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1、Association of Blood Pressure with Left Ventricular Mass in Untreated Hypertensives in Rural Yunnan Province 云南的农村的血压和左心室的粒量的关系A Akasheh, Y Wu武阳丰, Y Li李易, LD Dustin, ND Wong, JM Gardin, SP Azen, RC Detrano狄家诺. University of California, Irvine加州大学, Peking University School of Public Health北京大学公共卫生学院,
2、Yunnan Province Second Peoples Hospital云南省第二人民医院, China California Heart Watch中加心脏检查机构American Journal of Hypertension, 2009China27.5Rural ChinaOne eigth of the worlds population800000000One eigth of the worlds population八分之一Prevalence of Hypertension in China 中国高血压的患病率a: Proceedings of the National
3、 Cardiovascular Diseases Conference, 1959. Peoples Health Publisher, 1960, Beijing. b: Wu YK, et al: Nation-wide hypertension screening in China during 1979-1980. Chin Med J, 1982;95:101-108. c: Wu XG, et al: Prevalence and development trends of hypertension in China. Chin J Hypertension, 1995;3(Sup
4、pl.):7-13. d: the National Nutrition and Health Survey in 2002 （material for the Press Conference of the State Council Information Office）: According to national census data in 1964 and WHO diagnosis criteria in 1978.#: SBP141 mmHg or DBP91mmHg, without consideration on use of medication.*: SBP140 m
5、mHg or DBP90 mmHg or on medication in 2 weeks.Methods 方法 Study Sample Design:研究采样 Random cluster sampling to select 10 villages 随机 抽样10村子 50 residents between the ages of 50 and 70 years from each village。每个村子50人 490 men and women. 490人 344 available, without other confounding vascular disease (stro
6、ke, MI, severe valve disease)344接受探 访的（没有脑梗没有心肌梗）Methods 方法 Smoking, alcohol use, medication use, hypertension, hyperlipidemia, and diabetes.抽烟喝酒服药高血脂糖尿病的病 历 Blood pressure measured three times三 次量血压 Height and weight.身高体重Methods 方法 Cardiac Ultrasound - Philips Optigo portable ultrasound, 2 -5 megah
7、ertz transducer. Parasternal long axis view.心脏 超声波（Philips Optigo)2-5MHz 探头，胸骨旁心长轴 End-diastolic 舒张期 Inter-ventricular septal wall thickness (IST)心室隔厚度 Left ventricular posterior wall thickness (PWT)心左室后 壁厚度 Left ventricular diastolic internal diameter (LVID) 心左室 内径 Four measurements each 四个测量Hand H
8、eld Ultrasound Machine37PWT = 1.6LVID = 4.6IST = 1.8Devereux FormulaDevereux 公式 LVM (g) = 0.8 x 1.04 (IST + LVID + PWT)3 - ( LVID)3 + 0.6.Methods 方法 Average of 3 SBP and DBP measurements. 三个收缩压和三个舒张压 的测量的平均值 Average four estimates of LVM.四个心左 室测量的平均值 Calculate left ventricular mass index: LVMI = LVM
9、/BSA.心左室指数368 participants consented. 368 参与者同意 7 excluded because of past stroke or myocardial infarction.7个中风和心肌梗除外 9 (2.4%) excluded because of ongoing medical treatment for hypertension.9个服降 压药治疗除外 8 excluded because of inadequate ultrasound images.8个超声波图像不清楚除外344 participants not undergoing tre
10、atment for hypertension 344 名无服降压药的参与者Age 年龄57.8 (5.8) Males 男48.3%BMI: 体重指数22.6kg/m2 (2.7)Present smoker 抽烟38.4 High cholesterol 高血脂0.9% Diabetes 糖尿病1.2% SBP 收缩压130 mm Hg (26.3) DBP 舒张压 75 (12.5)LVM 心左室粒量(g) 138.3 g (40.4)收缩压心左室粒量指数心左室粒量指数舒张压血压种类心左室粒量指数LVMI and Blood Pressure (SBP and DBP) Adjustin
11、g for Covariates (age, gender, BMI) 心左室粒量指数和血压条件共变量（年龄性别BMI)Coefficient (SE) p Model 1 SBP （收缩压）0.379 (0.043) 0.0001 Age 0.322 (0.195) 0.10 BMI 0.904 (0.411) 0.03 Male Gender 5.890 (2.179) 0.007Model 2 DBP （舒张压）0.714 (0.092) 0.0001 Age 0.653 (0.194) 0.0008 BMI 0.854 (0.424) 0.04 Male Gender 4.447 (2
12、.228) 0.05Conclusions 定论 High prevalence of untreated HTN (30%) in rural Yunnan。云南省的农村的高血压的患病率很高 Strong Linear Relationship between blood pressure and LV Mass. 血压和心左室的关系很大 Untreated diastolic blood pressure may have a greater effect on LV mass.未经治疗的舒张压的影 响比收缩压更大 Public health implications of uncontr
13、olled blood pressure in rural China are substantial.未经治疗的 血压的公共卫生的意味是实效Salt in China1.46 million metric tons per year2.Double production and increase in imports in past 20 years; Plans to continue increase. 3.Now higher than the US production4.Industry monopoly by government5.More consumed in North
14、than SouthSalt Production in ChinaSo salt production and increased disease incidence increase together with time. So what?Systolic Blood PressureSodium ExcretionCheng (2006)So blood pressure increases with salt consumption. So what?Systolic Blood PressureSodium ExcretionCVD and Salt in China 1. Incr
15、easing together 2. Geographically related 3. Mechanism? 4. Does decreasing salt ingestion decrease risk in China?Why is salt bad for you? Increase in blood pressure due to fluid retention and deleterious renal-endocrine effects. Independent effect on Left Ventricular Mass.Does decreasing salt ingestion decrease risk?The China Salt Substitute Study Collaborative Group. (2007). Preliminary Data from Survey of Hypertension and LV Mass in Yunnan Farmers 173 men and 188 women.Mean age was 57.7 +/- 5.7 years. Prevalence of Hypertension 32% Untreated Hypertension: 96%Preliminary Data fro
