{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T14:37:23Z","timestamp":1793716643400,"version":"4.6.1"},"reference-count":48,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2017,4,3]],"date-time":"2017-04-03T00:00:00Z","timestamp":1491177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Science and Technology Support Program of China","award":["2012BAJ18B02"],"award-info":[{"award-number":["2012BAJ18B02"]}]},{"name":"Liaoning Research Center for Translational Medicine of Cardiovascular Disease","award":["2014225017"],"award-info":[{"award-number":["2014225017"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Previous studies found that hypertension and high homocysteine (HHcy) exhibited a synergistic effect on the risk of cardiovascular diseases. This study aimed to investigate the prevalence of hypertension accompanied by HHcy and its risk factors in the rural areas of northeast China. This study was conducted using a stratified cluster random sampling method, and included 6529 subjects with complete data. Demographic characteristics were obtained from a questionnaire. Blood pressure and anthropometric indices were measured, and serum indices were analyzed. Hypertension accompanied by HHcy was defined as hypertension plus HHcy [homocysteine (Hcy) &gt; 10 \u00b5mol\/L]. The mean concentration of Hcy was 17.29 \u03bcmol\/L in the general population. The prevalence of hypertension accompanied by HHcy was so high that it reached 45.1% of our study population and accounted for 86.8% of the total participants with hypertension. Multiple logistic regression analysis indicated that the modifiable risk factors of hypertension accompanied by HHcy included obesity, diabetes, dyslipidemia, and inactive physical activities. We found that the mean level of Hcy, and the prevalences of HHcy and hypertension accompanied by HHcy were very high among the rural population of northeast China. Obesity, diabetes, dyslipidemia, and inactive physical activities were modifiable risk factors of hypertension accompanied by HHcy.<\/jats:p>","DOI":"10.3390\/ijerph14040376","type":"journal-article","created":{"date-parts":[[2017,4,3]],"date-time":"2017-04-03T13:32:30Z","timestamp":1491226350000},"page":"376","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["The Prevalence of Hypertension Accompanied by High Homocysteine and its Risk Factors in a Rural Population: A Cross-Sectional Study from  Northeast China"],"prefix":"10.3390","volume":"14","author":[{"given":"Ye","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Cardiology, the First Hospital of China Medical University, Shenyang 110001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, the First Hospital of China Medical University, Shenyang 110001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofan","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, the First Hospital of China Medical University, Shenyang 110001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yintao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, the First Hospital of China Medical University, Shenyang 110001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongxue","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Cardiology, the First Hospital of China Medical University, Shenyang 110001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingxian","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Cardiology, the First Hospital of China Medical University, Shenyang 110001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/S0140-6736(02)11403-6","article-title":"Selected major risk factors and global and regional burden of disease","volume":"360","author":"Ezzati","year":"2002","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1161\/CIRCULATIONAHA.106.171016","article-title":"Metabolism. Obesity and cardiovascular disease: Pathophysiology, evaluation, and effect of weight loss: An update of the 1997 American Heart Association scientific statement on obesity and heart disease from the obesity committee of the council on nutrition, physical activity, and metabolism","volume":"113","author":"Poirier","year":"2006","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.jash.2015.02.014","article-title":"Grim status of hypertension in rural china: Results from northeast china rural cardiovascular health study 2013","volume":"9","author":"Li","year":"2015","journal-title":"J. Am. Soc. Hypertens."},{"key":"ref_4","unstructured":"(2017, April 02). Report on Cardiovascular Diseases in China 2015. Available online: http:\/\/www.nccd.org.cn\/UploadFile\/201607\/20160718113619135135.pdf."},{"key":"ref_5","unstructured":"(2017, April 02). Available online: http:\/\/www.nhfpc.gov.cn\/xcs\/s3574\/201506\/6b4c0f873c174ace9f57f11fd4f6f8d9.shtml."},{"key":"ref_6","first-page":"976","article-title":"Prevention of stroke relies on valid control \u201ch\u201d type hypertension","volume":"47","author":"Hu","year":"2008","journal-title":"Zhonghua. Nei. Ke. Za. Zhi."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1038\/labinvest.3780275","article-title":"Impaired homocysteine metabolism and atherothrombotic disease","volume":"81","author":"Durand","year":"2001","journal-title":"Lab. Invest."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1161\/01.STR.0000199147.30016.74","article-title":"Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: A statement for healthcare professionals from the American Heart Association\/American Stroke Association council on stroke: Co-sponsored by the council on cardiovascular radiology and intervention: The american academy of neurology affirms the value of this guideline","volume":"37","author":"Sacco","year":"2006","journal-title":"Stroke"},{"key":"ref_9","first-page":"897","article-title":"Homocysteine concentration and the risk of death in the adult polish population","volume":"70","author":"Waskiewicz","year":"2012","journal-title":"Kardiol. Pol"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/S0140-6736(05)70152-5","article-title":"Homocysteine and stroke: Evidence on a causal link from mendelian randomisation","volume":"365","author":"Casas","year":"2005","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/1475-2891-14-6","article-title":"Role of homocysteine in the development of cardiovascular disease","volume":"14","author":"Ganguly","year":"2015","journal-title":"Nutr. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/BF03195624","article-title":"Homocysteine, MTHFR gene polymorphisms, and cardio-cerebrovascular risk","volume":"49","author":"Trabetti","year":"2008","journal-title":"J. Appl. Genet."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Qin, X., Li, Y., Sun, N., Wang, H., Zhang, Y., Wang, J., Li, J., Xu, X., Liang, M., and Nie, J. (2016). Elevated homocysteine concentrations decrease the antihypertensive effect of angiotensin-converting enzyme inhibitors in hypertensive patients. Arterioscler. Thromb. Vasc. Biol.","DOI":"10.1161\/ATVBAHA.116.308515"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5373","DOI":"10.3390\/ijerph120505373","article-title":"Ethnic differences in the prevalence of high homocysteine levels among low-income rural Kazakh and Uyghur adults in far western china and its implications for preventive public health","volume":"12","author":"Guo","year":"2015","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Zhang, Q., Qiu, D.X., Fu, R.L., Xu, T.F., Jing, M.J., Zhang, H.S., Geng, H.H., Zheng, L.C., and Wang, P.X. (2016). H-type hypertension and C reactive protein in recurrence of ischemic stroke. Int. J. Environ. Res. Public Health, 13.","DOI":"10.3390\/ijerph13050477"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"424","DOI":"10.3109\/10641963.2015.1116547","article-title":"H-type hypertension is an important risk factor of carotid atherosclerotic plaques","volume":"38","author":"Chen","year":"2016","journal-title":"Clin. Exp. Hypertens."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/j.hlc.2016.02.007","article-title":"Prevalence and metrics distribution of ideal cardiovascular health: A population-based, cross-sectional study in rural china","volume":"25","author":"Chang","year":"2016","journal-title":"Heart Lung Circ."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Chang, Y., Li, Y., Guo, X., Dai, D., and Sun, Y. (2016). The association of ideal cardiovascular health and atherogenic index of plasma in rural population: A cross-sectional study from northeast china. Int. J. Environ. Res. Public Health, 13.","DOI":"10.3390\/ijerph13101027"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e3763","DOI":"10.1097\/MD.0000000000003763","article-title":"The association between alcohol consumption and left ventricular ejection fraction: An observational study on a general population","volume":"95","author":"Li","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Qiao, Y., Shi, R., Hou, B., Wu, L., Zheng, L., Ding, L., Chen, G., Zhang, S., and Yao, Y. (2015). Impact of alcohol consumption on substrate remodeling and ablation outcome of paroxysmal atrial fibrillation. J. Am. Heart Assoc., 4.","DOI":"10.1161\/JAHA.115.002349"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"234","DOI":"10.15288\/jsa.2001.62.234","article-title":"Validation of the screening strategy in the NIAAA \u201cphysicians\u2019 guide to helping patients with alcohol problems\u201d","volume":"62","author":"Friedmann","year":"2001","journal-title":"J. Stud. Alcohol"},{"key":"ref_22","first-page":"439","article-title":"The transition of chinese dietary guidelines and food guide pagoda","volume":"20","author":"Ge","year":"2011","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1016\/j.ehj.2004.10.020","article-title":"Joint effects of physical activity, body mass index, waist circumference and waist-to-hip ratio with the risk of cardiovascular disease among middle-aged Finnish men and women","volume":"25","author":"Hu","year":"2004","journal-title":"Eur. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1161\/CIRCULATIONAHA.109.192703","article-title":"Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association\u2019s strategic impact goal through 2020 and beyond","volume":"121","author":"Hong","year":"2010","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1161\/01.CIR.0000154900.76284.F6","article-title":"Recommendations for blood pressure measurement in humans and experimental animals: Part 1: Blood pressure measurement in humans: A statement for professionals from the subcommittee of professional and public education of the American Heart Association council on high blood pressure research","volume":"111","author":"Pickering","year":"2005","journal-title":"Circulation"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"World Health Organization Expert Consultation (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363, 157\u2013163.","DOI":"10.1016\/S0140-6736(03)15268-3"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Liu, X., Wang, Y., Wang, C., Shi, C., Cheng, C., Chen, J., Ma, H., Lv, L., Li, L., and Lou, T. (2013). A new equation to estimate glomerular filtration rate in chinese elderly population. PLoS One, 8.","DOI":"10.1371\/journal.pone.0079675"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.arcmed.2007.07.009","article-title":"The 677 C\/T MTHFR polymorphism is associated with essential hypertension, coronary artery disease, and higher homocysteine levels","volume":"39","author":"Ilhan","year":"2008","journal-title":"Arch. Med. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.3945\/ajcn.110.004671","article-title":"MTHFR 677c->t genotype is associated with folate and homocysteine concentrations in a large, population-based, double-blind trial of folic acid supplementation","volume":"93","author":"Crider","year":"2011","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/jn\/137.2.407","article-title":"High prevalence of hyperhomocysteinemia in chinese adults is associated with low folate, vitamin B-12, and vitamin B-6 status","volume":"137","author":"Hao","year":"2007","journal-title":"J. Nutr."},{"key":"ref_31","first-page":"614","article-title":"[efficacy and safety of enalapril-folate acid tablets in lowering blood pressure and plasma homocysteine]","volume":"39","author":"Li","year":"2007","journal-title":"Beijing Da Xue. Xue. Bao."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1038\/sj.ejcn.1602097","article-title":"Prevalences of hyperhomocysteinemia, unfavorable cholesterol profile and hypertension in European populations","volume":"59","author":"Mennen","year":"2005","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Fakhrzadeh, H., Ghotbi, S., Pourebrahim, R., Nouri, M., Heshmat, R., Bandarian, F., Shafaee, A., and Larijani, B. (2006). Total plasma homocysteine, folate, and vitamin B12 status in healthy Iranian adults: The tehran homocysteine survey (2003\u20132004)\/a cross-sectional population based study. BMC Public Health, 6.","DOI":"10.1186\/1471-2458-6-29"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1111\/1753-0407.12333","article-title":"H-type hypertension, stroke and diabetes in china: Opportunities for primary prevention","volume":"8","author":"Qin","year":"2016","journal-title":"J. Diabetes"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1515\/jtim-2015-0027","article-title":"H-type hypertension and risk of stroke in chinese adults: A prospective, nested case-control study","volume":"3","author":"Li","year":"2015","journal-title":"J. Transl. Int. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1024\/0301-1526\/a000347","article-title":"Hyperhomocysteinaemia, low folate concentrations and MTHFR C677T mutation in abdominal aortic aneurysm","volume":"43","author":"Cao","year":"2014","journal-title":"Vasa"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1001\/jama.2015.2274","article-title":"Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in china: The CSPPT randomized clinical trial","volume":"313","author":"Huo","year":"2015","journal-title":"JAMA"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1093\/ajh\/hpu053","article-title":"China National Survey of Chronic Kidney Disease Working, G. Prevalence, awareness, treatment, and control of hypertension in china: Results from a national survey","volume":"27","author":"Wang","year":"2014","journal-title":"Am. J. Hypertens."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/S1474-4422(07)70004-2","article-title":"Stroke in china: Epidemiology, prevention, and management strategies","volume":"6","author":"Liu","year":"2007","journal-title":"Lancet Neurol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"207","DOI":"10.3390\/ijerph13020207","article-title":"Modified ideal cardiovascular health status is associated with lower prevalence of stroke in rural northeast china","volume":"13","author":"Guo","year":"2016","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_41","first-page":"253","article-title":"Etiopathogenesis and pathogenesis of H type hypertension","volume":"33","author":"Zhang","year":"2012","journal-title":"Adv. Cardiovasc. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.jns.2010.07.013","article-title":"Pronounced association of elevated serum homocysteine with stroke in subgroups of individuals: A nationwide study","volume":"298","author":"Towfighi","year":"2010","journal-title":"J. Neurol. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2679","DOI":"10.1161\/CIRCULATIONAHA.108.788166","article-title":"Prevalence, awareness, treatment, and control of hypertension in china: Data from the china National Nutrition and Health Survey 2002","volume":"118","author":"Wu","year":"2008","journal-title":"Circulation"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s12013-010-9079-y","article-title":"Homocysteine to hydrogen sulfide or hypertension","volume":"57","author":"Sen","year":"2010","journal-title":"Cell. Biochem. Biophys."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.cardiores.2005.08.016","article-title":"Hyperhomocysteinemia inhibits post-injury reendothelialization in mice","volume":"69","author":"Tan","year":"2006","journal-title":"Cardiovasc. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"3648","DOI":"10.1182\/blood-2007-06-096701","article-title":"Homocysteine inhibits endothelial cell growth via DNA hypomethylation of the cyclin a gene","volume":"110","author":"Jamaluddin","year":"2007","journal-title":"Blood"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1182\/blood-2011-01-333310","article-title":"Hyperhomocysteinemia impairs endothelium-derived hyperpolarizing factor-mediated vasorelaxation in transgenic cystathionine beta synthase-deficient mice","volume":"118","author":"Cheng","year":"2011","journal-title":"Blood"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1161\/CIRCRESAHA.112.269472","article-title":"Severe hyperhomocysteinemia promotes bone marrow-derived and resident inflammatory monocyte differentiation and atherosclerosis in LDLR\/CBS-deficient mice","volume":"111","author":"Zhang","year":"2012","journal-title":"Circ. Res."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/4\/376\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:31:54Z","timestamp":1760207514000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/4\/376"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4,3]]},"references-count":48,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2017,4]]}},"alternative-id":["ijerph14040376"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14040376","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,4,3]]}}}