patients with CSVD at high altitude, a special environmental status, limited information is known about their clinical phenotype and specific neuroimaging change. We investigated the clinical and neuroimaging features of patients residing at high altitude by comparing with those in the plain, trying to explore the impact of high altitude environment on CSVD. Methods Two cohorts of CSVD patients from the Tibet Autonomous Region and Beijing were recruited retrospectively. In addition to the collection of clinical diagnoses, demographic information and traditional vascular risk factors, the presence, location, and severity of lacunes and white matter hyperintensities were assessed by manual counting and using age-related white matter changes (ARWMC) rating scale. Differences between the two groups and influence of long-term residing in the plateau were analyzed. Results A total of 169 patients in Tibet (high altitude) and 310 patients in Beijing (low altitude) were enrolled. Fewer patients in high altitude group were found with acute cerebrovascular events and concomitant traditional vascular risk factors. The median (quartiles) ARWMC score was 10 (4, 15) in high altitude group and 6 (3, 12) in low altitude group. Less lacunes were detected in high altitude group [0 (0, 4)] than in low altitude group [2 (0, 5)]. In both groups, most lesions located in the subcortical (especially frontal) and basal ganglia regions. Logistic regressions showed that age, hypertension, family history of stroke, and plateau resident were independently associated with severe white matter hyperintensities, while plateau resident was negatively correlated with lacunes. Conclusion Patients of CSVD residing at high altitude showed more severe WMH but less acute cerebrovascular events and lacunes in neuroimaging, comparing to patients residing at low altitude. Our findings suggest potential biphasic effect of high altitude on the occurrence and progression of CSVD.
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Affiliation(s)
- Junlong Shu
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Wen Fei
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Jing Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Fan Li
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yu Hao
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Zhijie Ding
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Tseyang
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Drolma
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Shiyong Ji
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Weiwei Zhao
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Yaxiong Hu
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Yuhua Zhao
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
- Yuhua Zhao
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
- *Correspondence: Wei Zhang
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23
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Perger E, Baillieul S, Esteve F, Pichon A, Bilo G, Soranna D, Doutreleau S, Savina Y, Ulliel-Roche M, Brugniaux JV, Stauffer E, Oberholzer L, Howe C, Hannco I, Lombardi C, Tamisier R, Pepin JL, Verges S, Parati G. Nocturnal hypoxemia, blood pressure, vascular status and chronic mountain sickness in the highest city in the world. Ann Med 2022; 54:1884-1893. [PMID: 35786084 PMCID: PMC9258438 DOI: 10.1080/07853890.2022.2091791] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Chronic mountain sickness (CMS) is a condition characterized by excessive erythrocytosis in response to chronic hypobaric hypoxia. CMS frequently triggers cardiorespiratory diseases such as pulmonary hypertension and right or left heart failure. Ambient hypoxia might be further amplified night-time by intermittent hypoxia related to sleep-disordered breathing (SDB) so that sleep disturbance may be an important feature of CMS. Our aim was to characterize in a cross-sectional study nocturnal hypoxaemia, SDB, blood pressure (BP), arterial stiffness and carotid intima-media thickness (CIMT) in highlanders living at extreme altitude. METHODS Men aged 18 to 55 years were prospectively recruited. Home sleep apnoea test, questionnaires (short-form health survey; Montreal cognitive assessment; Pittsburgh Sleep Questionnaire Index and the Insomnia severity index), 24-h ambulatory BP monitoring, CIMT and arterial stiffness were evaluated in 3 groups: i) Andean lowlanders (sea-level); ii) highlanders living at 3,800 m and iii) highlanders living at 5,100 m. Analyses were conducted in sub-groups according to 1) CMS severity 2) healthy subjects living at the three different altitude. RESULTS Ninety-two males were evaluated at their living altitudes. Among the 54 highlanders living at 5,100 m, subjects with CMS showed lower mean nocturnal oxygen saturation (SpO2), SpO2 nadir, lower pulse wave velocity and higher nocturnal BP variability than those with no-CMS. Lower nocturnal SpO2 nadir was associated with higher CMS severity (ß= -0.14, p=.009). Among the 55 healthy subjects, healthy highlanders at 5,100 m were characterized by lower scores on quality of life and sleep quality scales and lower mean SpO2 compared to lowlanders. CONCLUSIONS Lower nocturnal SpO2 and higher nocturnal BP variability are associated with CMS severity in individuals living permanently at high altitude. The role of lower SpO2 and higher nocturnal BP variability in the cardiovascular progression of CMS and in the overall prognosis of the disease need to be evaluated in further studies.
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Affiliation(s)
- Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Biostatistic Unit, University of Milano-Bicocca, Milan, Italy
| | - Sébastien Baillieul
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - François Esteve
- Inserm UA7, Rayonnement Synchrotron pour la Recherche Biomédicale, Grenoble, France
| | - Aurélien Pichon
- Faculty of Sport Sciences, Université de Poitiers, Laboratory Mobility, aging & exercise (MOVE, EA6314), Poitiers, France
| | - Gzregorz Bilo
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Biostatistic Unit, University of Milano-Bicocca, Milan, Italy
| | - Davide Soranna
- Istituto Auxologico Italiano, IRCCS, Biostatistics unit, Milan, Italy
| | - Stéphane Doutreleau
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Yann Savina
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Mathilde Ulliel-Roche
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Julien V Brugniaux
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Emeric Stauffer
- Interuniversity Laboratory of Human Movement Biology (LIBM, EA7424), "Red Blood cell and Vascular Biology" team, Univ Lyon - University Claude Bernard Lyon 1, Villeurbanne, France
| | - Laura Oberholzer
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Connor Howe
- Centre for Heart, Lung, and Vascular Health, University of British Columbia, Kelowna, Canada
| | - Ivan Hannco
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Biostatistic Unit, University of Milano-Bicocca, Milan, Italy
| | - Renaud Tamisier
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Jean-Louis Pepin
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Samuel Verges
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Biostatistic Unit, University of Milano-Bicocca, Milan, Italy
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24
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Zhu J, Duan Y, Duo D, Yang J, Bai X, Liu G, Wang Q, Wang X, Qu N, Zhou Y, Li X. High-altitude Hypoxia Influences the Activities of the Drug-Metabolizing Enzyme CYP3A1 and the Pharmacokinetics of Four Cardiovascular System Drugs. Pharmaceuticals (Basel) 2022; 15:ph15101303. [PMID: 36297415 PMCID: PMC9612038 DOI: 10.3390/ph15101303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: High-altitude hypoxia has been shown to affect the pharmacokinetic properties of drugs. Although there is a high incidence of cardiovascular disease among individuals living in high-altitude areas, studies on the effect of high-altitude hypoxia on the pharmacokinetic properties of cardiovascular drugs are limited. (2) Methods: The aim of this study was to evaluate the pharmacokinetics of nifedipine, bosentan, simvastatin, sildenafil, and their respective main metabolites, dehydronifedipine, hydroxybosentan, simvastatin hydroxy acid, and N-desmethyl sildenafil, in rats exposed to high-altitude hypoxia. Additionally, the protein and mRNA expression of cytochrome P450 3A1 (CYP3A1), a drug-metabolizing enzyme, were examined. (3) Results: There were significant changes in the pharmacokinetic properties of the drugs in rats exposed to high-altitude hypoxia, as evidenced by an increase in the area under the curve (AUC) and the half-life (t1/2z) and a decrease in total plasma clearance (CLz/F). However, most of these changes were reversed when the rats returned to a normoxic environment. Additionally, there was a significant decrease in CYP3A1 expression in rats exposed to high-altitude hypoxia at both the protein and mRNA levels. (4) Conclusions: High-altitude hypoxia suppressed the metabolism of the drugs, indicating that the pharmacokinetics of the drugs should be re-examined, and the optimal dose should be reassessed in patients living in high-altitude areas.
