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Some Risk Factors for Hypertension of Khmer People Aged From 25 to 64 Years in Tra Vinh Province, Viet Nam

Tap Nguyen-Van1*, Binh Nguyen-Thanh1 and Huong Tran-Van2

1University of Medicine and Pharmacy of Ho Chi Minh City, Vietnam

2University of Thang Long, Hanoi, Vietnam

*Corresponding Author:
A/Pr. Tap Nguyen-Van
MD, PhD, University of Medicine and
Pharmacy of Ho Chi Minh City, Vietnam
Tel: +84.914064340
E-mail: [email protected]

Received Date: June 02, 2017; Accepted Date: June 09, 2017; Published Date: June 14, 2017

Citation: Nguyen-Van T, Nguyen-Thanh B, Tran-Van H (2017) Some Risk Factors for Hypertension of Khmer People Aged From 25 to 64 Years in Tra Vinh Province, Viet Nam. J Vasc Med Surg 5: 318. doi: 10.4172/2329-6925.1000318

Copyright: © 2017 Nguyen-Van T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

A cross-sectional study was conducted on 1,200 Khmer people aged 25-64 years living in Tra Vinh province to propotion of hypertension some related factors. 30 communes (clusters) were selected by probability proportional to size (PPS) method, evaluating their risk factors of coronary artery disease (CAD) in the next 10 years using Framingham scale in face-to-face interviews. Results showed that propotion of hypertension was 33.5%, inside, having 37.3% people don’t know that they are getting hypertension disease. About some risk factors: 83.6% of participants had diet with less fat, 26.2% had adequate fruit and vegetable consumption, 10.6% had less-salt diet, 85.2% were non-alcohol abuse, 62.5% were non-smokers and 79.3% had moderate physical activity. About coronary artery disease: 79.7% of respondents have low risk, 16.3% with moderate risk and 4.0% with high risk of CAD in the next 10 years according to Framingham scale. The risk increases proportionally to the age and higher among men than women.

Keywords

Hypertension; Coronary artery disease; KHMER people

Introduction

Hypertension and coronary artery disease (CAD) is a common heart disease in developed countries and tends to increase sharply in developing countries. In the world, one out of three deaths is caused by heart diseases [1]. In Vietnam, the mortality rate of CAD is 45 per 100.000 populations [2]. The identified risk factors of hypertension and CAD include age, sex, and family history of the disease, blood lipid disorder, and diet with salty foods, smoking, alcohol abuse, inadequate nutrition, and insufficient physical activity. Tra Vinh is a province, where Khmer people are more populated with limited socio-economic conditions and low utilization of health services. It is necessary to determined proportion of hypertension and evaluates some risk factors and risk of CAD among Khmer people in order to recommend the effective interventions for the improvement of health in this community. The study was conducted to determined proportion of hypertension and evaluates the risk of CAD in the next 10 years among Khmer people aged 25-64 years in Tra Vinh in 2015.

Methods

Participants and duration

Participants: Khmer people aged 25-64 years who are permanent residents or temporary residents in at least 1 year, excluding pregnant women, people with foot malformation or osteopathic scoliosis.

Duration: The study was conducted from July to October 2015.

Research design

A descriptive cross-sectional study

Sample Size:

Equation

n: minimum sample size

p= 0.22.

According report of WHO about the proportion of hypertension in Vietnam, 2014 [3].

α: statistical significant level at 95% level of confidence (α=0.05).

ε=0.04: acceptable error.

Design effect DE=2.

Minimum sample size is n=1,188 people.

In fact, we recruited 1,200 people.

Sample selection: 30 clusters by probability proportional to size method.

The cumulative population of Khmer people living in 104 communes of Tra Vinh was 187,096 people aged 25-64 years. In this study, we selected 30 clusters of 40 people in each commune. All Khmer people aged 25-64 years in each communes were listed and classified into 4 age group: 25-34, 35-44, 45-54, 55-64. We randomly selected 5 men and 5 women in each age group.

Data collection: Interview using structured questionnaire adapted from the tool of World Health Organization. Blood pressures were measured by Microlife BP 3BM1-3.

Total cholesterol, serum triglycerides, HDL-cholesterol were measured by enzymatic end point method using automatic biochemical machine AU680.

