481 JOURNAL OF SCIENCE, Hue University, N 0 61, 2010 STUDY OF THE HYPERTENSION SITUATION AT DONGHA TOWN, QUANGTRI PROVINCE IN 2008 Le Thi Thu Trang,Tran Kim Phung Quang Tri Health Service SUMMARY Hypertension has been a leading risk factor of cardiovascular disease (CDV) and a main cause of deaths from heart complications as well. The prevalence rate of hypertension has been increasing throughout the world over and also in Vietnam, yet no research into this issue has ever been carried out in Quangtri. An investigation named "A Study of the hypertension situation at Dongha town, Quangtri in 2008" was conducted accordingly.The study aimed to investigate the rate of hypertension in Dongha, Quangtri and explore the relationship between hypertension and several CVD risk factors in Dongha, Quangtri. Study design: A cross-sectional investigation and analysis. Subjects: 461 men and women aged ≥ 25 years residing at Dongha, Quang Tri. Methods: All enrolled participants underwent measurements of height, weight, waist and BMI calculation, blood pressure, and were quantitatively tested for a fasting venous blood glucose in the morning, and lipid components. Evaluations were based on criteria issued by the WHO, NCEP ATPIII and the Vietnam national heart association. Results: The hypertension rate was 26.68% and increased with age, the age groups of 25-34, 35-44, 45-54, 55-64 and ≥ 65 accounted for 7.5%, 15.6%, 30.3%, 38.4% and 42.5% respectively. Risk factors related to hypertension included: overweight (OR = 2.19), android obesity (OR = 2.34), dyslipidemia of at least one lipid component (OR = 2.19), hypercholesterolemia (OR = 2.53), elevated plasma LDL-C (OR = 2.15), and hypertriglyceridemia (OR = 2.25). Diabetes mellitus, fasting glucose intolerance (FGI), and general raised blood glucose (BG) were all evidently correlated to hypertension. The rate of hypertension in those who had elevated levels of BG (with BG ≥ 6.1mmol/l) was 41/107 = 38.3%, those who were diabetic being 23/56 = 41%, and those who suffered from FGI being 18/41 = 35.3%. Conclusions: the high rate of hypertension was similar to other regions throughout the country, and the rate obviously increased with age, overweight, android obesity, metabolic dyslipidemia, hyperglycemia, and diabetes. 1. Introduction Cardiovascular disease (CVD) is the cause of one third of all deaths in the world,and increasingly poses a health burden on the population. Hypertension (HT) has been a leading risk factor of CVD and a main cause of deaths from heart complications 482 such as stroke, myocardial infarction, heart failure, and renal failure. While lifespans, overweight and obesity have been increasing and socio-psychological events have begun to have stronger effects on people's lives, the prevalence rate of HT continued to rise in the population. Moreover, although risk factors of uncontrolled HT were identified, HT itself was insufficiently managed and treated in almost all patients, thus giving rise to the high rate of cardiovascular events in the majority of treated or untreated hypertensive persons. In Vietnam, the prevalence rate of HT was 27.2% in 2008, and understanding and management of HT were to a certain extent restricted. In our home province Quangtri, no investigation on HT has been carried out so far. Objectives of the study are to investigate the rate of hypertension in the population of Dongha, Quangtri and reveal the relationship between hypertension and several risk factors of CVD at Dongha, Quangtri. 