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Affiliation(s)
- Junbo Zhu
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining 810000, China
- State Key Laboratory of Plateau Ecology and Agriculture, Qinghai University, Xining 810000, China
| | - Yabin Duan
- Department of Clinical Pharmacy, Qinghai University Affiliated Hospital, Xining 810000, China
| | - Delong Duo
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining 810000, China
| | - Jianxin Yang
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining 810000, China
| | - Xue Bai
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining 810000, China
| | - Guiqin Liu
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining 810000, China
| | - Qian Wang
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining 810000, China
| | - Xuejun Wang
- Department of Anesthesiology, Red Cross Hospital of Qinghai, Xining 810000, China
| | - Ning Qu
- Department of Anesthesiology, Qinghai Hospital of Traditional Chinese Medicine, Xining 810000, China
| | - Yang Zhou
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang 550004, China
- Correspondence: (Y.Z.); (X.L.)
| | - Xiangyang Li
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining 810000, China
- State Key Laboratory of Plateau Ecology and Agriculture, Qinghai University, Xining 810000, China
- Correspondence: (Y.Z.); (X.L.)
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25
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Ma X, Mao Y, Wang J, Zewangzhandui, Wang X. Anthropometric indices, body function, and physical fitness reference values for Tibetan ethnic children aged 6-17 residing at 3,650 meters above sea level. Front Nutr 2022; 9:1036470. [PMID: 36313099 PMCID: PMC9615562 DOI: 10.3389/fnut.2022.1036470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives It is known that high altitude influences the growth metrics of high-altitude residents. Using a WHO-recommended standard, the research aimed to establish growth and development reference values for children of Tibetan ethnicity between the ages of 6 and 17 years old. Methods The measurements took place in Jomda County, Tibet with an average altitude of 3,650 m above sea level. A total of 3,955 observations (1,932 boys and 2,023 girls) were utilized to model the centile estimations. Included in the measurements are height, weight, body mass index, heart rate, blood pressure, forced lung capacity, sit and reach, and standing long jump. The measurements were modeled using the generalized additive models for location, scale, and shape (GAMLSS). Models were fitted with suitable distributions and locally smoothed using the P-spline for each GAMLSS hyper-parameter. Using the smallest Schwarz Bayesian criterion, the optimal model for each measurement was selected. After model adjustment, centile estimations were calculated for each model. Results Compared to the height reference values at the 50th percentile for multi-ethnic Chinese children residing at low altitudes, Tibetan ethnic children exhibit apparent stunted growth. In terms of forced vital capacity, it is remarkable that Tibetan ethnic children lag behind multi-ethnic Chinese children residing at low altitudes. Heart rate and blood pressure regulation are generally normal. Centile estimations are provided in this article and tabulated centiles (1p, 3p, 5p, 15p, 25p, 50p, 75p, 85p, 95p, 97p, 99p) in Chinese, Tibetic, and English are openly available in FigShare (doi: 10.6084/m9.figshare.20898196.v1). Conclusion This study established the first GAMLSS based growth and development reference values for Tibetan ethnic children aged 6–17. These reference values have numerous clinical and scientific applications. We offer Chinese policymakers with practical initiatives to further enhance the health of Tibetan ethnic children.
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Affiliation(s)
- Xiaowei Ma
- College of Health and Exercise Science, Tianjin University of Sport, Tianjin, China
| | - Yong Mao
- Education (Sports) Bureau of Jomda County, Chamdo, China
| | - Jian Wang
- College of Health and Exercise Science, Tianjin University of Sport, Tianjin, China,*Correspondence: Jian Wang,
| | - Zewangzhandui
- Education (Sports) Bureau of Jomda County, Chamdo, China
| | - Xiaomei Wang
- College of Health and Exercise Science, Tianjin University of Sport, Tianjin, China
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26
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The association between altitude and the prevalence of hypertension among permanent highlanders. Hypertens Res 2022; 45:1754-1762. [PMID: 35941357 DOI: 10.1038/s41440-022-00985-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/17/2022] [Accepted: 06/23/2022] [Indexed: 02/06/2023]
Abstract
Hypertension (HTN) is a growing contributor to the global disease burden, and it is prevalent among people living at high altitudes (H-ALTs). This study aimed to explore the relationship between altitude and the prevalence of HTN among inhabitants living at H-ALTs. We searched electronic databases, including PubMed, Embase, and Web of Science, up to April 30, 2022. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) checklist for prevalence studies. A total of 1273 articles were screened, and 32 studies (86,487 participants) were eligible for further analyses. The pooled prevalence among highlanders was 28.7%. General additive model (GAM)-based meta-regression analysis was conducted to explore the association between altitude and the prevalence of HTN. A curve-shaped line was found between altitude and the prevalence of HTN (β = 0.998, p = 0.039) after adjusting for factors including publication year, sample size, age, sex, ethnic group, body mass index (BMI), smoking and alcohol consumption. The turning point was observed at 3300 m. The predictive parameter indicated that the smoothness and goodness of model fit were good (GCV = 0.014, R2 = 0.60, respectively). The findings may provide clues for further mechanistic studies that can improve HTN prevention among highlanders.
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27
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Peng W, Li K, Yan AF, Shi Z, Zhang J, Cheskin LJ, Hussain A, Wang Y. Prevalence, Management, and Associated Factors of Obesity, Hypertension, and Diabetes in Tibetan Population Compared with China Overall. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148787. [PMID: 35886633 PMCID: PMC9316255 DOI: 10.3390/ijerph19148787] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 02/04/2023]
Abstract
Tibetans’ life expectancy lags behind China’s average. Obesity and noncommunicable diseases (NCDs) contribute to health disparity, but NCD patterns among Tibetans are unknown. To examine the prevalence, management, and associated factors for obesity, hypertension, and diabetes among Tibetans, compared with China’s average, we systematically searched PubMed and China National Knowledge Infrastructure databases for studies between January 2010 and April 2021. Thirty-nine studies were included for systematic review, among thirty-seven that qualified for meta-analysis, with 115,403 participants. Pooled prevalence was 47.9% (95% CI 38.0–57.8) for overweight/obesity among adults (BMI ≥ 24 kg/m2) and 15.4% (13.7–17.2) among children using Chinese criteria, which are lower than the national rates of 51.2% and 19.0%, respectively. The estimate for hypertension (31.4% [27.1–35.7]) exceeded China’s average (27.5%), while diabetes (7.5% [5.2–9.8]) was lower than average (11.9%). Men had a higher prevalence of the three conditions than women. Residents in urban areas, rural areas, and Buddhist institutes had monotonically decreased prevalence in hypertension and diabetes. Awareness, treatment, and control rates for hypertension and diabetes were lower than China’s average. Urban residence and high altitude were consistent risk factors for hypertension. Limited studies investigated factors for diabetes, yet none exist for obesity. Tibetans have high burdens of obesity and hypertension. Representative and longitudinal studies are needed for tailored interventions. There are considerable variations in study design, study sample selection, and data-analysis methods, as well as estimates of reviewed studies.
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Affiliation(s)
- Wen Peng
- Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University, Xining 810016, China;
- Global Health Institute, School of Public Health, Xi’an Jiaotong University, Xi’an 710049, China;
| | - Ke Li
- Global Health Institute, School of Public Health, Xi’an Jiaotong University, Xi’an 710049, China;
| | - Alice F. Yan
- Division of Research Patient Care Services, Stanford Health Care, Palo Alto, CA 94305, USA;
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar;
| | - Junyi Zhang
- Department of Clinical Nutrition, The Third People’s Hospital of Chengdu, Chengdu 610014, China;
| | - Lawrence J. Cheskin
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, VA 22030, USA;
- Johns Hopkins School of Medicine, Baltimore, MD 21218, USA
| | - Ahktar Hussain
- International Diabetes Federation (IDF), 1000 Brussels, Belgium;
- Faculty of Health Sciences, Belgian and Nord University, 8001 Bodø, Norway
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi’an Jiaotong University, Xi’an 710049, China;
- Correspondence: ; Tel.: +86-29-8896-7396
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Prevalence of hypertension and its relationship with altitude in highland areas: a systematic review and meta-analysis. Hypertens Res 2022; 45:1225-1239. [PMID: 35705740 DOI: 10.1038/s41440-022-00955-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023]
Abstract
This systematic review and meta-analysis synthesized the pooled prevalence of hypertension at high altitudes and explored its correlation with altitude using studies published in Chinese and English from database inception to February 2021. A systematic literature search was conducted among bibliographic databases (PubMed, Embase, and Web of Science) and three Chinese databases (CNKI, VIP, and Wanfang data) to identify eligible studies. A random-effects model was used to calculate the overall pooled prevalence of hypertension. The I2 statistic was used to assess heterogeneity across studies. Random-effects meta-regression was conducted to investigate covariates that may have influenced between-study heterogeneity. The pooled prevalence of hypertension among the general population in high-altitude areas was 33.0% (95% CI: 29.0-38.0%), with high between-study heterogeneity (I2 = 99.4%, P < 0.01). Subgroup analyses showed the pooled prevalence of hypertension in Tibetan individuals was significantly higher than that in non-Tibetan individuals living in the Himalayas and Pamir Mountains (41% vs. 18%). A trend toward an increase in the prevalence of hypertension was found with every 100-m increase in elevation (coefficient: 0.012, 95% CI: -0.001 to 0.025, P = 0.069) only in Tibetan individuals. In addition, in these individuals, we found an increase in mean diastolic BP with each 100-m increase in altitude (coefficient: 0.763, 95% CI: 0.122-1.403, P = 0.025). Our meta-analysis suggests that the pooled prevalence of hypertension among the general population in high-altitude areas is 33.0%. Subjects of Tibetan ethnicity were more prone to developing hypertension at high altitudes. However, a very weak relationship between altitude and the prevalence of hypertension was found only in Tibetan individuals.