Indicators: Diet with salty foods: the consumption of salty foods of 3 days or more per week or of 5 gram or more of salt per day for each person in a household. Diet with plenty of fat: the intake of more than 25% lipid/day and more than 7% saturated fat or more than 300 gram/person/month or consume animal’s fat, lipid in more than 4 days/week. Fruit and vegetable consumption: the intake of 5 units or more of fruit or vegetable per day. Each unit is equivalent to 80 g. Alcohol abuse: drink 5 standard units or more of alcoholic beverage (for men) and 4 standard units or more (for women) on any day in a week (01 standard unit is equivalent to 10 g ethanol or 330 mL beer, 30 mL strong alcoholic drinks, 120 mL wine). Smoking: current smoking or have been stopped smoking in less than 6 months of any type of cigarette like tobacco, cigar or pipes.

Physical activity: Vigorous physical activity of at least 75 minutes per week or moderate physical activity of at least 150 minutes per week or combination of both vigorous and moderate physical activity of 600 MET-minute per week. Overall good practice: consume less fat, no alcohol abuse, and engage regular physical activity.

The level of CAD risk in the next 10 years using Framingham scale which is based on 5 variables: age, HDL-C level, total cholesterol, smoking, systolic blood pressure. Low risk: <10%. Moderate risk: 10 - 20%. High risk: >20%.

Data analysis

The data were entered by Epidata software, and analysed by Stata 12 software. χ² test was used with p value<0.05.

Ethical consideration

The benefits and personal information of the participants are protected according to the regulation of Institutional Review Board of the National Institute of Hygiene and Epidemiology and Tra Vinh Department of Health before implementation.

Results

Demographical characteristics of Khmer people in Tra Vinh province

The study included 1200 participants, among those 57.8% had the education level lower than primary school and 77.7% were farmers, 42.3% had the household income between 2,150,000 to less than 4,300,000 VND.

Situation of hypertension of Khmer people in Tra Vinh province

Result showed 402 people with hypertension disease, proportion was 33.5%; inside, the proportion of hypertension was discovered to be 21.0%, proportion of newly diagnosed with hypertension was 12.5% (Table 1).

  Hypertension Freq. %
No hypertension   798 66.5
Hypertension Having been diagnosed 252 21
Newly diagnosed 150 12.5

Table 1: Propotion of hypertension of Khmer people in Tra Vinh province.

After control impaction of variables together, some factors associated really to proportion of hypertension were sex, age group, diet with less fat, diet with salty foods, fruit and vegetable consumption, alcohol abuse, obesity (Table 2).

Factors Cruve-OR (95%CI) Combined-OR (95%CI) p-value
Sex 1.4 (1.1-1.8) 1.7 (1.2-2.4) <0.05
Age groups  
25-34 1 1 1
35-44 2 (1.3-3.0) 2.1 (1.3-3.3) <0.05
45-54 3.6 (2.5-5.2) 5.1 (3.3-8.0) <0.05
55-64 4.9 (3.4-7.0) 9.0 (5.8-14.0) <0.05
Diet with less fat 1.9 (1.4-2.6) 1.7 (1.2-2.4) <0.05
Fruit and vegetable consumption 2.3 (1.2-4.5) 2.2 (1.1-4.6) <0.05
Diet with salty foods 2.1 (1.3-3.3) 1.4 (1.1-2.1) <0.05
Alcohol abuse 1.5 (1.1-2.1) 1.6 (1.1-2.4) <0.05
Smoking 1.4 (1.1-1.8) 0.8 (0.6-1.2) >0.05
Dyslipidemia 2.0 (1.6-2.6) 1.3 (0.9-1.7) >0.05
Obesity 2.6 (1.9-3.5) 2.3 (1.7-3.3) <0.05
Glucose disorder 2.3 (1.5-3.6) 1.4 (0.9-2.1) >0.05

Table 2: Some risk factors of hypertension among Khmer people through multivariate analysis.

Practice of hypertension prevention Khmer people

The correct overall practice towards hypertension prevention and control accounts for 54.7% of respondents. The proportion were 10.6% for less-salt diet, 83.6% for no/less-fat diet, 26.2% for adequate fruit and vegetable consumption, 85.2% for no alcohol abuse, 62.5% for no smoking, and 79.3% for physical activity (Table 3).