2. Methods 2.1. Subjects: 461 men and women aging ≥ 25 years and residing at Dongha, Quangtri 2.2. Methods Design: cross-sectional investigation and analysis, simple random sampling. Diagnosis and classification of HT according to JNC VI. All enrolled participants underwent measurements of height, weight, waist and body mass index(BMI) calculation, and were quantitatively tested for morning fasting venous blood glucose, and lipid components. Evaluations were based on criteria issued by WHO, NCEP ATPIII, WPRO and the Vietnam national heart association. Collected data were statistically analysed. 3. Results 3.1. Rate of hypertension Table 1. General rate of Hypertension in Dongha to compare with other region and country Places n HT Percentage p Dongha, Quangtri,Vietnam (2008) 461 123 26.68 Khanhhoa, Vietnam (2004) [1] 856 204 23.83 > 0.05 Vietnam (2008) [5] 9797 2661 27.2 > 0.05 Prevalence rate of HT at Dongha was similar to other regions in Vietnam. 483 Table 2. Hypertension classification Blood pressure (mm Hg) Dongha Vietnam p Normal: < 130/< 85 278/461 (60.3%) 6244/9797 (63.73%) > 0.05 High normal: 130-139/85-89 60/461 (13%) 1260/9797 (12.9%) > 0.05 HT Stage 1: 140-159/90-99 69/461 (14.97%) 1346/9797 (13.8%) > 0.05 Stage 2: 160-179/100- 109 40/461 (8.68%) 555/9797 (5.7%) < 0.005 Stage 3: 180/ 110 14/461 (3.04%) 325/9797 (3.3%) > 0.05 Total 461 (100%) 9797 (100%) Rates of HT in stages were the same as other places in Vietnam. 3.2. Relationship between HT and other cardiovascular risk factors 3.2.1. Relationship between HT and anthropometric risk factors Table 3. Gender Male Female p Normal n 116 160 < 0,05 Percentage (%) 55.24 63.75 High normal N 30 32 > 0,05 Percentage (%) 14.29 12.75 HT Stage 1 n 35 34 > 0,05 Percentage (%) 16.67 13.35 Stage 2 N 23 17 > 0,05 Percentage (%) 10.95 6.77 Stage 3 N 6 8 > 0,05 Percentage (%) 2.86 3.19 484 Subtotal N 64 59 < 0,05 Percentage (%) 30.5 23.5 Total 210 251 HT was significantly higher in men than in women (30.5% vs. 23.5%) Table 4. Aging groups Age groups (year) n % Normal BP High normal BP HT Stage 1 Stage 2 Stage 3 Subtotal 25-34 93 20,2 78 (83.9%) 8 (8.6%) 6 (6.5%) 0 1 7 (7.5%) 35-44 90 19,5 67 (74.4%) 9 (10%) 12 (13.3%) 1 1 14 (15.6%) 45-54 99 21,5 59 (59.6%) 10 (10.1%) 16 (16.1%) 11 (11.1%) 3 30 (30.3%) 55-64 99 21,5 46 (46.5%) 16 (16.2%) 19 (19.2%) 14 (14.1%) 5 38 (38.4%) 65 80 17,4 28 (35%) 17 (21%) 16 (20%) 14 (17.5%) 4 34 (42.5%) Total 461 100% 278 (60.3%) 60 (13%) 69 (15%) 40 (8.7%) 14 (3%) OR(95%CI) Dongha 1.82 (1.48-2.23) Vietnam 1.39 (1.176-1.592) p Dongha <0.001 Vietnam <0.001 Rates of HT and severe HT both increased on aging. Table 5. Body mass index (BMI) BMI HT (n) Normal BP (n) Total < 23 67 277 344 23 56 61 117 Total 123 338 461 485 2 35.96 OR (95%CI) Dongha 3.8 (2.45-5.87) Vietnam 1.82 (1.656-1.988) p Dongha < 0.001 Vietnam 0,001 Overweight (BMI 23) was significantly associated with HT. Table 6. Android obesity HT Normal BP Total Android obesity 39 56 95 Normal 84 282 366 Total 123 338 461 2 12.63 OR (95%CI) 2.34 (1.46-3.37) P < 0.001 Android obesity was significantly associated with HT. 3.2.2. Relationship between HT and dyslipidemia Table 7. At least one abnormal lipid component HT Normal BP Total Yes 103 237 340 No 20 101 121 Total 123 338 461 2 8,64 OR (95%CI) Dongha 2.19 (1.30-3.71) Vietnam 8.31 (1.95-35.39) P Dongha < 0.005 Vietnam 0.004 Dyslipidemia of at least one