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High Carriage of Extended-Spectrum, Beta Lactamase-Producing, and Colistin-Resistant Enterobacteriaceae in Tibetan Outpatients with Diarrhea. Antibiotics (Basel) 2022; 11:antibiotics11040508. [PMID: 35453259 PMCID: PMC9032258 DOI: 10.3390/antibiotics11040508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022] Open
Abstract
Antibiotic-resistant bacteria (ARB) and antibiotic-resistance genes (ARGs) have been detected in human-impacted habitats, especially in densely populated cities. The Qinghai–Tibet Plateau is located far from the heavily populated regions of China, and Tibetan residents have distinct dietary habits and gut microbes. Antibiotic-resistance monitoring in the Tibetan population is rare. Here, we collected stool samples from Tibetan outpatients with diarrhea. From 59 samples, 48 antibiotic-resistant Enterobacteriaceae isolates were obtained, including 19 extended-spectrum beta lactamase (ESBL)-producing isolates from 16 patients and 29 polymyxin-resistant isolates from 22 patients. Either ESBL or mcr genes were found in 17 Escherichia coli isolates, approximately 58.8% of which were multidrug-resistant, and ten incompatible plasmid types were found. The gene blaCTX-M was a common genotype in the ESBL-producing E. coli isolates. Four E. coli isolates contained mcr-1. The same mcr-1-carrying plasmid was found in distinct E. coli isolates obtained from the same sample, thus confirming horizontal transmission of mcr-1 between bacteria. Genomic clustering of E. coli isolates obtained from Lhasa, with strains from other regions providing evidence of clone spreading. Our results reveal a strong presence of ARB and ARGs in Tibetan outpatients with diarrhea, implying that ARB and ARGs should be monitored in the Tibetan population.
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Tan L, Furian M, Li T, Tang X. Effect of acetazolamide on obstructive sleep apnoea in highlanders: protocol for a randomised, placebo-controlled, double-blinded crossover trial. BMJ Open 2022; 12:e057113. [PMID: 35256446 PMCID: PMC8905944 DOI: 10.1136/bmjopen-2021-057113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is a highly prevalent disease that causing systemic hypertension. Furthermore, altitude-dependent hypobaric hypoxic condition and Tibetan ethnicity have been associated with systemic hypertension independent of OSA, therefore patients with OSA living at high altitude might be at profound risk to develop systemic hypertension. Acetazolamide has been shown to decrease blood pressure, improve arterial oxygenation and prevent high altitude periodic breathing in healthy volunteers ascending to high altitude and decrease blood pressure in patients with systemic hypertension at low altitude. However, the effect of acetazolamide on 24-hour blood pressure, sleep-disordered disturbance and daytime cognitive performance in patients with OSA permanently living at high altitude has not been studied. METHODS AND ANALYSIS This study protocol describes a randomised, placebo-controlled, double-blinded crossover trial. Highland residents of both sexes, aged 30-60 years, Tibetan ethnicity, living at an elevation of 3650 m and apnoea-hypopnoea index over 15/hour will be included. Participants will be randomly assigned to a 2×2 week treatment period starting with 750 mg/day acetazolamide followed by placebo treatment or vice versa, separated by a 1-week wash-out phase. Clinical assessments, 24-hour ambulatory blood pressure monitoring (ABPM), polysomnography (PSG), near-infrared spectroscopy, nocturnal fluid shift and cognitive performance will be assessed before and at the end of each treatment period. The primary outcome will be the difference in 24-hour mean blood pressure between acetazolamide therapy and placebo; secondary outcomes will be the difference in other 24-hour ABPM-derived parameters, PSG-derived parameters, cognitive performance and overnight change in different segments of fluid volume between acetazolamide therapy and placebo. Accounting for potential dropouts, 40 participants will be recruited. ETHICS AND DISSEMINATION The protocol was approved by the West China Hospital of Sichuan University Biomedical Research Ethics Committee. Recruitment will start in spring 2022. Dissemination of the results include presentations at conferences and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2100049304.
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Affiliation(s)
- Lu Tan
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Michael Furian
- Sleep Disorders Center, Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Taomei Li
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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Marbaniang SP, Chungkham HS, Lhungdim H. A structured additive modeling of diabetes and hypertension in Northeast India. PLoS One 2022; 17:e0262560. [PMID: 35025967 PMCID: PMC8758063 DOI: 10.1371/journal.pone.0262560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 12/30/2021] [Indexed: 12/12/2022] Open
Abstract
Background Multiple factors are associated with the risk of diabetes and hypertension. In India, they vary widely even from one district to another. Therefore, strategies for controlling diabetes and hypertension should appropriately address local risk factors and take into account the specific causes of the prevalence of diabetes and hypertension at sub-population levels and in specific settings. This paper examines the demographic and socioeconomic risk factors as well as the spatial disparity of diabetes and hypertension among adults aged 15–49 years in Northeast India. Methods The study used data from the Indian Demographic Health Survey, which was conducted across the country between 2015 and 2016. All men and women between the ages of 15 and 49 years were tested for diabetes and hypertension as part of the survey. A Bayesian geo-additive model was used to determine the risk factors of diabetes and hypertension. Results The prevalence rates of diabetes and hypertension in Northeast India were, respectively, 6.38% and 16.21%. The prevalence was higher among males, urban residents, and those who were widowed/divorced/separated. The functional relationship between household wealth index and diabetes and hypertension was found to be an inverted U-shape. As the household wealth status increased, its effect on diabetes also increased. However, interestingly, the inverse was observed in the case of hypertension, that is, as the household wealth status increased, its effect on hypertension decreased. The unstructured spatial variation in diabetes was mainly due to the unobserved risk factors present within a district that were not related to the nearby districts, while for hypertension, the structured spatial variation was due to the unobserved factors that were related to the nearby districts. Conclusion Diabetes and hypertension control measures should consider both local and non-local factors that contribute to the spatial heterogeneity. More importance should be given to efforts aimed at evaluating district-specific factors in the prevalence of diabetes within a region.
