Epidemiological Perspective on Hypertension and High-Risk Groups for Sub-health: Multidimensional Analysis of Occupational Stress, Obesity, and Genetics

Part 1: Sub-health and Disease Risk Factors Chapter 1: Hypertension and Sub-health Section 1: Epidemiology of Hypertension

Hypertension is the most common cardiovascular disease. It is a prevalent and frequently occurring disease in my country and most parts of the world, and is currently one of the leading causes of death from cardiovascular and cerebrovascular diseases. The prevalence of hypertension varies globally, with higher rates in Europe and America than in Asia and Africa, and higher rates in industrialized countries than in developing countries. According to data from the World Health Organization's MONICA program, the prevalence of hypertension among adults (35-64 years old) in Europe and America is over 20%. Even within the same country, there are differences in prevalence among different ethnic groups; for example, the prevalence of hypertension among African Americans in the United States is approximately twice that of white Americans.

The incidence of hypertension in my country is lower than in Western countries, but it is showing an upward trend. For example, using blood pressure above 140/90 mmHg as the standard for calculating the prevalence of hypertension in people aged 15 and above, the average prevalence rate in 1959, based on a survey of 739,204 people in 13 provinces and municipalities across the country, was 5.11%, with Shanghai at 6.96%; in 1979, a survey of 4,012,128 people in 29 provinces, municipalities, and autonomous regions showed an average prevalence rate of 7.73%, with Shanghai at 7.89%; and by 1991, the national average prevalence rate had risen to 11.88%, with Shanghai at 12.69%. Although the above data includes borderline hypertension and secondary hypertension, the standards are uniform, the time span is large, and the comparability is relatively strong. A nationwide survey conducted by the MONICA program in 1988-1989 on the prevalence of hypertension in people aged 35-64 showed that the highest prevalence among men was in Jilin Province (25.8%), and the lowest was in Mianyang City, Sichuan Province (4.9%). Among women, the highest prevalence was in Shenyang City (24.3%), and the lowest was in Fuzhou City (6.3%). Compared with data from 1984-1986, the prevalence increased in most northern cities, with Shenyang City showing the largest increase in female hypertension prevalence (5.7%). The data also indicate significant differences in hypertension prevalence across provinces and cities in my country. The prevalence is higher in Northeast and North China than in Southwest and Southeast China; and higher in the eastern region than in the western region. These differences may be related to factors such as salt intake, the proportion of obese individuals, and climate. In recent years, the prevalence in rural areas has also been rising; for example, the prevalence of hypertension in rural suburbs of Beijing increased from 8.7% in 1979 to 9.6% in 1991. There is little difference in hypertension prevalence between the sexes, with slightly higher prevalence in young men than in women, and slightly higher in women than in men after middle age.

A 1991 sample survey of 940,000 people aged 15 and above in my country found that the prevalence of hypertension was 11.26%, an increase of 25% over 10 years compared to 1979-1980. Further epidemiological surveys show that the number of people with hypertension in my country is currently increasing by 3 million per year, with 1.2 million patients in Shanghai alone, and this trend is expected to continue.

According to recent surveys, the prevalence of hypertension has reached over 11.3%. The total number of people with hypertension in China has exceeded 100 million, and the number is increasing by 3.5 million new cases every year. The target organ damage caused by hypertension, such as stroke, is developing at a rate of 5 to 6 million cases per year, and it has become one of the leading causes of cardiovascular disease death in my country.

Hypertension has become a major health threat to modern urban dwellers, and this cannot be ignored.

Section 2 Sub-healthy individuals with hypertension

People at high risk of hypertension are also people with hypertension who are in a sub-healthy state.

Related surveys indicate that accountants, drivers, obese individuals, and those who consume excessive salt are among the high-risk groups for hypertension, particularly those who are under chronic stress.

Obese individuals have a higher probability of developing hypertension. A recent sampling survey showed that among people aged 25 to 40, the prevalence rate was only 11.3% for those with normal weight, while it reached 44.5% for obese individuals; in the 40 to 60 age group, the prevalence rate was 29.1% for those with normal weight, while it was as high as 54.1% for obese individuals; and in the age group over 60, the prevalence rate was 54.2% for those with normal weight, while it was as high as 72.1% for obese individuals.

The survey also found that people under mental stress are more likely to suffer from hypertension. Those engaged in occupations with high levels of mental stress, such as drivers, stockbrokers, ticket sellers, and accountants, are also prone to hypertension if they lack physical exercise.

People who consume more salt have a higher probability of developing hypertension because high sodium intake can raise blood pressure, while low sodium intake helps lower blood pressure. A diet high in calcium and potassium can reduce the incidence of hypertension. Clinical observations have found that patients who strictly limit their salt intake experience a decrease in blood pressure.

Hypertension has a strong hereditary component; therefore, children of parents with hypertension are also at high risk of developing the disease. The presence of multiple hypertension patients within the same family is not only due to shared lifestyles but, more importantly, the presence of a genetic predisposition. Additionally, long-term alcohol and tobacco consumption, as well as a high intake of animal fats, also increase the risk of hypertension.

I. High-risk groups for hypertension include those with hypertension and those in a sub-healthy state.

High-risk groups for hypertension are defined as individuals who meet one of the following criteria: (1) have a family history of hypertension; (2) consume more than 10 grams of salt per day; (3) are long-term smokers and drinkers of strong alcohol; (4) have serum total cholesterol levels above 5.72 mmol/L (220 mg/dL) or are overweight or obese; (5) have diabetes; (6) are long-term exposed to harmful factors such as noise; or (7) are long-term users of birth control pills. High-risk individuals should undergo a physical examination every six months to one year. Hypertensive patients should receive timely non-pharmacological treatments such as diet and exercise, or antihypertensive medication.

II. High-risk groups for primary hypertension include those with primary hypertension who are in a sub-healthy state.

Hypertension exhibits a clear familial clustering pattern. Statistics show that children whose parents have hypertension are significantly more likely to develop the disease than those whose parents have normal blood pressure. If one or both parents have hypertension, their children are 1.5 times and 2-3 times more likely to develop hypertension, respectively, compared to parents with normal blood pressure. Scientists have also identified the genes responsible for hypertension and have successfully conducted genetic experiments on animals.

Of course, this does not mean that genetics determines everything. The occurrence of hypertension is also related to many environmental factors. According to epidemiological statistics, some groups of people are at high risk of hypertension. (1) If parents have hypertension, their children are more likely to have hypertension than if their parents have normal blood pressure. (2) People with high salt intake are more likely to have hypertension. High sodium intake can raise blood pressure, while low sodium intake can lower blood pressure. High calcium and high potassium diets can reduce the incidence of hypertension. (3) People who consume saturated fatty acids (such as animal fats) are more likely to have hypertension than people who consume unsaturated fatty acids (such as vegetable oils and fish oils). (4) The incidence of hypertension is higher in long-term drinkers and is directly proportional to the amount of alcohol consumed. (5) People who engage in work that requires high concentration, are under long-term mental stress, or are exposed to noise and other adverse stimuli are more likely to have hypertension. (6) In addition, smokers and obese people are also more likely to have hypertension.