Practice Correct Incorrect
Freq. % Freq. %
Diet with less fat 1003 83.6 197 16.4
Fruit and vegetable consumption 314 26.2 886 73.8
Diet with salty foods 127 10.6 1073 89.4
Alcohol abuse 1022 85.2 178 14.8
Smoking 750 62.5 450 37.5
Moderate or vigorous physical activity in more than 150 minutes per week 952 79.3 248 20.7
Regular health check 758 63.2 442 36.8
Receipt of information related to hypertension 585 48.8 615 51.3

Table 3: Practice of hypertension prevention among Khmer people (n=1.200).

The of people with correct overall hypertension prevention and control practices is 50.5% among men that is lower than among women with 58.8%, p<0.05. The figures are 47.6% and 56.5% among people with and without history of hypertension, respectively, p<0.05 (Table 4).

Associated factors Correct overall practice Total p-value OR (95% CI)
Freq. %
Sex Female 353 58.8 600 <0.05 (*) 1
Male 303 50.5 600 0.71(0.56-0.90)
Age group 25-34 168 56 300   1
35-44 153 51 300 >0.05 0.82(0.59-1.13)
45-54 172 57.3 300 >0.05 1.06(0.76-1.46)
55-64 163 54.3 300 >0.05 0.93(0.68-1.29)
Occupation Farmers 522 56 932   1
Blue- or white- collar workers 22 53.7 41 >0.05 0.91(0.48-1.70)
Others* 112 49.3 227 >0.05 0.76(0.57-1.02)
Education level Lower than primary school 387 55.8 694   1
Primary school 169 53.8 314 >0.05 0.92(0.71-1.21)
Secondary school 75 56 134 >0.05 1.01(0.69-1.46)
High shool 16 38.1 42 >0.05 0.48(0.26-0.93)
Higher than high school 9 56.2 16 >0.05 1.02(0.37-2.77)
Household income (million dong) <2.15 226 53.4 423   1
2.15-<4.30 266 52.4 508 >0.05 0.96(0.74-1.24)
4.3 -< 6.45 97 62.2 156 >0.05 1.43(0.98-2.09)
6.45 -<8.60 32 64 50 >0.05 1.55(0.84-2.85)
= 8.60 35 55.6 63 >0.05 1.09(0.64-1.85)
History of hypertension No 536 56.5 948 <0.05 (*) 1
Yes 120 47.6 252 0.70 (0.52-0.93)
Obesity No 551 55.3 997 >0.05 1
  Yes 105 51.7 203 0.87(0.63-1.19)

Table 4: Some associated factors of practices towards hypertension prevention.

Risk of coronary artery disease and demographical characteristics

The risk of CAD in the next 10 years is 79.7% with low risk, 16.3% with moderate risk and 4.0% with high risk. Males are more likely to get CAD with 7.9% than females with 0% (Table 5).

Factors Risk of CAD Total p
Low Moderate High
Overall   957 79.7 196 16.3 47 4 1200  
Sex Female 583 97.1 17 2.8 0 0 600 <0.01
Male 374 62.3 179 29.8 47 7.9 600
Age group 25–34 299 99.7 1 0.3 0 0 300 <0.01
35–44 279 93 18 6 3 1 300
45–54 220 73.3 67 22.3 13 4.4 300
55–64 159 53 110 36.7 31 10.3 300
Education level Able to read and write 548 78.9 121 17.4 25 3.7 694 0.61
Primary school 248 78.9 51 16.2 15 4.9 314
Secondary school 110 82.1 19 14.2 5 3.7 134
High school 35 83.3 5 11.9 2 4.8 42
Higher than high school 16 100 0 0 0 0 16
Occupation Blue- or white- collar workers 35 85.4 3 7.3 3 7.3 41 0.27
Farmers 735 78.9 160 17.2 37 3.9 932
Others* 187 82.4 33 14.5 7 3.1 227
Household income (million dong) <2.15 317 79.7 69 17.3 12 3 423 0.44
2.15-<4.30 407 80.1 78 15.4 23 4.5 508
4.30-<6.45 123 78.9 28 17.9 5 3.2 156
6.45-<8.60 42 84 8 16 0 0 50
≥ 8.60 51 80.9 7 11.1 5 8 63

Table 5: Risk of CAD according demographical characteristics.

