He Mianwang, Yu Shengyuan, Liu Ruozhuo, Yang Xiaosu, Zhao Gang, Qiao Xiangyang, Feng Jiachun, Fang Yannan, Cao Xiutang, Steiner Timothy J
Department of Neurology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, 100853, Beijing, China.
Department of Neurology, Xiangya Hospital, Central-South University, Xiangya Road 87, 410008, Changsha, Hunan Province, China.
J Headache Pain. 2015;16:86. doi: 10.1186/s10194-015-0570-0. Epub 2015 Oct 5.
Both hypertension (HTN) and headache disorders are highly prevalent worldwide. Our purpose, in a nationwide study of the Chinese general population, was to evaluate any association between primary headache disorders and elevated blood pressure (eBP). We could not collect data on antihypertensive therapy, but took the view that, whatever such therapy might be taken, eBP was a sign that it was failing to meet treatment needs. Therefore, as a secondary purpose, important from the public-health perspective, we would present the prevalence of eBP (treated or not) as indicative of unmet health-care need in China.
This was a questionnaire-based nationwide cross-sectional door-to-door survey using cluster random-sampling, selecting one adult (18-65 years) per household. Headache was diagnosed by ICHD-II criteria and eBP as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Chi-squared test and multivariate logistic regression analysis were used to assess the strength and significance of associations. We set significance at P ≤ 0.05.
Of 5,041 survey participants (participation rate 94.1 %), 154 were excluded because of missing BP data, leaving 4,987 for analysis [mean age: 43.6 ± 12.8 years; male 2,532 (mean age: 43.4 ± 12.9 years); female 2,455 (mean age 43.9 ± 12.8 years)]. There were 466 participants with migraine, 535 with tension type headache (TTH) and 48 with all causes of headache on ≥15 days/month. The prevalence of eBP was 22.1 % (males 22.9 %, females 21.3 %). No associations of eBP with any of the headache disorders survived multivariate adjusted analysis. The demographic and anthropometric variables most strongly associated with eBP were higher age (AOR 3.7) and being overweight (AOR 2.4), seen in both genders. Less strong were male gender, lower educational level and urban habitation.
We found no clear-cut associations between eBP and any headache disorder. The associations with demographic and anthropometric variables may have acted as confounders in past reports to the contrary. We did find an alarmingly high prevalence of eBP, recognizing that this signals substantial under-treatment in China of a serious condition, and therefore a major public-health concern.
高血压（HTN）和头痛疾病在全球范围内都极为普遍。在一项针对中国普通人群的全国性研究中，我们旨在评估原发性头痛疾病与血压升高（eBP）之间的任何关联。我们无法收集抗高血压治疗的数据，但认为无论采取何种此类治疗，eBP都表明治疗未能满足需求。因此，从公共卫生角度来看，作为次要目的，我们将呈现eBP（无论是否接受治疗）的患病率，以表明中国未满足的医疗保健需求。
这是一项基于问卷调查的全国性横断面挨家挨户调查，采用整群随机抽样，每户选取一名成年人（18 - 65岁）。头痛根据国际头痛疾病分类第二版（ICHD-II）标准进行诊断，eBP定义为收缩压≥140 mmHg和/或舒张压≥90 mmHg。采用卡方检验和多因素逻辑回归分析来评估关联的强度和显著性。我们将显著性设定为P≤0.05。
在5041名调查参与者中（参与率94.1%），154人因血压数据缺失被排除，剩余4987人进行分析[平均年龄：43.6±12.8岁；男性2532人（平均年龄：43.4±12.9岁）；女性2455人（平均年龄43.9±12.8岁）]。有466名偏头痛患者，535名紧张型头痛（TTH）患者，48名每月头痛≥15天的各种原因头痛患者。eBP的患病率为22.1%（男性22.9%，女性21.3%）。在多因素调整分析中，eBP与任何头痛疾病均无关联。与eBP最密切相关的人口统计学和人体测量学变量是年龄较大（比值比[AOR] 3.7）和超重（AOR 2.4），在男女中均如此。男性、教育水平较低和居住在城市的关联较弱。
我们发现eBP与任何头痛疾病之间没有明确的关联。与人口统计学和人体测量学变量的关联可能在过去相反的报告中起到了混杂因素的作用。我们确实发现eBP的患病率高得惊人，认识到这表明中国对一种严重疾病的治疗严重不足，因此是一个重大的公共卫生问题。