component was significantly associated with HT. 486 Table 8. Elevated total cholesterolemia HT Normal BP Total Yes 58 88 146 No 65 250 315 Total 123 338 461 2 18.59 OR (95%CI) Dongha 2.53 (1.66-3.87) Vietnam 2.28 (1.492-3.479) P Dongha < 0.001 Vietnam < 0.001 Hypercholesterolemia was significantly associated with HT Table 9. Elevated lower density lipoprotein – cholesterol(LDL-C) HT Normal BP Total Yes 40 62 102 No 83 276 359 Total 123 338 461 2 10.52 OR (95%CI) Dongha 2.15 (1.35-3.4) Vietnam 1.49 (1.145-1.936) P Dongha < 0.005 Vietnam 0.003 Elevated LDL-C was significantly associated with HT Table 10. Reduced high density lipoprotein cholesterol (HDL-C) HT Normal BP Total Yes 56 141 179 No 67 197 246 Total 123 338 416 2 0.54 487 OR (95%CI) Dongha 1.17 (0.77-1.77) Vietnam 1.19 (0.663-2.235) P Dongha > 0.05 Vietnam 0.59 Reduced HDL-C was not a risk factor of HT. Table 11. Elevated triglyceridemia HT Normal BP Total Yes 78 147 225 No 45 191 336 Total 123 338 461 2 14,33 OR (95%CI) Dongha 2.25 (1.48-3.43) Vietnam 1.55 (1.554-2.122) P Dongha < 0.001 Vietnam 0.008 Elevated triglyceridemia was significantly associated with HT 3.3. Relationship between hypertension with elevated blood glucose Table 12. Relationships between hypertension and diabetes (DM) and fasting glucose intolerance (FGI) HT DM and FGI DM FGI Yes No Yes No Yes No Yes 41 82 23 100 18 105 No 66 272 33 305 33 305 OR (95%CI) 2.06 (1.3÷3.25) 2.13(1.2÷3.76) 1.58 (0.68÷2.92) p < 0.005 < 0.05 > 0.05 HT was significantly correlated with elevated blood glucose (DM and FGI) and DM; but not with single FGI. Prevalence rates of HT in elevated blood glucose, DM and FGI persons were respectively 38.3%, 41% and 35.3%. 488 4. Discussions Prevalence the rate of HT in persons 25 years at Dongha (26.7%) was relatively similar to other regions in Vietnam. Rates of stage-1, -2 and -3 HT were 15%, 8.7% and 3% respectively, and similar to those in Vietnamese people [5]. Gender: HT was significantly higher in men than in women (30.5% vs. 23.5%), but there was no difference between the two in each stage of classification [1], [5]. Age: The rate of HT increased on aging, and age groups of 25-34, 35-44, 45-54, 55-64 and 65 respectively accounted for 7.5%, 15.6%, 30.3%, 38.4% and 42.5%. These figures were relatively similar to those in Pham Gia Khai's and Phan Long Nhon's (Binh Dinh) studies [5]. The rate of severe HT, likewise, increased with age (stage-1 HT was primarily seen in those < 45 years, while stage-2 HT in those > 45 years). The rate of HT was considerably high in working age groups. Especially in the still very young age group of 25-34, the rates of HT mounted up to 7.5%, not including 8.6% of which had high normal BP- which may cause injuries to target organs and progress to real HT. BMI: Overweight (BMI 23) was significantly associated with HT (OR = 3.8, 95%CI = 2.45-5.87). Android obesity: Android obesity was also significantly associated with HT. The rate of HT in those with android obesity was 39/95 = 41.05%, while in those without android obesity 84/366 = 22.95%. Sanjay Vikrant proved in his study [10] that HT was more likely detected in obese persons than in people with normal BMI, and the higher the BMI, the higher the rate of HT. Dyslipidemia: Dyslipidemia was significantly associated with HT. The rate of HT in those with dyslipidemia of at least one component was 30%, while in others with normal lipid levels 16.5%. The rate of HT in