Comparative analysis of blood pressure distribution and prevalence in different altitudes regions between Tibetan and other ethnicities in Yunnan Province
-
摘要:
目的 通过对云南省不同海拔地区藏族和其他民族居民的血压分布及高血压患病情况进行对比分析，为高原人群的高血压精准防控提供科学依据。 方法 2020―2021年，采用多阶段分层整群随机抽样方法，将云南省迪庆藏族自治州香格里拉市海拔≥2 500 m的建塘镇、小中甸镇以及海拔 < 2 500 m的五镜乡、金江镇等4个乡镇作为调查点。抽取1 549名≥18岁常住居民进行问卷调查、体格检查和血生化检查，采用χ2检验分析不同海拔条件下不同民族居民血压水平分布及高血压患病情况，采用多因素非条件logistic回归分析模型分析不同海拔人群高血压患病影响因素。 结果 海拔≥2 500 m组的高血压患病率高于 < 2 500 m组(P=0.002)。藏族居民平均收缩压水平比汉族居民高5.29 mmHg(P < 0.001)。海拔 < 2 500 m组的藏族居民高血压患病率高于同等海拔条件的其他民族(P < 0.017)，但海拔≥2 500 m组的藏族居民高血压患病率低于同等海拔条件的汉族及其他民族(均P < 0.017)。不同海拔条件的藏族人群高血压患病率及平均收缩压和舒张压水平差异均无统计学意义(均P>0.05)。藏族与海拔之间对高血压患病风险有负向交互作用。居住在海拔≥2 500 m组居民与海拔 < 2 500 m组相比，有更多的高血压危险因素。 结论 随海拔升高，汉族及其他民族居民高血压患病率增加。藏族对于高原及不同海拔的血压变化表现出更强的适应性。 Abstract:Objective This study aims to comparatively analyse the risk of hypertension in Tibetans and other ethnicities at different altitudes regions in Yunnan Province, and to provide a scientific basis for the control of hypertension among people living at high altitudes. Methods During 2020-2021, a multistage stratified cluster random sampling method was used to select four townships in the Diqing Tibetan Autonomous Prefecture, Shangri-La City, Yunnan Province as survey points. These included Jiantang Town and Xiaozhongdian Town at altitudes ≥ 2500 meters, and Wujing Township and Jinjiang Town at altitudes < 2500 meters. A total of 1 549 permanent residents aged 18 years and above were sampled for questionnaire survey, physical examination and blood biochemistry tests. Theχ2 test was used to analyse the distribution of blood pressure levels and the prevalence of hypertension in different ethnic groups at different altitudes, and multifactorial logistic regression was used to analyse the factors affecting the prevalence of hypertension in people at different altitudes. Results The prevalence of hypertension was higher in the group with an altitude of ≥2 500 m than in the group with an altitude of < 2 500 m (P=0.002). The average systolic blood pressure of Tibetan nationality was 5.29 mmHg higher than that of Han nationality (P < 0.001). The prevalence of hypertension was higher among Tibetans than among other ethnic living at the same altitude in the altitude < 2 500 m group (P < 0.017), but lower among Tibetans than among Han Chinese and other ethnic groups living at the same altitude in the altitude ≥2 500 m group (P < 0.017).There were no significant differences in the hypertension prevalence and mean systolic and diastolic blood pressure among Tibetan populations at different altitudes (all P>0.05). There was a negative interaction between Tibetan ethnicity and altitude on the risk of developing hypertension. People living at ≥2 500 m altitude have more risk factors for hypertension compared to those at < 2 500 m altitude. Conclusions The hypertension prevalence among Han and other people increased as the altitude increased. Tibetans seem to show greater adaptation to plateaus and changes in blood pressure at different altitudes. -