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Affiliation(s)
- Strong P. Marbaniang
- Department of Public Health & Mortality studies, International Institute for Population Sciences, Mumbai, India
- Department of Statistics, Sankardev College, Shillong, Meghalaya, India
- * E-mail:
| | - Holendro Singh Chungkham
- Indian Statistical Institute, North-East Centre, Tezpur, Assam, India
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Hemkhothang Lhungdim
- Department of Public Health & Mortality studies, International Institute for Population Sciences, Mumbai, India
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Tan L, Li T, Luo L, Xue X, Lei F, Ren R, Zhang Y, He J, Bloch KE, Tang X. The Characteristics of Sleep Apnea in Tibetans and Han Long-Term High Altitude Residents. Nat Sci Sleep 2022; 14:1533-1544. [PMID: 36072275 PMCID: PMC9444001 DOI: 10.2147/nss.s371388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Obstructive sleep apnea (OSA) is common both at low and high altitude. Since adaptations to high altitude and respiratory control may differ among Tibetans and Hans, we compared characteristics of sleep-disordered breathing in the two ethnic groups at high altitude. MATERIALS AND METHODS This was a prospective observational study including 86 Tibetan and Han long-term (>5 years) high altitude residents with chief complaints of snoring and/or witnessed apnea underwent clinical evaluation and polysomnography at 3200 meters in Shangri-La, China. RESULTS In 42 Tibetans, 38 men, median (quartiles) age was 50.0 (41.0; 56.0)y, total apnea/hypopnea index (AHI) 53.9 (32.0; 77.5)/h, obstructive AHI 51.0 (28.0; 72.2)/h and central AHI 1.5 (0.2; 3.1)/h. In 44 Hans, 32 men, median (quartiles) age was 47.0 (43.5; 51.0)y, total AHI 22.2 (12.8; 39.2)/h, obstructive AHI 17.7 (12.0; 33.0)/h and central AHI 2.4 (0.5; 3.4)/h (p < 0.001 total and obstructive AHI vs Tibetans). In Tibetans, mean nocturnal oxygen saturation was lower [median 85.0 (83.0; 88.0)% vs 88.5 (87.0; 90.0)%] and obstructive apnea and hypopnea duration was longer [22.0 (19.6; 24.8) sec vs 18.3 (16.7; 20.6) sec] than in Hans (all p < 0.001). In regression analysis, Tibetan ethnicity, neck circumference and high-altitude living duration were the predictors of total AHI. We also found that with every 10/h increase in total AHI, there were an approximately 0.9 beat/min and 0.8 beat/min increase in mean heart rate during rapid eye movement (REM) and non-REM sleep and 1.9 mmHg and 2.0 mmHg increase in evening and morning systolic blood pressure. CONCLUSION Our data suggest that Tibetans presented more severe obstructive sleep apnea, hypoxemia and longer apnea duration compared to Hans at 3200 meters, which was correlated with higher heart rate and blood pressure suggesting a greater cardiovascular risk.
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Affiliation(s)
- Lu Tan
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Taomei Li
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Lian Luo
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xiaofang Xue
- Department of Emergency, Diqing Tibetan Autonomous Prefectural People's Hospital, Shangri-La, People's Republic of China.,Department of Intensive Care Unit, Diqing Tibetan Autonomous Prefectural People's Hospital, Shangri-La, People's Republic of China
| | - Fei Lei
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Rong Ren
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ye Zhang
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jiaming He
- Department of Emergency, Diqing Tibetan Autonomous Prefectural People's Hospital, Shangri-La, People's Republic of China.,Department of Intensive Care Unit, Diqing Tibetan Autonomous Prefectural People's Hospital, Shangri-La, People's Republic of China
| | - Konrad E Bloch
- Department of Respiratory Medicine, Sleep Disorders Center, University Hospital of Zurich, Zurich, Switzerland
| | - Xiangdong Tang
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Mental Health Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Mirdamadi A, Abrishamkar R, Kargaran A. Comparing outcomes of clonidine and captopril in patients with hypertensive urgency: A randomized clinical trial. ARYA ATHEROSCLEROSIS 2022; 18:1-6. [PMID: 36818154 PMCID: PMC9931607 DOI: 10.48305/arya.v18i1.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/12/2021] [Indexed: 02/24/2023]
Abstract
BACKGROUND Hypertension (HTN) is the second leading risk factor for death and disability. One fourth of healthcare in Eastern Europe and Central Asia is being spent on blood pressure (BP)-related diseases. An important situation in patients with high BP is hypertensive crisis (BP > 180/120 mmHg), which is divided to hypertensive emergency and urgency. Therefore, here, we decided to compare the effect of captopril and clonidine in patients with hypertensive urgencies, and their side effects. METHODS This was a parallel-group randomized clinical trial. Patients, who referred to emergency ward with any symptoms of hypertensive crisis, underwent a careful history taking and clinical examination. Individuals with systolic BP (SBP) ≥ 180 mmHg or diastolic BP (DBP) ≥ 110 mmHg with no evidence of end organ damage were randomly assigned into two interventions, clonidine and captopril. 25% decrease in BP was considered as ideal relief. RESULTS Regarding the duration of response to treatment drugs, patients who received clonidine relieved significantly faster than those who received captopril (P = 0.016). Moreover, the frequencies of side effects such as headache, dizziness/vertigo, dry mouth, and drowsiness in the clonidine group were significantly lower than captopril group (P < 0.05). CONCLUSION Patients in clonidine group relieved sooner and experienced fewer side effects. Therefore, this study suggests clonidine as a more effective therapeutic for hypertensive urgency compared with captopril.
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Affiliation(s)
- Ahmad Mirdamadi
- Associate Professor, Department of Cardiology, Najafabad Branch, Islamic Azad University, Isfahan, Iran
| | - Rana Abrishamkar
- Medical Practitioner, Najafabad Branch, Islamic Azad University, Isfahan, Iran,Address for correspondence: Rana Abrishamkar; Medical Practitioner, Najafabad Branch, Islamic Azad University, Isfahan, Iran
| | - Afrooz Kargaran
- Medical Practitioner, Najafabad Branch, Islamic Azad University, Isfahan, Iran
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Zhou W, Wang W, Fan C, Zhou F, Ling L. Residential elevation and its effects on hypertension incidence among older adults living at low altitudes: a prospective cohort study. Environ Health Prev Med 2022; 27:19. [PMID: 35527011 PMCID: PMC9251620 DOI: 10.1265/ehpm.22-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Research on the relationship between residential altitude and hypertension incidence has been inconclusive. Evidence at low altitudes (i.e., <1,500 m) is scarce, let alone in older adults, a population segment with the highest hypertension prevalence. Thus, the objective of this study is to determine whether hypertension risk may be affected by altitude in older adults living at low altitudes. Methods This prospective cohort study collected data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We selected 6,548 older adults (≥65 years) without hypertension at baseline (2008) and assessed events by the follow-up surveys done in 2011, 2014, and 2018 waves. The mean altitude of 613 residential units (county or district) in which the participants resided was extracted from the Digital Elevation Model (DEM) of the National Aeronautics and Space Administration (NASA) and was accurate to within 30 m. The Cox regression model with penalized splines examined the linear or nonlinear link between altitude and hypertension. A random-effects Cox regression model was used to explore the linear association between altitude and hypertension. Results The overall rate of incident hypertension was 8.6 per 100-person years. The median altitude was 130.0 m (interquartile range [IQR] = 315.5 m). We observed that the exposure–response association between altitude and hypertension incidence was not linear. The shape of the exposure–response curve showed that three change points existed. Hypertension risk increased from the lowest to the first change point (247.1 m) and slightly fluctuated until the last change point (633.9 m). The risk decreased above the last change point. According to the categories stratified by the change points, altitude was only significantly associated with hypertension risk (hazard ratio [HR] = 1.003; 95% confidence interval [CI] = 1.002–1.005) under the first change point (247.1 m) after adjusting for related covariates. Conclusion Our study found that the association between altitude and hypertension risk might not be linear. We hope the further study can be conducted to confirm the generality of our findings. Supplementary information The online version contains supplementary material available at https://doi.org/10.1265/ehpm.22-00001.
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Affiliation(s)
- Wensu Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University
| | - Wenjuan Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University
| | - Chaonan Fan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University
| | - Fenfen Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University
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Xiao Z, Sun X, Zhaxi D, Zhang F, Ji Y, Cheng T, Li X, Xu X. Distinct Nutrient Intake Style in Inhabitants of Ultra-High-Altitude Areas in North of Tibet, China: A Cross-Sectional Study Based on Newly Developed Tibetan Food Frequency Questionnaires. Front Nutr 2021; 8:743896. [PMID: 35004798 PMCID: PMC8733569 DOI: 10.3389/fnut.2021.743896] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022] Open
Abstract
Dietary pattern is quite distinct among the inhabitants of high-altitude areas because of environmental and geographical uniqueness; hence, it is important to investigate this data as accurately as possible. However, very few data are related to these populations up to now. Based on the food frequency questionnaire (FFQ) used in the Chinese population, a revised Tibetan edition was developed with respect to the lifestyle in high-altitude areas. After assessment of validity and reproducibility, a nutrition intake survey was conducted among 1,071 randomly sampled Tibetan people. In addition, the Bland-Altman approach was used to compare the agreement between the two dietary tools. For the reproducibility analysis, intraclass correlation coefficients (ICC) were calculated to examine the agreement of food groups and nutrients from the two FFQs (FFQ1 and FFQ2). Nutrient intake was calculated using food composition tables. For the validity analysis, Pearson's correlation of food groups intakes varied from 0.22 to 0.91 (unadjusted). The correlations of nutrients ranged from 0.24 to 0.76 (unadjusted). In the analysis of reliability, the ICC of food groups varied from 0.27 to 0.70 (unadjusted). The ICC of nutrient intakes ranged from 0.22 to 0.87 (unadjusted). The results of nutritional analysis showed that ~25% of foods consumed frequently were traditional Tibetan foods. However, traditional Han foods were frequently consumed. In addition, the energy, iron, and protein intakes for male or female subjects were close to the Chinese Dietary Nutrient Reference Intake (Chinese DRIs); however, fat and sodium intakes were significantly higher than the Chinese DRIs. Interestingly, lower intakes of other types of nutrition, such as vitamin C were detected in people living in high-altitude areas. Our data indicated that excess consumption of fat and sodium and insufficient intake of vitamin C were common among Tibetan people, as compared with the most Chinese people living in the plateau areas. More investigations are needed to reveal the association between the food intake style and high-altitude endemic diseases.
