Prevalence of hypertension in endemic and non-endemic areas of Keshan disease: A cross-sectional study in rural areas of China

Jie Hou; Lifang Zhu; Shuran Jin; Jinshu Li; Zhifeng Xing; Yanling Wang; Xiaoyan Wan; Xianni Guo; Anwei Wang; Xiuhong Wang; Jinming Liu; Jing Ma; Shuang Zhou; Xiangdong Zhang; Heming Zheng; Jianhui Wang; Hongqi Feng; Shuqiu Sun; Tong Wang

doi:10.3389/fnut.2023.1086507

Prevalence of hypertension in endemic and non-endemic areas of Keshan disease: A cross-sectional study in rural areas of China

Front Nutr. 2023 Feb 13:10:1086507. doi: 10.3389/fnut.2023.1086507. eCollection 2023.

Authors

Jie Hou^{1

2}, Lifang Zhu¹, Shuran Jin¹, Jinshu Li³, Zhifeng Xing⁴, Yanling Wang⁵, Xiaoyan Wan⁶, Xianni Guo⁷, Anwei Wang⁸, Xiuhong Wang⁹, Jinming Liu¹⁰, Jing Ma¹¹, Shuang Zhou¹², Xiangdong Zhang¹³, Heming Zheng¹⁴, Jianhui Wang¹⁵, Hongqi Feng^{1

2}, Shuqiu Sun^{1

2}, Tong Wang^{1

2}

Affiliations

¹ Institute of Keshan Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China.
² National Health Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, China.
³ Sichuan Center for Disease Control and Prevention, Chengdu, China.
⁴ Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, China.
⁵ Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China.
⁶ The Second Research Institute for Endemic Disease Control and Prevention of Jilin Province, Jilin City, China.
⁷ Shaanxi Institute for Endemic Disease Control and Prevention, Xi'an, China.
⁸ Yunnan Institute of Endemic Disease Control and Prevention, Dali, China.
⁹ Shandong Provincial Institute for Endemic Disease Control, Jinan, China.
¹⁰ The Inner Mongolia Autonomous Region Comprehensive Center for Disease Control and Prevention, Hohhot, China.
¹¹ Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China.
¹² Chongqing Center for Disease Control and Prevention, Chongqing, China.
¹³ Shanxi Institute of Endemic Disease Control and Prevention, Linfen, China.
¹⁴ Henan Provincial Center for Disease Control and Prevention, Zhengzhou, China.
¹⁵ Liaoning Center for Disease Control and Prevention, Shenyang, China.

Abstract

Background: Hypertension is a major public health concern that strongly influences the quality of life of people worldwide. Keshan disease (KD) is an endemic cardiomyopathy related to low selenium, threatening residents in rural areas of 16 provinces in China. Furthermore, the prevalence of hypertension in the KD-endemic areas has been increasing annually. However, hypertension research associated with KD has only focused on endemic regions, and no studies have compared hypertension prevalence between endemic and non-endemic areas. Therefore, this study investigated the prevalence of hypertension to provide a basis for preventing and controlling hypertension in the KD-endemic areas, even in rural areas.

Methods: We extracted blood pressure information from cardiomyopathy investigation data from a cross-sectional study of the KD-endemic and non-endemic areas. The hypertension prevalence between the two groups was compared using the Chi-square test or Fisher s exact test. Additionally, Pearson's correlation coefficient was employed to evaluate the relationship between the per capita gross domestic product (GDP) and hypertension prevalence.

Results: There was a statistically significant increase of hypertension prevalence in the KD-endemic areas (22.79%, 95% confidence interval [CI]: 22.30-23.27%) over the non-endemic areas (21.55%, 95% CI: 21.09-22.02%). In the KD-endemic areas, more men had hypertension than women (23.90% vs. 21.65%, P < 0.001). Furthermore, the hypertension prevalence was higher in the north than in the south in the KD-endemic areas (27.52% vs. 18.76%, P < 0.001), non-endemic areas (24.86% vs. 18.66%, P < 0.001), and overall (26.17% vs. 18.68%, P < 0.001). Finally, the prevalence of hypertension positively correlated with per capita GDP at province level.

Conclusions: The increasing hypertension prevalence is a public health problem in the KD-endemic areas. Healthy diets, such as high consumption of vegetables and seafoods, and foods that are rich in selenium, might help prevent and control hypertension in the KD-endemic areas and other rural areas in China.

Keywords: Keshan disease; blood pressure; cross-sectional study; diet; hypertension; selenium.

Grants and funding

This work was sponsored by Endemic Disease Prevention Project from Ministry of Health of People’s Republic of China.