Relationship between hypertension and cardiovascular and cerebrovascular diseases among adult residents in Hainan Province: A prospective cohort study

WANG Xiao-huan1 HU Xi-min1 GUO Yu2 BIAN Zheng2 LI Li-ming3 CHEN Zheng-ming4 LI Hui-mei5 LI Yi-Lei5 FU Zhi-fang5

(1.Institute of Tropical and Chronic Diseases, Hainan Provincial Center for Disease Control and Prevention, Haikou, Hainan Province, China 570203)
(2.Chinese Academy of Medical Sciences)
(3.School of Public Health, Peking University)
(4.Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford)
(5.Center for Disease Control and Prevention, Meilan District, Haikou City)

【Abstract】 Objective To explore the relationship of hypertension with cardiovascular and cerebrovascular diseases among adult residents in Hainan Province and to provide references for the prevention and control of cardiovascular and cerebrovascular diseases. Methods We conducted a prospective cohort study among 30 000 residents aged 30–79 years selected with cluster sampling in Meilan District of Hainan Province. The baseline survey for the study was performed from June 2005 to July 2008 and then a long-term follow-up was conducted among the residents. Univariate and multivariate Cox regressions were used to analyze the association of hypertension with cardiovascular and cerebrovascular diseases among the residents. Results Among all the residents, 309 deaths were observed and only 3 (0.01%) were lost to follow-up till December 31, 2013; and the follow-up time ranged from 0 to 9 years and the mean time was 6.7 ± 1.4 years, with a total of 175 667 person years of follow-up. By the end of the follow-up, the incidents and accumulated incidence rate were 2 824 and 10.8% for cardiovascular diseases, 669 and 2.6% for ischemic heart disease, 2 059 and 7.8% for cerebrovascular diseases, 91 and 0.4% for haemorrhagic stroke, and 1 716 and 6.5% for ischaemic stroke, respectively. Multivariate Cox regression analysis indicated that compared with the residents with normal blood pressure, the residents with hypertension had significantly increased risks of cardiovascular and cerebrovascular diseases after adjusting for gender, age, education, marital status, smoking, alcohol drinking, diabetes, familial cardiovascular and cerebrovascular disease history, body mass index (BMI), and other confounding factors, with the hazard ratios (HRs) (95% confidence interval [95% CI]) of 2.76 (1.77–4.29) for haemorrhagic stroke, 1.25 (1.06–1.49) for ischemic heart disease, 1.19 (1.10–1.30) for cardiovascular disease, 1.15 (1.04–1.27) for cerebrovascular disease, and 1.11 (1.00–1.23) for ischemic stroke, respectively. The residents with isolated systolic hypertension had significantly increased risks of haemorrhagic stroke (HR = 1.79, 95% CI: 1.07–3.00), ischemic heart disease (1.23, 1.01–1.50), and cardiovascular disease (1.15, 1.04–1.27). The residents with systolic-diastolic hypertension had significantly increased risks of haemorrhagic stroke (HR = 3.84, 95% CI: 2.14–6.88), ischemic heart disease (1.45, 1.10–1.91), cardiovascular disease (1.32, 1.14–1.51), ischaemic stroke (1.30, 1.09–1.54), and cerebrovascular disease (1.29, 1.10–1.52). Conclusion Hypertension, especially systolic-diastolic hypertension, increases the risks of cardiovascular and cerebrovascular diseases among adult community residents in Hainan Province.

【Keywords】 hypertension; cardiovascular and cerebrovascular diseases; incidence; relationship; prospective cohort study;

【Funds】 National Key Research and Development Program of China (2016YFC0900500) Wellcome Trust of the United Kingdom (088158/Z/09/Z)

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(Translated by ZHAO B)


    [1] Ma LY, Wu YZ, Wang W, et al. Interpretation of the report on cardiovascular diseases in China (2017) [J]. Chinese Journal of Cardiovascular Medicine, 2018, 23 (1): 3–6 (in Chinese).

    [2] Disease Prevention and Control Bureau of National Health and Family Planning Commission of China. 中国居民营养与慢性病状况报告 (2015) [M]. Beijing: People’s Medical Publishing House, 2015: 33–35 (in Chinese).

    [3] Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 [J]. Lancet, 2012, 380 (9859): 2095–2128.

    [4] Wang HB, Li YL, Wang LQ, et al. Stroke prevalence and its risk factors among population aged 40 years and over in Haidian District, Beijing [J]. Chinese Journal of Public Health, 2014, 30 (5): 583–585 (in Chinese).

    [5] Zhu WH, Huang JY, Guan YT. Risk factors of stroke among urban community residents aged 50 years and older in Shanghai: a cross-sectional study [J]. Chinese Journal of Public Health, 2015, 31 (3): 276–279 (in Chinese).

