Hypertension, characterized as blood vessels having persistently raised pressure (1), was a well-known risk factor leading to cardiovascular diseases (CVDs), and has contributed to the majority of premature death globally (2). It has been reported that half of CVDs were caused by elevated blood pressure (BP), and more than 1.5 billion people are suffering from hypertension nowadays (3).

As the most populous country, China has been having soaring cases of hypertensives over the decades (4). With the rapid development of economy and a huge transition in dietary and life habits in China, the prevalence of hypertension has increased over the decades (5). It is worth mentioning that blood pressure increases with age (6), therefore, old population are of greater risk of hypertension. Additionally, a national survey published recently suggested that the prevalence of hypertension was higher in rural areas than urban ones in some developed areas in our country (7). The acceleration of aging and urbanization plays an important role in this phenomenon as well (8). Therefore, old population aged over 60 living in rural areas was a noteworthy crowd to which more attention should be paid to.

Over decades, substantial studies had presented the epidemiological characteristics and influencing factors of hypertension at home and abroad (4, 9, 10). However, researches covering a large sample among rural old population in central China was still limited. Hence, this large sample crosssectional study which involved the levels of blood pressure in conjunction with prevalence, awareness, treatment, and control of hypertension was conducted to provide the latest evidence on the current status of hypertension among older population in central rural China. Moreover, the present study also calculated life expectancy (LE) and health-adjusted life expectancy (HALE) in people with or without hypertension to intuitively illustrate the burden caused by hypertension in this population.

The crude and age-standardized prevalence, awareness, treatment, and control of hypertension were 44.52%, 65.02%, 53.65%, 19.78% and 45.36%, 65.05%, 53.74%, 19.68%, respectively. The prevalence of hypertension was lower than 53.24% reported in a national study conducted in 2012–2015, and the awareness, treatment, and control rates were slightly higher than that national level of the older population (19). The LE and HALE were decreased with increasing age among participants in both genders, which was in line with other studies. Furthermore, within people in the age of 60, 65, 70, and 75, they would gain 0.3840, 0.3548, 0.3115, 0.1927 years of HALE after eliminating hypertension, respectively, which revealed the impact of hypertension on health to be more realistic. Therefore, increased attention should be paid to older adults in rural China, and more reasonable strategies and measures should be urgently proposed and adopted. Additionally, the huge prehypertension population (29.83%) in this study suggested a remarkable risk burden of cardiovascular and cerebrovascular diseases among older adults in rural regions. Investigators of Framingham Heart Study have reported that individuals with prehypertension were two-fold to three-fold more likely to progress to hypertension compared with those with normal BP (20).

The current study also demonstrated that hypertension was more common among old female than their male counterparts, which was in line with previous researches (15, 21). This phenomenon may be explained by the hormonal changes at different ages for men and women (15). It has been previously reported that the prevalence of hypertension in postmenopausal women was higher than in premenopausal ones (22). It is worth noting that the prevalence of hypertension kept increasing with age, whereas, as for prehypertension, the prevalence was maintained decreasing with age among participants, with the exception of the age group of 75–79. The findings might be because prehypertension, a phase in the progression to hypertension from normal BP, tends to be more severe over time and was inclined to progress to hypertension with aging (23). Another cohort study also reported that prehypertension tends to become severe over time (24). Simultaneously, the increasing trend of prehypertension that began at age 75 remained unexplainable in our study and needs to be elucidated by further studies. Concerning participants in the age group of 60, those without hypertension can live 0.3840 years more (0.3368 and 0.3497 years for men and women, respectively) in healthy status, compared with their counterparts suffering from hypertension. With the exception of those aged over 75, the difference between the gap of HALE in nonhypertensive and hypertensive groups was higher among women than men. In addition, the LE and HALE decreased sharply with increasing age among both genders, showing that the quality of life of rural older population deteriorated with age, which has been reported in other areas (25).