Key words:
- Altitude /
- Tibetan /
- Hypertension /
- Blood pressure /
- Comparative analysis
-
表 1 云南省不同海拔、民族血压分布及患病差异比较
Table 1. Comparison of blood pressure distribution and prevalence at different altitudes and nationalities in Yunnan Province
变量 Variable 海拔 Altitude/m① t/χ2值 value P值 value 民族 Ethnic① t/χ2值 value P值 value < 2 500 (n=845) ≥2 500 (n=704) 藏族 Tibetan (n=920) 汉族 Han (n=179) 其他 Other (n=450) 平均 Mean SBP/mmHg 130.72±21.69 135.03±23.05 3.763 < 0.001 134.73±23.00 129.44±22.08② 129.78±20.86② 9.580 < 0.001 平均 Mean DBP/mmHg 80.14±11.78 81.64±12.19 2.450 0.014 81.14±12.26 80.94±11.58 80.12±11.58 1.102 0.332 正常血压 Normal blood pressure/mmHg 261(30.89) 197(27.98) 8.744 0.068 254(27.61) 52(29.05) 152(33.78) 11.773 0.162 正常高值 Normally high/mmHg 316(37.40) 241(34.23) 335(36.41) 68(37.99) 154(34.22) Ⅰ级高血压 Grade Ⅰ hypertension/mmHg 151(17.87) 136(19.32) 167(18.15) 34(18.99) 86(19.11) Ⅱ级高血压 Grade Ⅱ hypertension/mmHg 86(10.17) 88(12.50) 111(12.07) 20(11.17) 43(9.56) Ⅲ级高血压 Grade Ⅲ hypertension/mmHg 31(3.67) 42(5.97) 53(5.76) 5(2.80) 15(3.33) 高血压 Hypertension/mmHg 9.561 0.002 1.314 0.518 是 Yes 286(33.85) 292(41.48) 354(38.48) 64(35.75) 160(35.56) 否 No 559(66.15) 412(58.52) 566(61.52) 115(64.25) 290(64.44) 注：SBP，收缩压；DBP，舒张压。
①以x±s或人数(占比/%)表示；②与藏族相比差异有统计学意义。
Note: SBP, systolic blood pressure; DBP, diastolic blood pressure.
① x±s or number of people (proportion/%); ② Differences are statistically significant compared to Tibetan.
下载: 导出CSV
表 2 云南省相同海拔条件下的不同民族血压分布及患病差异比较
Table 2. Comparison of blood pressure distribution and prevalence between among different ethnic groups at the same altitude in Yunnan province
变量 Variable < 2 500m① F/χ2值 value P值 value ≥ 2 500m① F/χ2值 value P值 value 藏族 Tibetan (n=372) 汉族 Han (n=145)) 其他 Other (n=328) 藏族 Tibetan (n=548) 汉族 Han (n=34) 其他 Other (n=122) 平均 Mean SBP/mmHg 135.86±22.74 126.36±19.70② 126.83±20.09② 19.440 < 0.001 133.97±23.17 142.56±26.78② 137.73±20.88 3.253 0.039 平均 Mean DBP/mmHg 81.60±12.17 79.82±11.49 78.63±11.35② 5.669 0.004 80.83±12.36 85.72±10.90② 84.14±12.89② 5.751 0.003 正常血压 Normal blood pressure/mmHg 83(22.31) 46(31.72) 132(40.24)② 35.073 < 0.001 171(31.20) 6(17.65) 20(16.39)② 20.155 0.010 正常高值 Normally high/mmHg 147(39.52) 58(40.00) 111(33.84) 188(34.31) 10(29.41) 43(35.25) Ⅰ级高血压 Grade Ⅰ hypertension/mmHg 75(20.16) 25(17.24) 51(15.55) 92(16.79) 9(26.47) 35(28.69)② Ⅱ级高血压 Grade Ⅱ hypertension/mmHg 45(12.10) 15(10.34) 26(7.93) 66(12.04) 5(14.71) 17(13.93) Ⅲ级高血压 Grade Ⅲ hypertension/mmHg 22(5.91) 1(0.70)② 8(2.44) 31(5.66) 4(11.76)② 7(5.74)③ 高血压 Hypertension/mmHg 11.482 < 0.001 17.508 0.003 是 Yes 149(40.05) 43(29.66) 94(28.66)② 205(37.41) 21(61.76)② 66(54.10)② 否 No 223(59.95) 102(70.34) 234(71.34) 343(62.59) 13(38.24) 56(45.90) 注：SBP，收缩压；DBP，舒张压。
①以x±s或人数(占比/%)表示；②与藏族相比差异有统计学意义；③与汉族相比差异有统计学意义。
Note: SBP, systolic blood pressure; DBP, diastolic blood pressure.
① x±s or number of people (proportion/%); ② Differences are statistically significant compared to Tibetan; ③ Differences are statistically significant compared to Han.