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Affiliation(s)
- Zhen Xiao
- Institute of High Altitude Medicine, People's Hospital of Naqu Affiliated to Dalian Medical University, Naqu, China
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xianzhi Sun
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Duoji Zhaxi
- Institute of High Altitude Medicine, People's Hospital of Naqu Affiliated to Dalian Medical University, Naqu, China
| | - Fan Zhang
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Yuchen Ji
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Tingting Cheng
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Xiaofeng Li
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Xiaoguang Xu
- Institute of High Altitude Medicine, People's Hospital of Naqu Affiliated to Dalian Medical University, Naqu, China
- Department of Neurosurgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Li T, Shuai P, Wang J, Wang L. Prevalence, awareness, treatment and control of hypertension among Ngawa Tibetans in China: a cross-sectional study. BMJ Open 2021; 11:e052207. [PMID: 34489294 PMCID: PMC8422477 DOI: 10.1136/bmjopen-2021-052207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To explore the prevalence, awareness, treatment and control rate of hypertension and analyse the potential social environment factors among Ngawa Tibetans in China. DESIGN This was a cross-sectional observational study. SETTING The investigation based on a multistage stratified cluster sampling was conducted in the Ngawa area, Sichuan Province, Southwest China. Tibetan residents were selected by random sampling method from one city and six counties in Ngawa. METHODS Basic demographical information, physical activity and blood pressure were collected. In addition, the participants completed the questionnaire. A multivariate logistic regression analysis was used to examine the association between the prevalence, awareness, treatment and control rate of hypertension and the potential risk factors. PARTICIPANTS The sample comprised 2228 Ngawa Tibetan residents (age 18-80 years) from September 2018 to June 2019. RESULTS The prevalence rate of hypertension was 24.6%. The control rate was 6.2%, while the awareness rate (32.3%) and treatment rate (21.7%) of hypertension had been significantly improved. CONCLUSION The prevalence of hypertension among Ngawa Tibetans was high. The awareness and treatment were improved in recent years. But the control rate was low. The government needs to strengthen the basic medical care and health education for Ngawa Tibetans.
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Affiliation(s)
- Tingxin Li
- Health Management Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Ping Shuai
- Health Management Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jinghong Wang
- College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Lin Wang
- Health Management Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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Ye R, Zhang X, Zhang Z, Yang X, Chen X. A cross-sectional study on the ability of physicians to hypertension management in China's Sichuan Tibetan rural area. J Clin Hypertens (Greenwich) 2021; 23:1802-1809. [PMID: 34418250 PMCID: PMC8678753 DOI: 10.1111/jch.14351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/29/2021] [Accepted: 07/13/2021] [Indexed: 02/05/2023]
Abstract
This study aimed to investigate the hypertension management abilities of rural physicians in a high‐altitude Tibetan area. A cross‐sectional survey was conducted in the Ganzi Tibetan Autonomous Prefecture, China, in October 2020. Information about healthcare resources in local medical institutions, along with the knowledge, attitudes, practices, and training status of primary care physicians, was collected. Limited resources were observed in terms of equipment, drugs, and personnel in the 18 township hospitals included. A total of 132 physicians participated in this survey. The scores for hypertension‐related knowledge, attitudes toward hypertension management, routine practice ability, priority given to hypertension, and confidence in performing certain tasks were 32.60%, 67.40%, 18.90%, 65.15%, and 35.60%, respectively. The most concerning issues lay in the ignorance of the healthy lifestyle, undervaluation of cardiovascular risks, and lack of confidence in optimally performing management activities. Only 9.85% of the physicians received more than 24 days of training per year; 28.79% preferred a longer training time. While training was generally provided in conference sessions (63.64% of current training programs), physicians preferred remote education (55.30%), and on‐site guidance (46.21%) from professionals. The current training was centered around clinical skills (61.36%) and was identified as a major training requirement by the physicians surveyed (80.30%). This survey suggests that the medical resources may not be effective, with deficiencies present in the knowledge and practices of primary care physicians in the Sichuan Tibetan area. Hypertension education and skill‐development courses based on the specific issues identified should be provided to these physicians in the future.
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Affiliation(s)
- Runyu Ye
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhipeng Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangyu Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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André M, Brucato N, Plutniak S, Kariwiga J, Muke J, Morez A, Leavesley M, Mondal M, Ricaut FX. Phenotypic differences between highlanders and lowlanders in Papua New Guinea. PLoS One 2021; 16:e0253921. [PMID: 34288918 PMCID: PMC8294550 DOI: 10.1371/journal.pone.0253921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Altitude is one of the most demanding environmental pressures for human populations. Highlanders from Asia, America and Africa have been shown to exhibit different biological adaptations, but Oceanian populations remain understudied [Woolcock et al., 1972; Cotes et al., 1974; Senn et al., 2010]. We tested the hypothesis that highlanders phenotypically differ from lowlanders in Papua New Guinea, as a result of inhabiting the highest mountains in Oceania for at least 20,000 years. MATERIALS AND METHODS We collected data for 13 different phenotypes related to altitude for 162 Papua New Guineans living at high altitude (Mont Wilhelm, 2,300-2,700 m above sea level (a.s.l.) and low altitude (Daru, <100m a.s.l.). Multilinear regressions were performed to detect differences between highlanders and lowlanders for phenotypic measurements related to body proportions, pulmonary function, and the circulatory system. RESULTS Six phenotypes were significantly different between Papua New Guinean highlanders and lowlanders. Highlanders show shorter height (p-value = 0.001), smaller waist circumference (p-value = 0.002), larger Forced Vital Capacity (FVC) (p-value = 0.008), larger maximal (p-value = 3.20e -4) and minimal chest depth (p-value = 2.37e -5) and higher haemoglobin concentration (p-value = 3.36e -4). DISCUSSION Our study reports specific phenotypes in Papua New Guinean highlanders potentially related to altitude adaptation. Similar to other human groups adapted to high altitude, the evolutionary history of Papua New Guineans appears to have also followed an adaptive biological strategy for altitude.
