title: Factors associated with grade 1 hypertension: implications for hypertension care based on the Dietary Approaches to Stop Hypertension (DASH) in primary care settings.
abstract: BACKGROUND
  A Reference Framework for Hypertension Care was recently developed by Hong Kong government to emphasise the importance of primary care for subjects with high blood pressure (BP). The Dietary Approaches to Stop Hypertension (DASH) interventional regime was recommended for patients aged 40-70 years with grade 1 hypertension (having systolic BP of 140-159 mmHg and/or diastolic BP of 90-99 mmHg). This study explored factors associated with grade 1 hypertension among subjects screened in primary care settings.
  
  
  METHODS
  The study sample consisted of community dwellers (N = 10,693) enrolled in a primary care programme in which participants overall had similar characteristics when compared to the Hong Kong population census. Invitation phone calls were given by trained researchers to a randomly selected subjects (N = 2,673, [50% of total subjects aged 40-70 years]) between January and June 2013. BP and body mass index (BMI) were measured by trained clinical professionals according to a standard protocol. Interviewer-administered survey questionnaires were used to collect self-report information on socio-demographics, family history, and lifestyle characteristics. Multiple logistic regression analysis was performed to explore factors associated with grade 1 hypertension. Adjusted odds ratios (aORs) were estimated with 95% confidence intervals (CI).
  
  
  RESULTS
  A total of 679 out of 2,673 subjects agreed to participate in the screening and completed the baseline assessment (100% completion rate), among which, 320 subjects (47.1%, [320/679]) were grade 1 hypertensive. Unhealthy diet (aOR = 2.19, 95%CI 1.04-4.62), irregular meals (aOR = 1.47, 95%CI 1.11-1.95), BMI >27.5 kg/m(2) (aOR = 1.87, 95%CI 1.53-2.27), duration of cigarette smoking (aOR = 1.83 per year), increased daily cigarette consumption (aOR  =1.59 per pack [20 cigarettes per pack]), duration of alcohol drinking (aOR = 1.65 per year), and higher frequency of weekly binge drinking (aOR = 1.87 per occasion) were independently associated with grade 1 hypertension. The increase in the number of risk factors combined significantly correlated with higher predicted probability of grade 1 hypertension.
  
  
  CONCLUSIONS
  Dietary-intake factors were significantly associated with grade 1 hypertension, echoing the recommendation in the Reference Framework on incorporating dietary-related intervention based on the DASH approach for hypertension care in primary care settings. The association between aggregate risk factors and grade 1 hypertension should also be taken into consideration in long-term preventive strategy.
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. Haoxiang.Wang@glasgow.ac.uk.|School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China. Haoxiang.Wang@glasgow.ac.uk.|General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK. Haoxiang.Wang@glasgow.ac.uk.
authors.forename: Harry H X
authors.initials: HH
authors.lastname: Wang
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. wong_martin@cuhk.edu.hk.
authors.forename: Martin C S
authors.initials: MC
authors.lastname: Wong
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. rosinamok@gmail.com.
authors.forename: Rosina Y
authors.initials: RY
authors.lastname: Mok
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. kwm417@ha.org.hk.|Family Medicine and Primary Health Care, Hospital Authority, Hong Kong, Hong Kong. kwm417@ha.org.hk.
authors.forename: Mandy W M
authors.initials: MW
authors.lastname: Kwan
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. skychanwm@cuhk.edu.hk.
authors.forename: Wai Man
authors.initials: WM
authors.lastname: Chan
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. ckmfan@fehd.gov.hk.|Food and Environmental Hygiene Department, Hong Kong, Hong Kong. ckmfan@fehd.gov.hk.
authors.forename: Carmen K M
authors.initials: CK
authors.lastname: Fan
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. catherinelee@cuhk.edu.hk.
authors.forename: Catherine L S
authors.initials: CL
authors.lastname: Lee
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. siangriffiths@cuhk.edu.hk.
authors.forename: Sian M
authors.initials: SM
authors.lastname: Griffiths
mesh_terms: D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D011320:Primary Health Care; D012307:Risk Factors