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(Circulation. 2008;118:1558-1566.)
© 2008 American Heart Association, Inc.

Hypertension

Hypertension Subtype and Risk of Cardiovascular Disease in Chinese Adults

Tanika N. Kelly, MPH; Dongfeng Gu, MD, PhD; Jing Chen, MD, MSc; Jian-feng Huang, MD; Ji-chun Chen, MD; Xiufang Duan, MD; Xigui Wu, MD; C. Lillian Yau, PhD; Paul K. Whelton, MD, MSc; Jiang He, MD, PhD

From the Departments of Epidemiology (T.N.K., J.C., J.H.) and Biostatistics (C.L.Y.), Tulane University School of Public Health and Tropical Medicine, and Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, La; Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (D.G., J.-f.H., J.-c.C., X.D., X.W.); and President’s Office, Loyola University Medical Center, Maywood, Ill (P.K.W.).

Correspondence to Jiang He, MD, PhD, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1430 Tulane Ave SL18, New Orleans, LA 70112 (e-mail jhe{at}tulane.edu); or Dongfeng Gu, MD, MSc, Division of Population Genetics and Prevention, Cardiovascular Institute and Fu Wai Hospital, 167 Beilishi Rd, Beijing 100037, China (e-mail gudongfeng@vip.sina.com).

Received June 23, 2007; accepted December 28, 2007.

Background— We examined the relationship between hypertension subtype and cardiovascular disease incidence and mortality in Chinese adults.

Methods and Results— We conducted a prospective cohort study in a nationally representative sample of 169 871 Chinese men and women aged 40 years. Data on systolic (SBP) and diastolic blood pressure (DBP) and other variables were obtained at a baseline examination in 1991 with the use of standard protocols. Follow-up evaluation was conducted in 1999–2000, with a response rate of 93.4%. Hypertension subtypes were defined as combined systolic and diastolic hypertension (SBP 140 and DBP 90 mm Hg), isolated systolic hypertension (SBP 140 and DBP <90 mm Hg), isolated diastolic hypertension (SBP <140 and DBP 90 mm Hg), and 2 categories of treated hypertension (SBP <140 and DBP <90 mm Hg or SBP 140 and/or DBP 90 mm Hg). After participants with missing BP values were excluded, 169 577 adults were included in the analyses. Compared with normotensives, relative risks (95% CIs) of cardiovascular disease incidence and mortality were 2.73 (2.60 to 2.86) and 2.53 (2.39 to 2.68) for combined systolic and diastolic hypertension, 1.78 (1.69 to 1.87) and 1.68 (1.58 to 1.78) for isolated systolic hypertension, 1.59 (1.43 to 1.76) and 1.45 (1.27 to 1.65) for isolated diastolic hypertension, 2.01 (1.64 to 2.48) and 1.61 (1.28 to 2.03) for treated hypertension with SBP <140 and DBP <90 mm Hg, and 3.37 (3.07 to 3.69) and 2.88 (2.60 to 3.19) for treated hypertension with SBP 140 and/or DBP 90 mm Hg, respectively, after adjustment for important covariables.

Conclusions— Our results indicate that all hypertension subtypes are associated with significantly increased risk of cardiovascular disease in Chinese adults. Primary prevention of hypertension should be a public health priority in the Chinese population.

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CLINICAL PERSPECTIVE

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Clinical Summaries
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