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POSSIBILITY OF ARTERIAL HYPERTENSION DEVELOPMENT IN NORTHWEST POPULATION OF RUSSIA WITH EXCESSIVE BODY WEIGHT AND OBESITY

Автор Доклада: 
Fishman B.B., Kuprin P.Е., Fishman M.B., Chorochevskaja A.I., Chapman M.E., Bober M.A.
Награда: 
POSSIBILITY OF ARTERIAL HYPERTENSION DEVELOPMENT IN NORTHWEST POPULATION OF RUSSIA WITH EXCESSIVE BODY WEIGHT AND OBESITY

POSSIBILITY OF ARTERIAL HYPERTENSION DEVELOPMENT IN NORTHWEST POPULATION OF RUSSIA WITH EXCESSIVE BODY WEIGHT AND OBESITY

Fishman Boris Borisovich, Doctor of Medicine, Professor
Chapman M.E., Candidate of Medical Sciences, doctoral candidate
Bober M.A., Candidate of Medical Sciences, doctoral candidate
NovgorodStateuniversity named after Yaroslav Mudryi 
Kuprin P.Е., Candidate of Medical Sciences, doctoral candidate
Fishman Michael Borisovich, Doctor of Medicine, Professor 
St.-Petersburg State Medical university named after I.P.Pavlova 
ChorochevskajaA.I., Candidate of Medical Sciences, doctoral candidate
Novgorod region medical centre

The results of the study showed the prevalence of arterial hypertension, excessive body weight and obesity in population of 2 areas of the Northwest of Russia. Possibility of arterial hypertension development in respondents with excessive body weight and obesity of various degrees was determined. High risk and strong correlation between 2-3 degrees of obesity and parameters of arterial hypertension was proved.
Keywords: Selective study, prevalence of arterial hypertension, obesity. Relation of chances, correlation dependence.

The aim of the work was to study prevalence of arterial hypertension, EBW and obesity in population of the Northwest of the Russian Federation, and also definition of combination of chances of obesity in patients with arterial hypertension of various degrees considering sex and age features.

Introduction

According to modern ideas, obesity serves a triggering mechanism of the whole metabolic cascade, predisposes to AH and may cause decrease of peripheral tissue sensitivity to insulin, and subsequent excessive body weight. According to Fremingemsky study, probability of AH development and cardiovascular pathology in general in subjects with excessive body weight is 50 % more than in those with normal body weight. There are convincing data, that obesity can be both an independent risk factor, and aggravating one significantly worsening the course and prognosis of both arterial hypertension, and ischemic heart disease (IHD). The risk of cardiovascular and general mortality rate was noted to increase even at achievement of body weight within the limits of the upper normal border. It was found that the risk of IHD in patients with arterial hypertension is 2-3 times and that of stroke 7 times higher than in normal subjects. According to the results of Fremingemsky study both systolic and diastolic BP increased on the average 1 mm Hg with the increase of body weight by1 kg (Ackroff K., Sclafani A., 1996). Degree of cardiovascular risk at obesity depends on distribution of fatty tissue in the body and is significantly higher at central or “android” type. The control of arterial pressure is a primary task in treatment of the given contingent of patients, it allows to reduce the number of the main cardiovascular events by 51% while lipidemia control reduces risk of mortality from ischemic heart disease only by 36 %, and correction of hyperglycemia level can reduce frequency of myocardial infarctions only by 16%.

Materials and methods
The characteristic of selective study

Selective epidemiological study (cross-sectional study) was carried out for revealing arterial hypertension (AH) and its separate risk factors (RF) in adult population of the Novgorod and Pskov areas. Single random sample based on the number of a general totality was used in the study.

Body weight parameter (BWP) was calculated by the formula: weight (kg) / height (m2) according to references of WHO international group on obesity (IOTF WHO, 1997). 