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Affiliation(s)
- Mathilde André
- Estonian Biocentre, Institute of Genomics, University of Tartu, Tartu, Tartumaa, Estonia
| | - Nicolas Brucato
- Laboratoire Évolution and Diversité Biologique (EDB UMR5174), Université de Toulouse Midi-Pyrénées, CNRS, IRD, UPS, Toulouse, France
| | - Sébastien Plutniak
- Laboratoire Travaux et Recherches Archéologiques sur les Cultures, les Espaces et les Sociétés (TRACES, UMR 5608), Université Toulouse Jean Jaurès, Maison de la Recherche, Toulouse, France
| | - Jason Kariwiga
- Strand of Anthropology, Sociology and Archaeology, School of Humanities & Social Sciences, University of Papua New Guinea, National Capital District, Papua New Guinea
- School of Social Science, University of Queensland, Australia, St Lucia, Australia
| | - John Muke
- Social Research Institute Ltd, Port Moresby, Papua New Guinea
| | - Adeline Morez
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Matthew Leavesley
- Strand of Anthropology, Sociology and Archaeology, School of Humanities & Social Sciences, University of Papua New Guinea, National Capital District, Papua New Guinea
- ARC Centre of Excellence for Australian Biodiversity and Heritage, College of Arts, Society and Education, James Cook University, Cairns, Australia
| | - Mayukh Mondal
- Estonian Biocentre, Institute of Genomics, University of Tartu, Tartu, Tartumaa, Estonia
| | - François-Xavier Ricaut
- Laboratoire Évolution and Diversité Biologique (EDB UMR5174), Université de Toulouse Midi-Pyrénées, CNRS, IRD, UPS, Toulouse, France
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Zhang X, Liao H, Ye R, Li X, Gou Q, Zhang Z, Shi R, Meng Q, Zhuoma Z, Zhang H, Chen X. Assessment and validation of three spot urine assay methods for the estimation of 24-hour urinary sodium excretion in Chinese Tibetan adults living in the mountains. J Clin Hypertens (Greenwich) 2021; 23:1588-1598. [PMID: 34196446 PMCID: PMC8678802 DOI: 10.1111/jch.14312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023]
Abstract
Twenty‐four‐hour urine collection is the gold standard method for the evaluation of salt intake, but it is often impractical in large‐scale investigations, especially in resource‐poor areas. Methods for the estimation of 24‐hour urinary sodium excretion (USE) using a spot urine sample have been established, but have not been validated in Chinese Tibetans. Therefore, the authors aimed to evaluate the Kawasaki, Tanaka, and the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) formulas for the prediction of 24‐hour USE in Chinese Tibetan adults. The authors analyzed the bias, correlation, agreements between estimated values and measured values, and the relative and absolute differences and misclassification at the individual level for the three methods in 323 Tibetan participants from the Ganzi Tibetan Autonomous Prefecture of Sichuan Province, China. The mean biases between the measured values and the estimated 24‐hour USE using the Kawasaki, Tanaka, and INTERSALT methods were 5.4 mmol/day (95% confidence interval [CI]: 0.8–10.1 mmol/day), −40.8 mmol/day (95% CI: −44.6 to −36.9 mmol/day), and −57.1 mmol/day (95% CI: −61.9 to −52.4 mmol/day), respectively. The Pearson correlation coefficients for the relationships between the measured values and the estimated 24‐hour USE were 0.43 (Kawasaki), 0.38 (Tanaka), and 0.27 (INTERSALT), respectively (all p < .01). The intraclass correlation coefficients showed similar patterns to the correlation data: 0.47 for Kawasaki, 0.40 for Tanaka, and 0.27 for INTERSALT (all p < .01). The upper and lower limits of agreement between the measured values and the estimated 24‐hour USE were −92.6 and 81.8 mmol/day for the Kawasaki method, −28.5 and 110.0 mmol/day for the Tanaka method, and −28.4 and 142.7 mmol/day for the INTERSALT method. Compared with the other two methods, the percentage of individuals that were misclassified by using the Kawasaki method was 48.2%, while those for the Tanaka and INTERSAL methods was 72.1% and 75.5%, respectively. However, when an individual's salt intake was higher than 12.8 g/day, the misclassification rates of the Kawasaki, Tanaka, and INTERSALT methods were 20%, 90%, and 97.5%, respectively. Thus, the authors found that the Kawasaki equation may have performed better than the other equations at Chinese Tibetan population level assessment, but none of these equations are suitable for use or perform well at the individual level. A more accurate method of using a spot urine sample to evaluate individual 24‐hour USE for Tibetans is needed.
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Affiliation(s)
- Xin Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Hang Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Runyu Ye
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Xinran Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Qiling Gou
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Zhipeng Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Rufeng Shi
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Qingtao Meng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Zewong Zhuoma
- Luohuo County Health Bureau, Ganzi Tibetan Autonomous Prefecture, Luhuo, Sichuan Province, People's Republic of China
| | - Hengyu Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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Shriraam V, Mahadevan S, Arumugam P. Prevalence and Risk Factors of Diabetes, Hypertension and Other Non-Communicable Diseases in a Tribal Population in South India. Indian J Endocrinol Metab 2021; 25:313-319. [PMID: 35136738 PMCID: PMC8793947 DOI: 10.4103/ijem.ijem_298_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/02/2021] [Accepted: 08/24/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The prevalence of non-communicable diseases is increasing in tribal areas of India owing to the development and adoption of modern lifestyle. This study was done to assess the prevalence and risk factors of obesity, diabetes and hypertension in a tribal area in South India. MATERIALS AND METHODS A cross-sectional study was conducted among all men and women 40 years and above in ten randomly selected villages in three village panchayats located in a hilly area in Vellore district, Tamil Nadu. Minimum sample size calculated was 370. Data collection was done using a pretested questionnaire, clinical examination, and capillary blood glucose measurement. Prevalence and 95% confidence interval were estimated for diabetes and hypertension. By univariate and multivariate logistic regression, the Odds Ratio was calculated to identify the risk factors. SPSS version 16.0 was used. A value of P < 0.05 was considered statistically significant. RESULTS The study included 502 subjects, 212 (42.2%) males and 290 (57.8%) females. The proportion of generalized and abdominal obesity was 21% and 36.5%. The prevalence of diabetes and hypertension among the tribal population was 7.4% and 36.5%. Approximately 62% of diabetes and 68% of hypertension were newly diagnosed during this study. Higher age, female sex, generalized and abdominal obesity, and diabetes were risk factors for hypertension and abdominal obesity and hypertension were risk factors for diabetes. CONCLUSION The prevalence of diabetes and hypertension is high with two-thirds being newly diagnosed during study in this tribal population mandating early screening, awareness campaigns for early health-seeking and improvement in health access.
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Affiliation(s)
- Vanishree Shriraam
- Department of Community Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Shriraam Mahadevan
- Endocrinology and Metabolism, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Parandhaman Arumugam
- Department of Medical Genetics, The Tamilnadu Dr. MGR Medical University, Chennai, India
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Mallet RT, Burtscher J, Richalet JP, Millet GP, Burtscher M. Impact of High Altitude on Cardiovascular Health: Current Perspectives. Vasc Health Risk Manag 2021; 17:317-335. [PMID: 34135590 PMCID: PMC8197622 DOI: 10.2147/vhrm.s294121] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Globally, about 400 million people reside at terrestrial altitudes above 1500 m, and more than 100 million lowlanders visit mountainous areas above 2500 m annually. The interactions between the low barometric pressure and partial pressure of O2, climate, individual genetic, lifestyle and socio-economic factors, as well as adaptation and acclimatization processes at high elevations are extremely complex. It is challenging to decipher the effects of these myriad factors on the cardiovascular health in high altitude residents, and even more so in those ascending to high altitudes with or without preexisting diseases. This review aims to interpret epidemiological observations in high-altitude populations; present and discuss cardiovascular responses to acute and subacute high-altitude exposure in general and more specifically in people with preexisting cardiovascular diseases; the relations between cardiovascular pathologies and neurodegenerative diseases at altitude; the effects of high-altitude exercise; and the putative cardioprotective mechanisms of hypobaric hypoxia.
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Affiliation(s)
- Robert T Mallet
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Johannes Burtscher
- Department of Biomedical Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
- Institute of Sport Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
| | - Jean-Paul Richalet
- Laboratoire Hypoxie & Poumon, UMR Inserm U1272, Université Sorbonne Paris Nord 13, Bobigny Cedex, F-93017, France
| | - Gregoire P Millet
- Department of Biomedical Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
- Institute of Sport Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, A-6020, Austria
- Austrian Society for Alpine and High-Altitude Medicine, Mieming, Austria
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Association of age and blood pressure among 3.3 million adults: insights from China PEACE million persons project. J Hypertens 2021; 39:1143-1154. [PMID: 33967218 DOI: 10.1097/hjh.0000000000002793] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the association between blood pressure (BP) with age and its heterogeneity across various sociodemographic subgroups in China. METHODS In this cross-sectional study, we analysed the data from nearly 3.3 million individuals aged 35-75 years from all 31 provinces in mainland China collected from September 2014 through August 2019. On the basis of possible combinations of eight characteristics and antihypertensive status, subgroups of at least 10 000 individuals were created and the age--blood pressure relationship was determined for each group. RESULTS The study included 3 291 058 participants (59.6% women), with a mean age of 55.8 ± 9.8 years. The prevalence of hypertension was 47.6%, of which 30.0% were taking antihypertensive medications. The mean SBP was 135.9 ± 20.2 mmHg. SBP increased at a mean unadjusted rate of 0.639 ± 0.001 mmHg/year. For 95% of the 25 145 subgroups, the SBP increased by 0.28--0.85 mmHg/year. The most common characteristics in the subgroups with the steepest association were female sex, rural area, low education, low-income family, Tibet region, and farmer occupation. The increase in SBP ranged from 0.13 to 0.41 mmHg/year for 95% of the treated subgroups and from 0.33 to 0.82 mmHg/year for 95% of the untreated subgroups. CONCLUSION Blood pressure is positively associated with age in this study, with almost three-fold variation across subgroups, indicating subgroup differences in biology, behaviour, or exposures. Antihypertension strongly blunts the association of age and blood pressure and diminishes the variation.