下载: 导出CSV
表 3 云南省相同民族、不同高低海拔条件下血压分布及患病差异比较
Table 3. Comparison of blood pressure distribution and prevalence between among different ethnic groups at the same altitude in Yunnan province
变量 Variable 藏族 Tibetan① t/χ2值 value P值 value 汉族 Han① t/χ2值 value P值 value 其他 Other① t/χ2值 value P值 value < 2 500 m(n=372) ≥2 500 m(n=548) < 2 500 m(n=145) ≥2 500 m(n=34) < 2 500 m(n=328) ≥2 500 m(n=122) 平均 Mean SBP/mmHg 135.86±22.74 133.97±23.17 -1.224 0.221 126.36±19.70 142.56±26.78 3.332 0.002 126.83±20.09 137.73±20.88 5.060 < 0.001 平均 Mean DBP/mmHg 81.60±12.12 80.83±12.36 -0.936 0.350 79.82±11.49 85.72±10.90 2.718 0.007 78.6±11.35 84.14±11.29 4.584 < 0.001 正常血压 Normal blood pressure/mmHg 83(22.31) 171(31.20) 9.413 0.052 46(31.72) 6(17.65) 13.384 0.007② 132(40.25) 20(16.39)③ 29.322 < 0.001 正常高值 Normally high/mmHg 147(39.52) 188(34.31) 58(40.00) 10(29.41) 111(33.85) 43(35.25) Ⅰ级高血压 Grade Ⅰ hypertension/mmHg 75(20.16) 92(16.79) 25(17.24) 9(26.47) 51(15.56) 35(28.69) Ⅱ级高血压 Grade Ⅱ hypertension/mmHg 45(12.10) 66(12.04) 15(10.34) 5(14.71) 26(7.94) 17(13.93) Ⅲ级高血压 Grade Ⅲ hypertension/mmHg 22(5.91) 31(5.66) 1(0.70) 4(11.76)③ 8(2.40) 7(5.74) 高血压 Hypertension/mmHg 0.655 0.418 12.362 < 0.001 25.116 < 0.001 是 Yes 149(40.05) 205(37.41) 43(29.66) 21(61.76) 94(28.66) 66(54.10) 否 No 223(59.95) 343(62.59) 102(70.34) 13(38.24) 234(71.37) 56(45.90) 注：SBP，收缩压；DBP，舒张压。
①以x±s或人数(占比/%)表示；② Fisher确切概率法；③层内比较差异有统计学意义。
Note: SBP, systolic blood pressure; DBP, diastolic blood pressure.
① x±s or number of people (proportion/%); ② Fisher exact probability method; ③ Differences within strata comparisons are statistically significant.
下载: 导出CSV
表 4 海拔与民族对高血压患病风险影响的交互作用分析
Table 4. Interaction analysis of the effect of altitude and ethnicity on the risk of developing hypertension
变量 Variable 模型1 Model 1 OR 值 value (95% CI) P值 value 模型2 Model 2 OR 值 value (95% CI) P值 value 海拔 Altitude/m < 2 500 1.000 ≥2 500 1.385(1.126~1.174) 0.002 1.322(1.031~1.695) 0.028 民族 Ethnic 汉族 Han 1.000 藏族 Tibetan 1.124(0.805~1.568) 0.492 1.377(0.938~2.020) 0.102 其他 Other 0.991(0.691~1.423) 0.963 1.358(0.898~2.054) 0.147 海拔×民族 Altitude×Ethnic 藏族 Tibetan×≥ 2 500 m 0.233(0.102~0.532) 0.001 0.405(0.235~0.698) 0.001 其他 Other×≥2 500 m 0.766(0.315~1.862) 0.556 0.427(0.169~1.079) 0.072 注：SBP，收缩压；DBP，舒张压；模型1未调整任何变量，模型2调整了年龄、性别、BMI、吸烟、饮酒、文化程度、腰围、血脂异常。
Note: SBP, systolic blood pressure; DBP, diastolic blood pressure; model 1 was not adjusted for any variables, and model 2 was adjusted for age, sex, BMI, smoking, alcohol consumption, literacy, waist circumference, dyslipidemia.