Table 1

The characteristic of age and sex structure of respondents

 Age

20-29

30-39

40-49

50-59

60-69

70 and over

Total

Men

Group of patients with AH

30

43

69

92

95

82

411

Control group

135

100

85

52

37

19

428

Women

Group of patients with AH

23

44

126

159

159

146

657

Control group

286

151

188

89

51

25

790

Total

2286

AH evaluation was carried out according to JNСclassification VII “the Seventh report of the United National Committee of the USA on Prevention, Revealing, Evaluation and Treatment of Hypertension” and ESH-ESC, 2003 “Recommendations of the European Society for Hypertension and the European Society of Cardiologists for AH Treatment” (Britov A.N., Bystrova M. M., 2003).

Considering that the data obtained are characterized by asymptomatic normal distribution, coefficient of disagreement or Mantek-Henzel relation of chances was used (Odds ratio).

Statistical data processing was done using the program STATISTICA 99, version 5,5А. License number axr 107b218402fa.

RESULTS OF OWN RESEARCHES

Results of the selective study performed in the population of the Novgorod and Pskov areas on AH prevalence have revealed statistically reliable differences between the level of AH prevalence in the Northwest Russian Federation population (due to materials of examination of the population of the Novgorod and Pskov areas) and the data for the Russian Federation.

Thus, if the level of AH prevalence in women in the Northwest of the Russian Federation is  7.7 % higher than an average index in Russia, at the same time it is 12.1 % in men. Accordingly parameters in the Novgorod area are the highest in the compared territories, and in men the parameter is 2.3 % higher than that in women (in the Pskov area – 2.6 %). As for sex-age features of AH prevalence in the population of the Novgorod area, high density of parameters (r=0.93) irrespective of gender features was found, except for the age group of 20-29 in which initial AH values in men were found to exceed similar values in women (Р<0.01). In other age groups no statistically significant differences were registered (> 0.05).

Rates of AH parameters increase (fig. 1) have different value and are most expressed at transition from the age group of 30-39 (24 %). In the subsequent age groups rates of growth of the parameter are reduced (18.2; 7.5 %, accordingly) and doubles again in the age group of 70 and over (15.1 %). The maximum figures are registered in the age group of 70 and over, however, a turning-point in the dynamics of parameter growth is the age group of 50-59.

Regarding dynamics of AH prevalence in the population of the Pskov area (fig. 2) gender features connected with the excess of AH level prevalence in men in the age groups of 20-29 (P <0.05) and 30-39 (P <0.01) and women in the age group of 60-69 (P <0,01) were found. In other age groups no statistical differences were registered. Lower initial AH values in the population of the Pskov area are of special interest. Dynamics of growth of AH parameter in women is of the linear character up to the age group of 60-69, and in men – step-like in whom critical age is 40-49 - 50-59 (parameter increase by 26.8 %).

The study showed (fig. 3; 4) that body weight deficiency (BWD) in man's subpopulation was 1.4 %, in women – 3.1 %, i.e. in women prevalence of the given parameter was 2.2 times higher than the same parameter in men.

The parameter of normal body weight (NBW) is in one statistical line and has no statistical gender differences and was 43.8 % in men and 38.2 % in women. Preobesity parameter is quite comparable with NBW and is 40.5 % in men and 31.4 % in women, i.e. in women the number of persons with NBW and preobesity is a little bit lower, than in men.

The most significant statistical differences were found in estimation of various degrees of obesity. Thus, if obesity of the 1-st degree in men was 11.8 %, while in women it was 19.3 %. Obesity of the 2-nd degrees was 1.8 % in men and 5.8% in women and obesity of the 3-d degree was 0.7 % and 2.2 %, accordingly.

Thus, the above data show that 27.3 % of women and 14.3 % of men suffer obesity. At the same time obesity of the 2-nd and 3-d degree involve 2.5 % of men and 8 % of women.

As for sex-age features of BWD prevalence (fig. 5 - 6) it was established, that the parameter tends to decrease with age. The highest values were noted in the age group of 20-29, especially in women, and in the age group of 30-39. In men the parameter is statistically non-uniform depending on the age group. Thus, in the senior age groups it is 1.5-2 times lower, than in the younger age groups. The most significant statistical differences were noted in the senior age groups in women, where the parameter is several times lower, than in the younger age groups.

