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Our hunter-gatherer ancestors appeared to survive on little salt. When today's rural dwellers move to urban environments, they increase their salt intake and the salt-sensitive among them become prone to age-related increase in blood pressure and hypertension. This paper reviews our knowledge of the mechanisms of salt disposal and plasma volume regulation, salt consumption in human evolution, salt intake and prevalence of hypertension, and the results of interventions aimed at modulating both. Finally, it discusses current hypotheses on the mechanisms of selective pressure that may have favored the emergence of a salt-sensitive, hypertensive genotype. Similar to 'thrifty' genes, which supported energy savers in times of scarcity, but may now be causing obesity and type 2 diabetes, 'thirsty' genes, by acting on salt and water retention, might have helped individuals survive the challenge of volume-depleting illnesses, especially when combined with stress-inducing situations, but may now cause high BP and related damage in the post-reproductive age.
Our hunter-gatherer ancestors appeared to survive on little salt. When today's rural dwellers move to urban environments, they increase their salt intake and the salt-sensitive among them become prone to age-related increase in blood pressure and hypertension. This paper reviews our knowledge of the mechanisms of salt disposal and plasma volume regulation, salt consumption in human evolution, salt intake and prevalence of hypertension, and the results of interventions aimed at modulating both. Finally, it discusses current hypotheses on the mechanisms of selective pressure that may have favored the emergence of a salt-sensitive, hypertensive genotype. Similar to 'thrifty' genes, which supported energy savers in times of scarcity, but may now be causing obesity and type 2 diabetes, 'thirsty' genes, by acting on salt and water retention, might have helped individuals survive the challenge of volume-depleting illnesses, especially when combined with stress-inducing situations, but may now cause high BP and related damage in the post-reproductive age.
Community-oriented primary care (COPC) provides a framework for identifying and addressing a defined community's health and health care needs. The research reported upon here is based on a community health survey in a new suburban neighborhood (Tayuan region) in the Haidian district of Beijing, conducted by the Beijing Medical University Department of Preventive Medicine and Health Care, to serve as a basis for planning health care services for the residents in that community. The analyses focus on the prevalence and predictors of hypertension among older adult residents (those 45 years of age and older). Based on logistic regression analyses, the odds ratios (in parentheses) confirm that individuals with a family history of cardiovascular disease were more likely to have been diagnosed as hypertensive (1.57). Hypertensives were also more likely to have uncontrolled systolic (3.85) or diastolic (4.75) blood pressure and associated behavioral and biologic risks, such as obesity (1.87) and renal damage (2.60). These risks were even greater among current or former smokers. These analyses will inform the design of community-oriented primary care interventions in that particular community in the People's Republic of China. They also signal important implications and highlight practical methods for assessing and targeting interventions in U.S. communities facing comparable, but unexamined, risks.
Chinese migrants have low cardiovascular mortality, particularly in their first 10 years of residence in Australia. The apparent increase in cardiovascular deaths among Asian migrants who have lived in Australia for more than 10 years suggests that cardiovascular risk transition may occur soon after migration. In this descriptive study, we found that Melbourne Chinese were not low in cardiovascular risk factors as usually defined. The prevalence of hyperlipidaemia (7.7 per cent for men and 5.2 per cent for women) was similar to the prevalence for other Australians (6.8 per cent for men and 4.4 per cent for women). In spite of low mean blood pressure (systolic blood pressure 114+23 mmHg (mean+standard deviation) and diastolic blood pressure 67.3+10.6 mmHg), Melbourne Chinese women were hypertensive as often as their Australian counterparts. The prevalence of cigarette smoking in men (26.9 per cent) was also comparable to prevalence for Australian males (24.1 per cent). Being slim is the only recognised cardiovascular protection that Melbourne Chinese may have. A high waist‐to‐hip ratio (0.91+0.054 for men and 0.88+0.077 for women), however, may outweigh the potential benefit of a lower prevalence of overweight (17.7 per cent for men and 14.1 per cent for women). Melbourne Chinese men had a multiple risk‐factor profile similar to their Australian counterparts. Differences in multiple risk factors in women were attributable to fewer Chinese women having a single risk factor (15.4 per cent versus 30.1 per cent). While cardiovascular mortality and risk‐factor prevalence is declining in Australia, our study suggests that migrants such as Melbourne Chinese may not share the same health improvement.
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