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The U-shaped association of altitudes with prevalence of hypertension among residents in Tibet, China

Journal of Human Hypertension volume 35, pages 546–555 (2021)Cite this article

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Abstract

We aimed to evaluate the association of altitudes with the prevalence of hypertension among residents aged 15 years and above in Tibet, China. Data for 11,407 Tibetan residents from the National Health Services Survey in 2013 were analyzed. Association between altitudes and prevalence of physician-diagnosed hypertension was assessed by two logistic regression models as follows: (i) a base model adjusted for age and gender, and (ii) a full model additionally adjusted for body mass index, education, marital status, area of residence, distance to the nearest medical institute, smoking, drinking, and exercise. Nonlinear relationship between altitudes and prevalence of hypertension was explored by restricted cubic spline analyses. Sensitivity analyses were conducted by restricting to residents of rural and/or nomadic areas. The prevalence of hypertension was estimated to be 37.6%. We found a U-shaped association between altitudes and prevalence of physician-diagnosed hypertension with a turning point at around 3800 m (12,467 ft). For residents living above 3800 m, a 1000 m increase in altitudes was associated with 2.05 (95% confidence interval [CI]: 1.62–2.61) times higher odds of having physician-diagnosed hypertension, after adjusting for age and gender. When further controlling for all covariates, the odds ratio (OR) dropped to 1.87 (95% CI: 1.46–2.41). For residents living below 3800 m, a 1000 m increase was associated with 0.29 (95% CI: 0.19–0.44) times less likelihood of having physician-diagnosed hypertension in the full model. Sensitivity analyses among residents in rural and/or nomadic areas showed similar associations. To conclude, altitudes were in a U-shaped association with prevalence of hypertension.

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Fig. 1: Prevalence of hypertension, proportions of adhering to anti-hypertensive medication, and having blood pressure controlled among hypertensive participants by gender and age groups.
Fig. 2: Prevalence of hypertension by gender and cities.
Fig. 3

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Acknowledgements

This study was supported by the China Medical Board (CMB) (Project ID:11-086), Tibet’s Health Human Resource Development Research (Project ID: 201804), and Tibet University university-level Cultivation Fund (Project ID: 0800013).

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Author notes

  1. These authors contributed equally: Labasangzhu Labasangzhu, Ruiyuan Zhang

Authors and Affiliations

  1. Department of Preventive Medicine, Tibet University Medical College, Lhasa, Tibet, China

    Labasangzhu Labasangzhu & Zhaxi Dawa

  2. High Altitude Medical Research Center of Tibet University, Lhasa, Tibet, China

    Labasangzhu Labasangzhu

  3. Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA, USA

    Ruiyuan Zhang, Luqi Shen & Changwei Li

  4. Department of Health Care Administration, College of Health and Human Services, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA, USA

    Yanling Qi

  5. Department of Clinical Medicine, Tibet University Medical College, Lhasa, Tibet, China

    Ouzhu Luobu

  6. Fukang Hospital, Lhasa, Tibet, China

    Ouzhu Luobu

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  1. Labasangzhu Labasangzhu
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Labasangzhu, L., Zhang, R., Qi, Y. et al. The U-shaped association of altitudes with prevalence of hypertension among residents in Tibet, China. J Hum Hypertens 35, 546–555 (2021). https://doi.org/10.1038/s41371-020-0367-8

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