As was published in other epidemiologic studies conducted at home and abroad, age was associated positively with hypertension (26, 27). Simultaneously, what was displayed in logistic regression analysis was that the ORs displayed a significant increase with increasing age for them, which hinted that more attention should be paid to older people. In addition, being overweight and obese is associated with a higher risk of hypertension, as has been found in a great many investigations (5, 28). An obvious association between BP increase and weight gain was discovered (28–30), and a dose-response effect of the magnitude of weight loss on BP reduction was reported by the American obesity guideline (31). For overweight and obese individuals, hence, several lines of evidence suggest that weight loss strategy is of utmost importance to refrain from higher blood pressure readings (29). Demonstrated in numerous observational and intervention studies, more vegetable and fruit intake offered a considerable benefit against the risk of hypertension (32), and this phenomenon was also found in this study. Additionally, those suffering from diabetes or dyslipidemia were more inclined to develop hypertension, which was consistent with studies published previously (33, 34). Yin Ruixing et al., discovered that dyslipidemia was associated with hypertension in many aspects, and this excited several common risk factors among these chronic noncommunicable diseases (35). More attention ought to be paid to those with diabetes and dyslipidemia when screening for hypertesnion. Futhermore, the results suggested that moderate or high physical activity was related to lower risk of having hypertension, in line with other publications. Given what was reported in a review from 27 randomized controlled trials, medium-to-high-intensity aerobic activity would reduce the BP by 11/5 mmHg among hypertensives (36). Therefore, for people with hypertension it would better to exercise more to lower BP.

The strengths of the study should be highlighted. Firstly, this was the latest study to explore the status of hypertension and health-adjusted life expectancy focusing on older population in rural regions. In addition, the present study covered a large sample of study population, which made the results more convincing. Nevertheless, several limitations of this study should be noted as well. Firstly, due to the crosssectional nature, the HALE was calculated by Sullivan method with death data from the 2017 China Cause-of-death Surveillance Data set. As the LE and HALE were calculated with crosssectional data, the LE and HALE in our study may be relatively underestimated. Indeed, follow-up surveys of this cohort are still ongoing and subsequent data would make the HALE more convincing by evaluating via multistate life table method. Secondly, considering all participants contained in the present study were older adults from rural areas in China, the generalizability of the current reported information to other regions or populations could be limited. Finally, the information on lifestyles and personal history of diseases was collected via a standardized questionnaire, as a consequence, recall bias was unavoidable. However, the questionnaire was concerned with high reliability and validity, and the researchers had been well-trained, and so the results in the present study were convincing even if there exsited recall bias.

In conclusion, the prevalence of hypertension was relatively high while the awareness, treatment, and control were fairly low. The HALE of older adults in resource-limited areas could increase from the reduction of hypertension. Unhealthy lifestyles should be adjusted and relevant policies should be formulated to help the older ones in rural areas access to reduce hypertension prevalence and increase the health-adjusted life expectancy for this population.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The study was approved by Zhengzhou University Life Science Ethics Committee (Code: [2015] MEC (S128)) and conducted following the principles of the Declaration of Helsinki. Additionally, written informed consent was obtained from each participant.

ZH: carried out data analysis and wrote the manuscript. XL, WL, NK, LM, ZM, JH, and WH: recruited the participants and administered the assessment. YL and CW: designed this study and guided the writing. All authors listed have read, corrected, and approved the final manuscript.

This research was supported by the Philosophy and Social Science Planning Project of Henan Province (Grant No: 2020BSH018), Foundation of National Key Program of Research and Development of China (Grant No: 2016YFC0900803), Science and Technology Innovation Team Support Plan of Colleges and Universities in Henan Province (Grant No: 21IRTSTHN029), National Natural Science Foundation of China (Grant Nos: 81602925 and 82003543), Foundation of Medical Science and Technology of Henan province (Grant Nos: 201702367 and 2017T02098), and Discipline Key Research and Development Program of Zhengzhou University (Grant Nos: XKZDQY202008 and XKZDQY202002). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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