Sex-age feature of NBW prevalence in the population is of the parabolic type of distribution with the orientation of the bottom part of the parabola to the age group of 50-59 and 60-69, irrespective of sex. Special feature of the given type of BW parameter is statistical compatibility of age parameters, irrespective of sex.

The same pattern was found in the study of preobesity, except for distribution of the type of the parabola, which had the classical form with the peak of distribution in the age group of 50-59.

In estimation of various degrees of obesity clear cut statistical gender differences with higher parameters in men were registered.

Prevalence of obesity of the 1-st degree is of exponential character in women with a step-like type of increase of trend waves with the increase of age gradation. In men less expressed "steepness" of the wave and statistical stabilization of the parameter in the senior age groups was noted.

Similar pattern was observed in the estimation of obesity of the 2-nd degree, except for the age group of 70 and over, in which decrease of the wave was noted. Both in the 1-st and 2-nd degrees of obesity distinctly expressed gender differences were present.

In the estimation of obesity of the 3-d degree the peak of distribution was found, which was in the age group of 60-69 in women and exponential type of distribution in the previous age cohorts. In men the distribution peak was in the age group of 50-59, and the parameter was present only in the senior age groups.

Thus, the above data show markedly expressed age and gender features of distribution of obesity of various degrees with the prevalence of obesity in women of the senior age groups and deficiency of weight in women in the age group of 20-29.

To evaluate the type of obesity, features of prevalence of the abdominal form of obesity were studies (tab. 3).

Table 3

Age-sex characteristics of distribution of abdominal type of obesity in the population of the Northwest Russian Federation (%).

Age group

20-29

30-39

40-49

50-59

60-69

70 and over

Mean

Men

13,9

9,8

20,8

16,7

14,4

17,8

15,6

Women

10,0

21,0

24,2

38,3

43,3

48,5

30,9

 

The abdominal type of obesity was shown to be characteristic for 30.9 % of women and 15.6 % of men. A turning-point in the formation of the given type of obesity is the age group of 40-49, irrespective of sex. Statistical stabilization of the parameter within 15 % is characteristic for men, in women prompt growth with maximum achievement was noticed in the age group of 70 and over (48.5 %).

 

Thus, the obtained results revealed feature of type of obesity in the population of the Northwest of the Russian Federation due to the prevailing of abdominal type of obesity in women in postmenopausal the period.

The studies with the use of criteria of demonstrative medicine on the parameter of excessive body weight showed that the relation of chances reached its maximum – 3.0 in women in the age group of 70 and over (CI 0.25 ? 35.3) and, as a whole, it was higher in women population (tab. 4).