下载: 导出CSV
表 5 云南省不同海拔人群高血压患病影响因素分析
Table 5. Analysis of risk factors for hypertension at different altitudes population in Yunnan
变量 Variable ＜2 500 m OR 值 value (95% CI) P值 value ≥2 500 m OR 值 value (95% CI) P值 value 性别 Gender 男性 Male 1.000 女性 Female ― 0.385(0.223~0.666) 0.001 年龄/岁 Age/years < 60 1.000 1.000 ≥60 3.972(2.706~5.829) 0.001 8.641(5.798~12.879) <0.001 腰围 Waist circumference 正常 Normal 1.000 异常 Abnormality ― 1.734(1.089~2.762) 0.020 BMI/(kg·m-2) 正常及以下 Normal and below 1.000 1.000 超重 Overweight 1.573(1.090~2.271) 0.016 1.906(1.227~2.960) 0.004 肥胖 Obesity 2.771(1.730~4.439) < 0.001 2.902(1.568~5.371) 0.001 文化程度 Education 小学及以下 Primary and below 1.000 1.000 初中及以上 Junior and above 0.653(0.460~0.927) 0.017 0.621(0.399~0.965) 0.034 饮酒 Drinking 否 No 1.000 是 Yes ― 1.666(1.021~2.718) 0.041 血脂异常 Dyslipidemia 否 No 1.000 是 Yes ― 1.686(1.109~2.561) 0.014 民族 Ethnic 汉族 Han 1.000 1.000 藏族 Tibetan 1.585(1.049~2.394) 0.029 0.370(0.181~0.755) 0.006 其他 Other 0.953(0.620~1.464) 0.826 0.730(0.335~1.588) 0.427 注：“―”表示该变量在此海拔条件下，P>0.05，故未列出。
Note："―" indicates that the variable is not listed at this altitude, P>0.05.
下载: 导出CSV
-
[1] GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet, 2020, 396(10258): 1223-1249. DOI: 10.1016/S0140-6736(20)30752-2. [2] 中国高血压防治指南修订委员会, 高血压联盟, 中华医学会心血管病学分会, 等. 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志, 2019, 24(1): 24-56. DOI: 10.3969/j.issn.1007-5410.2019.01.002.Writing Group of 2018 Chinese Guidelines for the Management ofHypertension, Chinese Hypertension League, Chinese Society of Cardiology, Chinese Medical Doctor Association Hypertension-Committee, et al. Chinese guidelines for the management of hyper-tension (2018 Revised Edition)[J]. Chin J Cardiovasc Med, 2019, 24(1): 24-56. DOI: 10.3969/.isn.1007-5410.2019.01.002. [3] 叶蓁蓁, 易剑锋, 苏露, 等. 不同海拔地区藏汉族成年人高血压患病率调查及相关因素分析[J]. 中国社会医学杂志, 2018, 35(5): 508-512. doi: 10.3969/j.issn.1673-5625.2018.05.021Ye ZZ, Yi JF, Su L, et al. Prevalence of hypertension and related factors in Tibetan and Han adults at different altitudes[J]. Chinese Journal of Social Medicine, 2018, 35(5): 508-512. DOI: 10.3969/j.issn.1673-5625.2018.05.021. [4] 赵菁华, 刘琳, 周瑶, 等. 不同海拔地区藏族就诊人群血脂、血液黏度、HCY水平与心血管疾病的相关性研究[J]. 现代生物医学进展, 2019, 19(12): 2311-2315. DOI: 10.13241/j.cnki.pmb.2019.12.024.Zhao JH, Liu L, Zhou Y, et al. Correlation between blood lipid, blood viscosity, HCY levels and cardiovascular disease in Tibetan patients at different altitudes[J]. Advances in modern biomedicine, 2019, 19(12): 2311-2315. DOI: 10.13241/j.cnki.pmb.2019.12.024. [5] Idris, Israel Oluwaseyidayo et al. Prevalence of non-communicable diseases and its risk factors among Ijegun-Isheri Osun residents in Lagos State, Nigeria: a community based cross-sectional study[J]. BMC public health vol, 2020, 20(1): 1258. DOI: 10.1186/s12889-020-09349-2. [6] 杨沧江, 秦明芳, 杨永芳, 等. 云南省成年居民高血压患病、知晓、治疗和控制现状调查[J]. 