Discussion

Situation of hypertension among Khmer people at Tra Vinh province

Result of this study showed that proportion of pretension among Khmer people at Tra Vinh province was 33.5%, inside; having 37.3% people don’t know that they are getting hypertension disease. This result higher when compared with report of Viet Nam Ministry of Health, the proportion hypertension among Khmer people from 25 years or older was 25.1% (2012-2015). Hypertension is rapidly increasing in Tra Vinh province and the increase in Khmer people is higher than in other communities.

Among 35 INTERSALT Populations with Allele Frequency Data, with an increase of one degree of latitude north or south, populationaverage systolic blood pressure increased by 0.3 mmHg. When GNB3 (G protein β3 subunit) 825T was included in the analysis, we were able to explain 64% of worldwide variation in blood pressure. With each 1% increase in GNB3 825T allele frequency, blood pressure increased 0.19 mmHg [4]. The genetic basis of blood pressure variation is largely unknown but is likely to involve genes. The research in Kenya-Africa, have a total of 1528 adults were surveyed with a mean age of 46.7 years, the age-standardized prevalence of hypertension was 29.4 % (95% CI 27.0-31.7) [5]. The same, the survey in sub-Saharan Africa shown that the age-standardized prevalence of hypertension ranged from 19.3% to 38.0%, with the mean age ranged from 36.8 years to 45.3 years [6]. Thus, the prevalence of hypertension in some ethnic minority communities is higher than in other communities.

Result this study showed that through multivariate, some factors associated really to proportion of hypertension were sex, age group, diet with less fat, diet with salty foods, fruit and vegetable consumption, alcohol abuse, obesity. Therefore, in interventions for the prevention of hypertension, attention should be paid to these factors.

Some risk factors of hypertension among Khmer people at Tra Vinh province

The correct overall practice of hypertension prevention and control among Khmer people accounts for 54.7% of respondents that is associated with sex, history of hypertension. More women than men have correct practices with 58.8% and 50.5%, respectively. The proportion of hypertension of male higher than female is 1.3 times p<0.01. Young women tend to have lower blood pressure, and less risk of hypertension, compared to young men. As people age, both blood pressure and the risk of hypertension increase in both sexes; this occurs most strikingly in women after menopause [7].

The majority of hypertension case was in age group of 55-64 years with 57.0%, the poorer health of those people in this age leads to the difficulties in physical activity so that the lower of correct practice was seen among those who had been diagnosed with hypertension (47.6%) than people without or had not been diagnosed with hypertension (56.5%).

About 16.4% of Khmer people in this study had the diet with plenty of animal’s fat. In contrast, the majority of Khmer people are farmers with lower socio-economic sources so that they have less opportunity to expose to fast foods. Thus, Khmer people have diet with less fat than Kinh people and other ethnicities living in other cities.

The intake significantly depends on the household’s economic. Although Tra Vinh is an agricultural province, the daily diet contains many natural vegetables. However, 77.5% of people participated in this survey have the income lower than 4.300.000 VND that hinders the access to vegetables and fruits to supplement daily diet. In the OHASAMA study, during 4-year follow-up period, After adjustment for all putative confounding factors, the highest quartile of fruit intake was associated with a significantly lower risk of future home hypertension (OR 0.40, 95% CI 0.22-0.74, p=0.004). In conclusion, this study, based on home blood pressure measurement, suggests that higher intake of fruit is associated with a lower risk of future home hypertension [8].

The commonly consumed foods in this region are fish and other seafood using to produce fish-sauce. The diet with salty foods is an important factor of hypertension. It suggests the needs of other intervention measures to improve the knowledge and practice in terms of reducing salt consumption among Khmer people, and thus contribute to hypertension prevention and control.

The alcohol consumption among Khmer people in this study is as twice as in other studies on Kinh people. The drinking habit is determined by social norms, economic conditions and especially local customs and festivals. In a study to appear in Alcoholism: Clinical and Experimental Research, Charles Holahan, who is professor of psychology at The University of Texas at Austin. The researchers followed 1,824 older adults, also found those who drank moderately were more likely to live longer across a 20-year follow-up than those who drank heavily or who didn’t drink at all. The findings showed increases in mortality risk of 42.0% for heavy drinkers and 49.0% for abstainers in comparison to moderate drinkers [9]. This study of among Khmer people shown that proportion of alcohol abuse is 14.8%, alcohol abuse in the Khmer youngers are highest and lasted many years can cause hypertension when older.

