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Between June 2013 and February 2014, a cross-sectional study was conducted to determine the distribution of the anthropometric measures (BMI, WC, WHR, WHtR etc. ), indicators (SBP, DBP, PPI, ABI etc.) for achieved levels of BP control, their inter-relationship and predictors among Kazakh-Chinese hypertensive patients in Xinjiang pastureland in Western China. Using a stratified cluster random sampling strategy, hypertensive patients belonging to this minority group were recruited for the current study if they met all the following inclusion criteria: (a) systolic BP (SBP)≥140mmHg and/or diastolic BP (DBP)≥90mmHg or taking antihypertensive medication[19], (b) age≥18 years, (c) not suffering from any cognitive dysfunctions, severe enough to prevent appropriate communication and (d) provided voluntary informed consent for participating in the study. The cities/counties in Xinjiang province having congregation of Kazakh-Chinese communities were enlisted first and one of them was selected from the list randomly. Then hypertensive patients of Kazakh-Chinese ethnicity, aged≥18 years were identified based on individual health assessment records and periodic follow-up records of the residents, enlisted and then randomly recruited from that list according to their age and gender distribution.
Information on SBP level (158±22 mmHg) among Kazakh-Chinese hypertensive patients measured in an epidemiological investigation in Xinjiang during 2010[20], was used as the parameter value for the sample size calculation. Using the formula N = (1.96*S/δ)2[21], where S = standard deviation and δ = allowable error, assuming α = 0.05, the desired sample size (N) was determined to be 465 patients [(1.96*22/2)2]. Further assuming 20% non-response 550 eligible subjects were required to be recruited for the study.
Investigators and community public health physicians conducted the face-to-face interview and measurements (BP and anthropometry) respectively at home or health service centers.
Prior to the interview and examinations, written informed consent was obtained from each participant after explaining all details pertaining to the study. The content and procedure of the study were reviewed and approved (Reference No: 20130216–134) by the Ethics Committee of the First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China.
Using a pre-tested, structured, questionnaire, face to face interviews with eligible participants were conducted to collect information on the socio-demographic and behavioral aspects followed by the physical assessment and anthropometry.
After allowing the subject to rest for 5–10 minutes, two arm-type electronic sphygmomanometers (UA-621, A&D Medical, Japan)[22] were used to measure the right brachial BP at the level of the heart and the corresponding right ankle BP at the medial point between the external ankle and the malleolus in supine position. Standardized techniques and calibrated devices were used for all anthropometric measurements. For each of these measurements, arithmetic average of the observed values from two repeated observations were used. Height (in cm) was measured and rounded to the nearest 0.1 cm, using a stadiometer, with participants standing upright, without shoes. Body weight (kg) was measured and similarly rounded to the nearest 0.1 kg using an automatic electronic scale, with participants wearing light clothing and not wearing footwear. WC (in cm) was measured to the nearest 0.1cm, by an anthropometric tape, at the midpoint between the last palpable rib and iliac crest while the participants stood with feet 25–30 cm apart.
According to the JNC-8 the 2014 guideline, the targets for the general population aged≥60 years were defined as: “SBP<150mmHg and DBP<90mmHg”[23]. In the general population aged<60 years, SBP<140mmHg and DBP<90mmHg were targeted. In the population aged ≥18 years with diabetes or CKD, targets were set at: “SBP<140mmHg and goal DBP<90mmHg[23]” ABI was calculated as the systolic BP measured at ankle divided by that in brachial. ABI<0.9 an identified predictor for cardiac complications, was defined as the diagnostic criteria for the peripheral arterial disease [[24]]. Based on BMI [weight in kg/(height in meter)2] participants were categorized into three groups: obese (BMI ≥30), overweight (25≤BMI< 30) and normal/ underweight (BMI<25). Abdominal obesity was determined based on both WC as well as Waist-to-hip ratio (WHR = WC in cm/hip circumference in cm). Men with WC≥102cm and women with WC≥88cm were considered as having abdominal obesity while abdominal overweight meant 94cm≤WC<102cm in men and 80cm≤WC< 88cm in women. WC<94cm in men and WC<80cm in women were considered normal[25]. Again WHR≥0.90 in man and WHR≥0.85 in women were classified as abdominal obesity[26, 27]. Additionally, Waist-to-height ratio (WHtR = WC in cm/height in cm) ≥0.5 was defined as centralized obesity[28].
All analyses were conducted using SPSS version 20.0 (S1 Dataset). The results were considered statistically significant when p value was < 0.05. Distributions of the participant characteristics and anthropometric findings were determined by descriptive analyses [mean±standard deviation (SD) for continuous and subgroup-specific percentages for categorical variables]. T-test of Independent sample and One-way ANOVA were used to compare the continuous variables (SBP, DBP, PPI, ABI, BMI, WC, WHR and WHtR). Associations between categorical variables were tested using Chi-square test. Bivariate analysis was used to explore the association between BP and anthropometric findings. Multiple stepwise regression analysis was used to determine the risk factors for SBP, DBP, PPI and ABI among participants. To understand the role of the potential determinants in achieving targeted level of control over BP, binary logistic regression analysis was performed adjusting for age, gender and medical treatment.
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