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Ciren W, Yu W, Nima Q, Xiao X, Zhou J, Suolang D, Li Y, Zhao X, Jia P, Yang S. Social capital and sleep disorders in Tibet, China. BMC Public Health 2021; 21:591. [PMID: 33765991 PMCID: PMC7992333 DOI: 10.1186/s12889-021-10626-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/15/2021] [Indexed: 12/30/2022] Open
Abstract
Objective Sleep plays an important role in the health and well-being of middle aged and elderly people, and social capital may be one of the important factors for sleep disorders. This study aimed to understand the relationship between social capital and sleep disorders in a unique region of China –Tibet that generally has the disadvantaged economic status compared to other parts of China. Methods The study was based on Tibetan data from The China Multi-Ethnic Cohort (CMEC) and was conducted from May 2018 to September 2019. A total of 3194 Tibetans aged > 50 were selected from the community population by multi-stage stratified cluster sampling. Social capital was measured using two validated health-related social capital scales, family/community and society.. Sleep disorders were measured as the presence of disorders of initiating and maintaining sleep, early morning awakening, or daytime dysfunction. Logistic regression models were applied to examine the association between social capital and sleep disorders. Results 39.9% (1271/3194) of the participants had sleep disorders. In addition, after controlling for all potential variables, family social capital was significantly negatively associated with sleep disorders (OR = 0.95, P < 0.05), while community and society social capital was not associated with sleep disorders. Then, when we did all the sex-stratified analyses, the significant association between social capital and sleep disorders was found only in women (OR = 0.94, P < 0.05), while no association was found in males; neither males nor females showed any association with community and society social capital. Conclusion Our study would help to better understand the extent of health inequality in China, and guide future interventions, strategies and policies to promote sleep quality in low-income areas, taking into account both the role of Tibetan specific cultural traditions, lifestyles and religious beliefs in social capital and the gender differences in social capital. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10626-x.
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Affiliation(s)
- Wangla Ciren
- Lhasa Chengguan District Center for Disease Control and Prevention, Lhasa, 850000, China
| | - Wanqi Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qucuo Nima
- Center for Disease Control and Prevention of Tibet autonomous region, Lhasa, 850000, China.
| | - Xiong Xiao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Junmin Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Deji Suolang
- Center for Disease Control and Prevention of Tibet autonomous region, Lhasa, 850000, China
| | - Yajie Li
- Center for Disease Control and Prevention of Tibet autonomous region, Lhasa, 850000, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peng Jia
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China.,International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China. .,International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.
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Geographic variations and potential macro-environmental exposure of hypertension: from the China hypertension survey. J Hypertens 2021; 38:829-838. [PMID: 31990899 DOI: 10.1097/hjh.0000000000002352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study aimed to investigate the spatial variation of hypertension (HTN) and the associations between the risk of HTN and altitude, longitude, latitude in Chinese population. METHODS The newest China Hypertension Survey (CHS) study, which used a nationally representative sample, was conducted between 2012 and 2015. A total of 451 755 participants aged at least 18 years from 262 county-level regions in 31 provinces were analyzed to explore the geographical variations of HTN prevalence at county-level. A total of 444 375 participants were included in two-level logistic regression model to examine the association between HTN risk and exposure to altitude, longitude, and latitude after adjusting for potential confounding variables at individual level. RESULTS The findings of spatial analysis indicated that there were remarkably high and low HTN prevalence zones. High HTN prevalence zones extended from parts of the southeast to northern China and the northeast. The risk of HTN increased with increasing longitude, with adjusted odds ratios (aORs, 95% confidence interval [CI]) of 2.08 (1.04--4.18), 2.21 (1.15--4.22), 2.54 (1.31--4.93), 2.59 (1.32--5.08), and 2.81 (1.12--7.08) for longitudes of 90-100°E, 100-110°E, 110-120°E, 120-130°E, and at least 130°E, respectively, with a significant dose--response relationship that HTN risks increase as longitude rises from 90°E to ≥130°E(Ptrend <0.001), compared with the longitude group of less than 80°E, consistent with the conclusion that geographical variations of high HTN prevalence zones by spatial analysis. CONCLUSION The findings of remarkably high HTN prevalence zones modified previous understandings about the regional difference of HTN distribution, and provide an important basis for future efforts to prevent and control HTN in different regions of China.
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Effect of One Night of Nocturnal Oxygen Supplementation on Highland Patients With OSA: A Randomized, Crossover Trial. Chest 2021; 160:690-700. [PMID: 33667495 DOI: 10.1016/j.chest.2021.02.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The treatment of OSA in highland residents is not established. RESEARCH QUESTIONS Does nocturnal oxygen supplementation (NOS) improve sleep-related breathing disturbances, nocturnal oxygenation, and cognitive performance in patients with OSA living at 3,200 m? STUDY DESIGN AND METHODS Forty patients with OSA permanently living in Shangri-La, China at 3,200 m (median age [interquartile range], 47.0 [44.0-53.0] years; oxygen desaturation index, 38.4/h [34.2/h-52.3/h]), were randomly assigned to receive nasal NOS and sham oxygen (ambient air), for one night each, at 2 L/min, in a crossover design, separated by a washout period of 2 weeks. During treatment nights polysomnography was performed, and further outcomes were evaluated the next morning. The primary outcome was the difference in apnea-hypopnea index (AHI) between nights with NOS and nights with sham oxygen. RESULTS During nights with sham oxygen, the median (interquartile range) total AHI was 43.4/h (31.1/h-67.5/h), the obstructive AHI was 41.9/h (28.5/h-66.8/h), and the central AHI was 0.6/h (0.1/h-1.3/h); blood oxygenation as determined by pulse oximetry (Spo2) was 87.0% (84.5%-89.0%). In intention-to-treat analysis, NOS decreased the total AHI by a median of 17.9/h (95% CI, 8.0/h-27.1/h; P < .001), through a reduction in obstructive AHI by 16.0/h (95% CI, 6.8/h-26.0/h; P < .001) and central AHI by 0.4/h (95% CI, 0.1/h-0.9/h; P < .001). NOS also increased Spo2 by 7.0% (95% CI, 6.0%-8.0%; P < .001). Heart rate during sleep and pulse rate in the morning after NOS were significantly reduced, but subjective sleep quality and cognitive performance showed no changes. INTERPRETATION In highland residents with OSA, NOS significantly improved sleep-related breathing disturbances and nocturnal oxygenation. NOS also reduced heart rate during sleep and morning pulse rate. If these beneficial effects are confirmed in longer term studies, NOS may be a treatment option for highland patients with OSA who cannot be treated by CPAP. TRIAL REGISTRY Chinese Clinical Trial Registry; No.: ChiCTR1800017715; URL: http://www.chictr.org.cn/showproj.aspx?proj=29768.
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Mehata S, Shrestha N, Ghimire S, Atkins E, Karki DK, Mishra SR. Association of altitude and urbanization with hypertension and obesity: analysis of the Nepal Demographic and Health Survey 2016. Int Health 2021; 13:151-160. [PMID: 32623453 PMCID: PMC7902681 DOI: 10.1093/inthealth/ihaa034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/14/2020] [Accepted: 06/09/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nepal's Himalayan range attracts mountaineers, climbers and tourists from all across the globe. Limited recent evidence suggests that exposure to hypoxia at a higher altitude may be a risk factor for hypertension and a protective factor for obesity. The existing urban-rural disparities in Nepal in health and economic resources may be anticipated in the burden of hypertension and obesity, two rapidly growing public health issues, but they remain largely unstudied. Therefore this study aims to assess the association of altitude and urbanization with hypertension and overweight/obesity in Nepal. METHODS Data on 10 473 participants from a nationally representative survey, the 2016 Nepal Demographic and Health Survey (NDHS), was used. The NDHS assessed/measured blood pressure, height, weight, urbanization and the altitude of participants' households by following standard procedures. Logistic and linear regression models were used to study the association of altitude (per 100 m increases) and urbanization with hypertension and obesity, or their continuous measurements (i.e. systolic and diastolic blood pressure [SBP and DBP, respectively] and body mass index [BMI]). RESULTS The prevalence of hypertension, overweight and obesity was 25.6%, 19.6% and 4.8%, respectively. After controlling for covariates, residents of metropolitan cities had a 30% higher prevalence of overweight/obesity (adjusted prevalence ratio 1.30 [95% confidence interval {CI} 1.11 to 1.52]) than their rural counterparts. For altitude, there was a marginally increased odds of hypertension and overweight/obesity with elevation. Consistently, DBP (β = 0.18 [95% CI 0.09 to 0.27]) and BMI increased with altitude (β = 0.11 [95% CI 0.08 to 0.13]). CONCLUSION Urbanization was positively associated with BMI, while altitude showed a marginally positive association with hypertension and overweight/obesity. Given the role of obesity and hypertension in the aetiology of other chronic diseases and subsequently associated mortality and health care costs, residents in urban areas and at higher altitudes may benefit from weight control interventions and BP monitoring, respectively.