中国公共卫生, 2019, 35(10): 1306-1310. DOI: 10.11847/zgggws1120334.Yang CJ, Qin MF, Yang YF, et al. Survey on the current status of hypertension prevalence, knowledge, treatment and control among adult residents in Yunnan Province[J]. Chin J Public Health, 2019, 35(10): 1306-1310. DOI: 10.11847/zgggws1120334. [7] 庞林鸿, 施艺, 赵雅静, 等. 高血压患者行为危险因素聚集对血压控制的影响[J]. 现代预防医学, 2022, 49(21): 3962-3967. DOI: 10.20043/j.cnki.MPM.202204103.Pang LH, Shi Y, Zhao YJ, et al. Effect of behavioral risk factors clustering on blood pressure control in patients with hypertension[J]. Modern Preventive Medicine, 2022, 49(21): 3962-3967. DOI: 10.20043/j.cnki.MPM.202204103. [8] 周婕, 吴延莉, 王艺颖, 等. BMI水平及动态变化与高血压、糖尿病、血脂异常共病发生风险的前瞻性队列研究[J]. 中华疾病控制杂志, 2023, 27(12): 1421-1429. DOI: 10.16462/j.cnki.zhjbkz.2023.12.010.Zhou J, Wu YL, Wang YY, et al. A prospective cohort study of BMI levels and dynamic changes with the risk of developing hypertension, diabetes mellitus, and dyslipidemia co-morbidities[J]. Chin J Dis Control Prev, 2023, 27(12): 1421-1429. DOI: 10.16462/j.cnki.zhjbkz.2023.12.010. [9] 田美景. 超高海拔地区世居藏民高血压流行病学研究[D]. 大连: 大连医科大学, 2020.Tian MJ. Epidemiologic study of hypertension among native Tibetans at the very high altitude areas[D]. Dalian: Dalian Medical University, 2020. [10] Kapil U, Khandelwal R, Ramakrishnan L, et al. Prevalence of hypertension, diabetes, and associated risk factors among geriatric population living in a high-altitude region of rural Uttarakhand, India[J]. Family Med Prim Care, 2018, 7(6): 1527-1536. DOI: 10.4103/jfmpc.jfmpc_108_18. [11] Sinnott, Sarah-Jo et al. Trends for prevalence and incidence of resistant hypertension: population based cohort study in the UK 1995-2015[J]. BMJ, 2017, 358: j3984. DOI: 10.1136/bmj.j3984. [12] Kilar CR, Diao YP, Sautina L, et al. Activation of the β-common receptor by erythropoietin impairs acetylcholine-mediated vasodilation in mouse mesenteric arterioles[J]. Physiol Rep, 2018, 6(12): e13751. DOI: 10.14814/phy2.13751. [13] 陈聪, 刘宏, 吴新华. 高原地区高血压病机制的研究进展[J]. 高原医学杂志, 2021, 31(4): 53-58.Chen C, Liu H, Wu XH. Research progress on the mechanism of hypertension in high altitude area[J]. J High Altitude Med, 2021, 31(4): 53-58. [14] 王纯. 四川省康定地区不同民族大学生血压调查分析[J]. 成都体育学院学报, 2017, 43(2): 95-100. DOI: 10.15942/j.jcsu.2017.02.017.Wang C. Investigation and analysis of blood pressure of college students of different nationalities in Kangding area of Sichuan Province[J]. Journal of Chengdu Physical Education University, 2017, 43(2): 95-100. DOI: 10.15942/j.jcsu.2017.02.017. [15] 亢玉婷, 王馨, 陈祚等. 西藏不同海拔地区高血压患病情况调查[J]. 中国慢性病预防与控制, 2017, 25(6): 427-431. DOI: 10.16386/j.cjpccd.issn.1004-6194.2017.06.007.Kang YT, Wang X, Chen Z, et al. Prevalence of hypertension at different altitudes in Tibet[J]. Chin J Prev Contr Chron Dis, 2017, 25(6): 427-431. DOI: 10.16386/j.cjpccd.issn.1004-6194.2017.06.007. [16] Richalet JP, Hermand E, Lhuissier FJ, et al. Cardiovascular physiology and pathophysiology at high altitude[J]. Nat Rev Cardios. 2024, 21(2): 75-88. DOI: 10.1038/s41569-023-00924-9. -