those with hypercholesterolemia was 58/146 = 39.7%, while in the others with normal cholesterolemia it was 65/315 = 20.6%. Kaplan M.N. suggested that cholesterolemia was often elevated in hypertensive persons, for hypercholesterolemia evidently injures the intima-dependent vasodilatory mechanism [7]. Rates of HT in those with and without elevated LDL-C were 40/102 = 39.2% and 83/359 = 23.1%, respectively. Reduced HDL-C was not a risk factor of HT. Rates of HT in those with and without reduced HDL-C were approximately the same (31.3% vs. 27.2%, respectively). Rates of HT in groups with hypertriglyceridemia and with normal 489 triglyceridemia were 78//225 = 34.7% and 45/336 = 13.4% respectively. Diabetes mellitus and fasting glucose intolerance: Fasting blood glucose levels 6.1mmol/l were significantly associated with HT. The rate of HT in those with fasting blood glucose levels 6.1mmol/l was 41/107 = 38.3%, in diabetics being 23/56 = 41%, in those with FGI being 18/41 = 35.3%. Sanjay Vikrant [10] and Kaplan M.N. [7] supposed that insulin resistance and elevated blood glucose were related to HT. The NHANES III study reported 71% of diabetics had HT [7]. 5. Conclusions 5.1. Rate of HT was 26.68%. 5.2. Rates of HT in age groups of 25-34, 35-44, 45-54, 55-64 and 65 respectively accounted for 7.5%, 15.6%, 30.3%, 38.4% and 42.5%. 5.3. Risk factors associated with HT: Overweight (OR=3.8, 95%CI = 2.45-5.87, p<0.001), android obesity (OR = 2.34, 95%CI=1.46-3.37, p < 0.001), Dyslipidemia of at least one component (OR = 2.19, 95%CI= 1.3-3.71, p < 0.005), hypercholesterolemia (OR = 2.53 95%CI = 1.66-3.87, p < 0,001), elevated LDL-C (OR = 2.15, 95%CI =1.35-3.4, p < 0.005) and hypertriglyceridemia (OR = 2.25, 95%CI = 1.48-3.43, p < 0.001). 5.4. DM, elevated blood glucose of 6.1 mmol/l were obviously associated with HT and rates of HT in these two circumstances were 41% and 38.3%, respectively. REFERENCES 1. Tran Van Huy, Truong Tan Minh (2004), Epidemiology of main cardiovascular risk factors in adults in Khanh Hoa province, Journal of Vietnam Cardiology, No. 37/2004, 580-596. 2. Huynh Van Minh, Pham Gia Khai, Nguyen Huy Dung, ,(2008), Vietnam heart association recommendation on diagnosis, treatment and prevention of hypertension in adults, Recommendations on cardiovascular and metabolic diseases, 235-294. 3. Huynh Van Minh, Đoan Phuoc Thuoc, , (2008), Epidemiological features of metabolic syndrome in the Thua Thien-Hue population and in high risk subjects, Practical medicine, No. 616-617, 594-609. 4. Phan Long Nhon (2007), Study on hypertension situation in adults in northern Binh Dinh province, Journal of Vietnam Cardiology, No. 47, Aug 2007, 31-38. 5. Pham Gia Khai (2008), Epidemiology of hypertension in Vietnam, Reported at 17 th ASEAN cardiology conference. 490 6. Burt VL, Whelton P, Roccella EJ, , (1995) Prevalence of hypertension in the US adult population. Results from the third National Health and Nutrition Examination Survey, Hypertension, 1995 mar:25(3):305-13. 7. Kaplan MN, System Hypertension: Mechanism and diagnosis, Heart disease - chapter 37, 2005. 8. Lip G.Y.H, Hall J.E, Comprehensive Hypertension, Mosby Elsevier, (2007). 9. The Joint National Committee, The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of high blood pressure, (2004). 10. Vikrant S, Tiwari SC, Essential Hypertension - pathogenesis and pathophysiology, Journal, Indian Academy of Clinical Medicine vol.2, No.3: 2001, 140-161.