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Affiliation(s)
- Suresh Mehata
- Ministry of Population and Health, Nepal Government, Kathmandu
| | - Nipun Shrestha
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia
| | - Saruna Ghimire
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA.,Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Emily Atkins
- George Institute for Global Health, University of New South Wales Sydney, Newtown, NSW, Australia
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Variation of vital signs with potential to influence the performance of qSOFA scoring in the Ethiopian general population at different altitudes of residency: A multisite cross-sectional study. PLoS One 2021; 16:e0245496. [PMID: 33539398 PMCID: PMC7861372 DOI: 10.1371/journal.pone.0245496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/30/2020] [Indexed: 12/05/2022] Open
Abstract
Introduction The physiological range of different vital signs is dependent on various environmental and individual factors. There is a strong interdependent relationship between vital signs and health conditions. Deviations of the physiological range are commonly used for risk assessment in clinical scores, e.g. respiratory rate (RR) and systolic blood pressure (BPsys) in patients with infections within the quick sequential organ failure assessment (qSOFA) score. A limited number of studies have evaluated the performance of such scores in resource-limited health care settings, showing inconsistent results with mostly poor discriminative power. Divergent standard values of vital parameters in different populations, e.g. could influence the accuracy of various clinical scores. Methods This multisite cross-sectional observational study was performed among Ethiopians residing at various altitudes in the cities of Asella (2400m above sea level (a.s.l.)), Adama (1600m a.s.l.), and Semara (400m a.s.l.). Volunteers from the local general population were asked to complete a brief questionnaire and have vital signs measured. Individuals reporting acute or chronic illness were excluded. Results A positive qSOFA score (i.e. ≥2), indicating severe illness in patients with infection, was common among the studied population (n = 612). The proportion of participants with a positive qSOFA score was significantly higher in Asella (28.1%; 55/196), compared with Adama, (8.3%; 19/230; p<0.001) and Semara (15.1%; 28/186; p = 0.005). Concerning the parameters comprised in qSOFA, the thresholds for RR (≥22/min) were reached in 60.7%, 34.8%, and 38.2%, and for BPsys (≤100 mmHg) in 48.5%, 27.8%, and 36.0% in participants from Asella, Adama, and Semara, respectively. Discussion The high positivity rate of qSOFA score in the studied population without signs of acute infection may be explained by variations of the physiological range of different vital signs, possibly related to the altitude of residence. Adaptation of existing scores using local standard values could be helpful for reliable risk assessment.
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Song C, Chongsuvivatwong V, Wangdui S, Mima D, Zhuoma C, Ji D, Luobu O, Sriplung H. Coverage and effectiveness of hypertension screening in different altitudes of Tibet autonomous region. BMC Public Health 2021; 21:33. [PMID: 33407265 PMCID: PMC7788880 DOI: 10.1186/s12889-020-09858-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Tibet is an autonomous region in China located around an average altitude of 4500 m above sea level. Since 2012 the local government of Tibet has been providing free physical examinations, including screening for hypertension. However, the coverage and effectiveness of this free program have not been uncovered. This study aims to assess the coverage and effectiveness of hypertension screening and management program in 3 altitude levels of Tibet, and also the determinants of the success of the screening program. METHODS A stratified cluster survey was conducted among 1636 residents aged 18 years or over in three different altitude areas in Tibet. We adjusted for age and sex based on national census data and used weighted logistic regression models to find factors associated with hypertension screening. RESULTS The coverage of the hypertension screening program evaluated by participation rate in the previous screening was 94.9%, while 24.7% (95% CI: 22.1-27.3%) of them were diagnosed with hypertension. Females and alcohol drinkers were more likely to be screened. Among those diagnosed with hypertension, 28.7% had it under control. High altitude areas had a high proportion of controlled hypertension. The overall rate of controlled hypertension in high, moderate and low altitude areas was 35.1% (95% CI: 24.8-45.3%), 32.7% (95% CI: 22.2-43.2%) and 23.7% (95% CI: 14.7-32.6%), respectively. Younger aged persons were more likely to have better control of their hypertension. CONCLUSIONS The coverage of hypertension screening in Tibet was high, especially in the low altitude areas. However, the effectiveness of hypertension control was low, indicating a need to implement the treatment adherence routines into the current screening interventions.
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Affiliation(s)
- Ci Song
- Medical College, Tibet University, Lhasa, 850002 China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand
| | | | - Suolang Wangdui
- Bomi county centers for disease control and prevention, Nyingchi, 860300 China
| | - Danzeng Mima
- Dagze district centers for disease control and prevention, Lhasa, 850100 China
| | - Cuoji Zhuoma
- Nagarze county centers for disease control and prevention, Lhokha, 851100 China
| | - D. Ji
- Medical College, Tibet University, Lhasa, 850002 China
| | - Ouzhu Luobu
- Medical College, Tibet University, Lhasa, 850002 China
| | - Hutcha Sriplung
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand
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Beatrice DA, Priyadarshini RD. Nutritional profile of Kolagur tribal women in Yercaud, Tamil Nadu, India: An exploratory study. INTERNATIONAL JOURNAL OF ADVANCED MEDICAL AND HEALTH RESEARCH 2021. [DOI: 10.4103/ijamr.ijamr_274_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cardiovascular risk factors in China: a nationwide population-based cohort study. LANCET PUBLIC HEALTH 2020; 5:e672-e681. [PMID: 33271080 DOI: 10.1016/s2468-2667(20)30191-2] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/23/2020] [Accepted: 08/17/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND It is estimated that 4 million deaths are due to cardiovascular diseases each year in China. Comprehensive understanding about modifiable risk factors and how the risk differs across regions is needed to inform public health policies. We aimed to examine the geographical profile of cardiovascular disease risk across China. METHODS In this study, we analysed data from a nationwide, population-based screening project, which covered 152 rural counties and 100 urban districts from 31 provinces in China. Between Sept 1, 2015, and Nov 30, 2019, standardised measurements were taken from participants aged 35-75 years who had lived in the region for at least 6 of the preceding 12 months to collect information on blood pressure, blood lipids, blood glucose, physical activity, tobacco smoking, alcohol use, overweight or obesity, and intake frequencies of fruits, vegetables, whole grains, legumes, and red meat. Individuals with a high risk of cardiovascular disease were identified according to medical history and WHO risk prediction charts. FINDINGS 983 476 individuals were included in this study. Among the participants included, 10·3% (95% CI 10·2-10·3) had a high cardiovascular disease risk after standardising age and sex, with a range of 3·1-24·9% across counties or districts. Among the seven regions in mainland China, the prevalence of high risk of cardiovascular disease was relatively high in northeast China (12·6% [12·4-12·8]) and north China (11·4% [11·3-11·6]), whereas it was low in south China (8·0% [7·8-8·2]). The geographical profiles of the 12 major cardiovascular disease risk factors were different. We found that the regions with high cardiovascular disease risk were facing challenges such as obesity and high blood pressure (north China) and consumption of unhealthy non-staple food (low intake of fruits and vegetables or high intake of red meat; northeast China). By contrast, south China-the region with the lowest cardiovascular disease risk-had the highest prevalence of unhealthy staple food (low intake of whole grains and beans), abnormal metabolism (glucose and lipid), and low physical activity in the country. INTERPRETATION Risk for cardiovascular diseases varies geographically, and the major contributing risk factors are different across regions in China. Hence, geographically targeted interventions are needed to mitigate the risk and reduce the burden in such a vast country. FUNDING Ministry of Science and Technology, Ministry of Finance, and National Health Commission of China.
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