In this study, 32.0% of participants are smokers, of which 61.3% in males and 2.7% in females (PR=23; p<0.05). Furthermore, the smoking initiation among Khmer people is Tra Vinh is very early. Among the smokers, 84.6% have experienced smoking more than 10 years with the mean age of 22.2 ± 11.3 years. 36.2% smoke less than 10 cigarettes per day, 39.4% smoke from 10 to less than 20 cigarettes per day and 24.4% smoke 20 or more cigarettes per day.

The people who meet the recommended physical activity are 79.3%, which is mostly due to the works of farmers that require more physical activity (77.7% of respondents are farmers). 20.7% of Khmer people have physical inactivity. The distinction may be explained that the above ethnic people live in mountainous areas that they have to climb the mountains while carrying heavy tools to do farm works. This is why their physical activity is more intense than Khmer people living in delta areas. In study in Kenya, when fit in a multivariable logistic regression model, moderate physical activity [AOR = 1.9; (95%CI, 1.2- 3.0)], remained significantly associated with hypertension [5]. A metaanalysis of prospective cohort studies in China, including 136,846 persons who were initially free of hypertension, and 15 607 persons developed hypertension during follow-up. The pooled relative risk of main results from these studies suggests that both high and moderate levels of recreational physical activity were associated with decreased risk of hypertension (high vs. low: RR, 0.81; 95%CI, 0.76-0.85 and moderate versus low: RR=0.89; 95%CI 0.85-0.94) [10].

The risk of CAD in the next 10 years of Khmer people

According to Framingham scale, the risk of CAD in the next 10 years of Khmer people is 79.7% with low risk, 16.3% with moderate risk and 4.0% with high risk. CAD is a common disease among elderly people and resulted from many factors like high blood pressure, and particularly, blood lipid disorder. At the same time, the older people are not easy to convince to change in lifestyle and habits like smoking that occur with physical inactivity and low health care accountability. Thus, the elderly people have higher risk than younger adults.

To sum up, among Khmer people participated in this study, there are 956 people at low risk, 196 people at moderate risk and 48 people with high risk of CAD. The inference in 187,096 Khmer people aged 25-64 years living in Tra Vinh province in 2015 is that there will have been 7.484 Khmer people at high risk of CAD by 2025.

Age is an important factor of atherosclerosis. CAD develops silently and slowly in many years from young age. After a long time, the arteries are aging, hardening and loss of elasticity. The risk of CAD in the next 10 years by Framingham scale among study participants increases proportionally to age with statistical significance (p<0.01). The high risk of CAD in 10 coming years is highest among people aged 55-64 years with 10.3%. A cross-sectional study conducted on 13,769 adult people aged 20-79 years in the United States in 2004 also indicates that the older a person is, the higher risk of CAD in 10 years does the person get with p<0.05 [11]. It means that age is a risk factor of CAD that cannot be modified by medical intervention but it is valuable in CAD prediction among Khmer people in Tra Vinh.

Males are more likely to develop CAD than females with 7.9% and 0%, respectively. Besides, the moderate risk accounts for 29.8% among males and 2.8% among females. The results are in line with a cohort study of Framingham that follows up 5251 white people in 10 years. The CAD was found in 8.0% of males and 2.8% of females [12]. In one hand, the arteries are ageing more quickly among males than females. On the other hand, the estrogen hormone helps protect the women against CAD. It is demonstrated that the risk of CAD is reduced by 35- 50% with estrogen supplementation. This is explained that estrogen is conducive to the increase of HDL-C, decrease of LDL-C and lipoprotein (a) and accelerates the LDL-C oxidation.

This study cannot indicate the association between CAD risk in the next 10 years and education level, occupation and income. The factors considered in CAD risk evaluation are less likely to be influenced by level, occupation and income. It is necessary to conduct cohort studies to identify the association between those factors and CAD in the next 10 years.

Conclusions

Proportion of pretension was 33.5%, inside; having 37.3% people don’t know that they are getting hypertension disease. About some risk factors have related to the diet with less fat, adequate fruit and vegetable consumption, less-salt diet, alcohol abuse, smokers and physical activity. About coronary artery disease have the moderate risk (16.3%) and high risk (4.0%) of CAD in the next 10 years according to Framingham scale. The risk increases proportionally to the age and higher among men than women.

Disclosure

The authors declare no conflicts of interest.

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