    [6] Li LM, Lv Y, Guo Y, et al. The China Kadoorie Biobank: related methodology and baseline characteristics of the participants [J]. Chinese Journal of Epidemiology, 2012, 33 (3): 249–255 (in Chinese).

    [7] Li L, Guo Y, Chen Z, et al. Epidemiology and the control of disease in China, with emphasis on the Chinese Biobank Study [J]. Public Health, 2012, 126 (3): 210–213.

    [8] Chen Z, Lee L, Chen J, et al. Cohort profile: the Kadoorie Study of Chronic Disease in China (KSCDC) [J]. Int J Epidemiol, 2005, 34 (6): 1243–1249.

    [9] Wang X, Lv Y, Guo Y, et al. Regional differences in adults’ smoking pattern: findings from China Kadoorie Biobank study in 10 areas in China [J]. Chinese Journal of Epidemiology, 2015, 36 (11): 1200–1204 (in Chinese).

    [10] National Center for Cardiovascular Diseases. 职业人群高血压规范化管理效果评价实施方案 [S]. Beijing: National Center for Cardiovascular Diseases, 2012 (in Chinese).

    [11] Lv Y, Guo Y, Bian Z, et al. Regional differences in patterns of alcohol consumption: findings from the China Kadoorie Biobank study on half a million people from 10 regions [J]. Chinese Journal of Epidemiology, 2014, 35 (8): 875–881 (in Chinese).

    [12] Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 Compendium of Physical Activities: a second update of codes and MET values [J]. Med Sci Sports Exerc, 2011, 43 (8): 1575–1581.

    [13] Du HD, Bennett D, Li LM, et al. Physical activity and sedentary leisure time and their associations with BMI, waist circumference, and percentage body fat in 0.5 million adults: the China Kadoorie Biobank study [J]. Am J Clin Nutr, 2013, 97 (3): 487–496.

    [14] Department of Disease Control, National Health Commission of the People’s Republic of China. 中国成人超重和肥胖症预防控制指南 [M]. Beijing: People’s Medical Publishing House, 2006 (in Chinese).

    [15] Writing Group of Chinese Guidelines for the Management of Hypertension. 中国高血压防治指南2010 [J]. Chinese Journal of Cardiology, 2011, 39 (7): 579–616 (in Chinese).

    [16] National Basic Public Health Service Project Hypertension Management Office at the Basic Level. 国家基层高血压防治管理指南 [J]. Chinese Circulation Journal, 2017, 32 (11): 1041–1048 (in Chinese).

    [17] Chinese Diabetes Society. 中国2型糖尿病防治指南(2017年版) [J] Chinese Journal of Diabetes, 2018, 10 (1): 4–67 (in Chinese).

    [18] Yan L, Cao Y, Wang QS, et al. Influencing factors of stroke in adult hypertension patients: a Cox regression analysis [J]. Chinese Journal of Public Health, 2016, 32 (6): 748–752 (in Chinese).

    [19] Tang LY, Zhou YH, Pan YZ, et al. Relationships between metabolic syndrome and its components and incidence of stroke in Mongolian population: a cohort study [J]. Chinese Journal of Public Health, 2016, 32 (8): 1045–1049 (in Chinese).

    [20] Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [J]. J Am Coll Cardiol, 2017, 1097 (17): 41519–41521.

    [21] Rapsomaniki E, Timmis A, George J, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people [J]. Lancet, 2014, 383 (9932): 1899–1911.

    [22] Guo X, Zhang X, Guo L, et al. Association between pre-hyper tension and cardiovascular outcomes: a systematic review and meta-analysis of prospective studies [J]. Curr Hypertens, 2013, 15 (6): 703–716.

    [23] Zou J. Overview of hypertension and risk of cardiovascular diseases [J]. Cardiovascular Disease Electronic Journal of Integrated Traditional Chinese and Western Medicine, 2016, 4 (12): 127–128 (in Chinese).

    [24] Hisatomi A, Yoshitaka M, Tai HL, et al. Effects of prehypertension and hypertension subtype on cardiovascular disease in the Asia Pacific Region [J]. Hypertension (Dallas, Tex.: 1979), 2012, 59 (6): 1118–1123.

    [25] Wang K. A cohort study on the relationship of hypertension subtype and the incidence of stroke in Mongolian population [D]. Suzhou: Soochow University, 2014 (in Chinese).

This Article


CN: 21-1234/R

Vol 35, No. 08, Pages 986-991

August 2019


Article Outline


  • 1 Subjects and methods
  • 2 Results
  • 3 Discussion
  • References