Liu Yezhou, Mi Baibing, Pei Leilei, Dang Shaonong, Yan Hong, Li Chao
Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
Front Public Health. 2024 Nov 29;12:1443104. doi: 10.3389/fpubh.2024.1443104. eCollection 2024.
The impact of intensive hypertension criteria on multimorbidity prevalence and patterns remains understudied. We investigated the prevalence and patterns of multimorbidity using both the current (140/90 mmHg) and intensive (130/80 mmHg) hypertension criteria within a multi-ethnic Chinese population.
Data were obtained from the baseline survey of the Regional Ethnic Cohort Study in Northwest China, conducted from June 2018 to May 2019, which enrolled adults aged 35-74 years from five provinces. A total of 114,299 participants were included in this study. Multimorbidity was defined as the presence of at least two chronic diseases or conditions from a list of 26, ascertained through self-report and physical examination. Agglomerative hierarchical cluster analysis was employed to identify multimorbidity patterns. A hypertension-related multimorbidity pattern was identified and further analyzed. The prevalence of multimorbidity and hypertension-related pattern were analyzed in different subgroups, and subgroup cluster analyses were conducted stratified by sex, age, and ethnicity.
Applying the intensive 130/80 mmHg hypertension criteria resulted in an increase in multimorbidity prevalence from 17.6% (20,128 participants) to 21.7% (24,805 participants) compared to the 140/90 mmHg criteria. Four distinct multimorbidity patterns were consistently identified: cardiometabolic, digestive-bone-kidney, respiratory, and mental-cancer. Hypertension consistently clustered within the cardiometabolic pattern alongside diabetes, acute myocardial infarction, angina, and stroke/TIA, with relatively stable proportions observed even under the 130/80 mmHg threshold.
The revision of hypertension criteria significantly expands the population identified as having multimorbidity, without altering the identified multimorbidity patterns. Hypertension commonly co-occurs within the cardiometabolic cluster. These findings highlight the need for improved treatment and management strategies specifically targeting cardiometabolic multimorbidity.
强化高血压标准对多种疾病共患率及模式的影响仍未得到充分研究。我们在一个多民族中国人群中，使用现行（140/90 mmHg）和强化（130/80 mmHg）高血压标准，调查了多种疾病共患的患病率及模式。
数据来自2018年6月至2019年5月进行的中国西北区域队列研究的基线调查，该研究纳入了来自五个省份的35 - 74岁成年人。本研究共纳入114,299名参与者。多种疾病共患定义为通过自我报告和体格检查确定的26种疾病列表中至少存在两种慢性疾病或状况。采用凝聚层次聚类分析来识别多种疾病共患模式。确定并进一步分析了一种与高血压相关的多种疾病共患模式。在不同亚组中分析了多种疾病共患和高血压相关模式的患病率，并按性别、年龄和种族进行分层亚组聚类分析。
与140/90 mmHg标准相比，应用强化的130/80 mmHg高血压标准使多种疾病共患率从17.6%（20,128名参与者）增加到21.7%（24,805名参与者）。一致识别出四种不同的多种疾病共患模式：心脏代谢型、消化 - 骨骼 - 肾脏型、呼吸型和精神 - 癌症型。高血压始终与糖尿病、急性心肌梗死、心绞痛和中风/短暂性脑缺血发作一起聚集在心脏代谢模式中，即使在130/80 mmHg阈值下，比例也相对稳定。
高血压标准的修订显著扩大了被确定为患有多种疾病共患的人群，而未改变所确定的多种疾病共患模式。高血压通常在心脏代谢聚类中共存。这些发现凸显了针对心脏代谢型多种疾病共患改进治疗和管理策略的必要性。