Table 4

Absolute figures of the relation of chances considering CI ±95 %

 Age group

Sex

EBW

Obesity

Abdominal type

Rc

CI

-95%

CI

95%

Rc

CI

-95%

CI

95%

Rc

CI

-95%

CI

95%

20-29 аge

Men

1,7

0,6

4,6

9,8

1,5

63,5

0,9

0,2

4,0

Women

1,5

0,5

4,8

8,0

1,1

59,1

1,7

0,6

4,4

30-39 аge

Men

1,4

0,6

3,3

1,2

0,2

6,5

0,8

0,2

3,8

Women

2,5

1,0

6,5

1,0

0,2

4,5

1,9

0,7

5,2

40-49 аge

Men

1,5

0,6

3,7

4,7

1,2

18,0

0,7

0,3

2,0

Women

2,1

0,9

5,0

6,6

2,5

17,3

1,2

0,5

2,6

50-59 аge

Men

1,3

0,5

3,2

5,1

1,4

18,9

1,2

0,4

3,1

Women

1,8

0,8

4,3

5,6

2,0

15,2

2,3

1,1

4,7

60-69 аge

Men

0,8

0,3

2,9

3,0

0,5

17,3

1,1

0,3

3,5

Women

1,6

0,5

4,9

1,2

0,5

3,3

1,7

0,7

3,8

70 аgeand over

Men

1,8

0,6

6,1

1,9

0,2

21,5

1,5

0,4

6,4

Women

3,0

0,3

35,3

1,1

0,2

7,4

9,8

1,1

85,0

 Total

Men

2,0

1,4

2,8

6,2

3,5

11,1

1,6

1,0

2,4

Women

4,0

2,9

5,6

8,6

5,8

12,6

3,7

2,8

5,0

 
Due to the parameter of obesity it was established, that the most appreciable chances for AH are in women in the age groups of 20-29, 40 - 49 and 50-59, where Rc was 7.96 (CI 1.07 ? 59.12); Rc=6.6 (CI 2.52?17.25); Rc=5.56 (CI 2.03?15.19). Similar picture was observed in men, where Rc=9.84 (CI 1.52 ? 63.54); Rc=4.67 (CI 1.21?18.04); Rc=5.14 (CI 1.4?18.86), and the most vulnerable group of the population is men at the age of 20 - 29 suffering obesity (Rc = 9.84).

The characteristic of the relation of chances on the parameter of abdominal type of obesity shows, that the highest chances of development of arterial hypertension (Rc=9.78) is in women of the senior age group of 70 and over, the fact confirmed by the earlier results of prevalence of the parameter Ot/Ob in women.

Introduction in the analysis of EBW and obesity gradation, according to WHO classification (tab. 5) shows, that chances of arterial hypertension development exceed 1 beginning from the gradation of preobesity, and in women population the given tendency is more expressed.

Table 5

The characteristic of the relation of EBW and obesity chances in AH patients in comparison with the control group

EBW and obesity gradation

Rc

CI (± 95%)

Test ?2

Р

Men

Women

Men

Women.

Men

Women.

 

Body weight deficiency

0,37

0,39

0,05?3,08

0,15?1,01

17,45

59,56

0,000

Preobesity

2,05

3,5

1,42?2,94

2,49?4,91

16,52

59,65

0,000

Obesity 1-st degree

4,44

5,87

2,42?8,15

3,84?8,98

26,48

77,51

0,000

Obesity 2-nddegree

7,83

8,56

2,07?29,64

4,16?17,6

36,3

62,55

0,000

Obesity 3-d degree.

10,44

13,2

1,15?94,78

3,68?47,1

15,71

54,08

0,000

The maximum chances are noticed irrespective of sex in obesity of the 2-nd and 3-d degrees that determines a choice of the beginning of medical intervention as AH secondary prevention beginning from a preobesity stage. Taking into account test ?and the upper border of CI the women subpopulation is more vulnerable, which is probably due to the disturbance of a hormonal background already as early as 20-29 years of age.

Thus, significant influence of obesity on the possibility of arterial hypertension development in respondents was proved.

References:

1.      Almazov V.A., Blagosklonnaya Ya.V., Shlyakhto E.V. et al. Metabolic cardio-vascular syndrome. – SPb.: SPbGMU, 1999. - 208 p. [in Russian]
2.      Babich P.N., Chubenko A.V., Lapach S.N. Modern statistical methods in the practice of clinical investigations. Second report. Use of c-square criterion. Ukr. \ Med. chasopis,2004, 2(40): 138-144.[in Russian]
3.      Britov A.N., Bistrova M.M. New guidelines of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of arterial hypertension: fromJNC-VI till JNC-VII. Kardiologia,2003; 11: 93-6.[in Russian]
4.      Veber V.R., Fishman B.B. Risk factors of arterial hypertension. Sankt-Peterburg, Nauka,2005, 208 p.[in Russian]
5.      Obesity (ed. I.I. Dedov, G.A. Melnichenko). – M.: Med. informacionnoe agentstvo. - 2004. - 449 p. [in Russian]
6.      Flace G. Statistical methods for studying of tables of shares and proportions. (trans. from eng) Finasi I statistika, Moskva,1989,  319 p.[in Russian]
7. AckroffK., Sclafani A. Effect of the lipase inhibitor orlistat on intake and preferance for dietary fat in rats./ Am.J.Physiol. 1996. 271. (I Pt 2) R48-R54

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