Control of Hypertension in China

Study Questions:

What is the prevalence, awareness, and control of hypertension (HTN) in China?

Methods:

Data for this study were used from the PEACE (China Patient-Centered Evaluative Assessment of Cardiac Events) Million Persons Project, a population-based screening project that enrolled community-dwelling adults, aged 35-75 years. From Sept 15, 2014, to June 20, 2017, a convenience sampling strategy was used to select 141 sites (88 rural counties and 53 urban districts) from all 31 provinces in mainland China. HTN was defined as systolic blood pressure (SBP) of ≥140 mm Hg, or diastolic blood pressure (DBP) of ≥90 mm Hg, or self-reported antihypertensive medication use in the previous 2 weeks. HTN awareness, treatment, and control were defined, respectively, among hypertensive adults as a self-reported diagnosis of HTN, current use of antihypertensive medication, and blood pressure of <140/90 mm Hg. The authors assessed awareness, treatment, and control in 264,475 population subgroups defined a priori by all possible combinations of 11 demographic and clinical factors (age [35-44, 45-54, 55-64, and 65-75 years], sex [men and women], geographical region [western, central, and eastern China], urbanity [urban vs. rural], ethnic origin [Han and non-Han], occupation [farmer and nonfarmer], annual household income [<10 000, 10,000–50,000, and ≥50,000 in Chinese yuan], education [primary school and below, middle school, high school, and college and above], previous cardiovascular events [yes or no], current smoker [yes or no], and diabetes [yes or no]), and their associations with individual and primary healthcare site characteristics.

Results:

A total of 1,738,886 participants (mean age 55.6 years [standard deviation, 9.7]; 59.5% female) were included in this analysis. Those who had HTN comprised 44.7% (95% confidence interval, 44.6-44.8) of the cohort. Of the adults with HTN, 44.7% (44.6-44.8) were aware of their HTN diagnosis, and 30.1% (30.0-30.2) were taking prescribed antihypertensive medications. Only 7.2% (7.1-7.2) had achieved control. The age- and sex-standardized rates of HTN prevalence, awareness, treatment, and control were 37.2% (37.1-37.3), 36.0% (35.8-36.2), 22.9% (22.7-23.0), and 5.7% (5.6-5.7), respectively. The most commonly used medication class was calcium-channel blockers (55.2%, 55.0-55.4). Among individuals whose HTN was treated but not controlled, 81.5% (81.3-81.6) were using only one medication. The proportion of participants who were aware of their HTN and were receiving treatment varied significantly across subpopulations; lower likelihoods of awareness and treatment were associated with male sex, younger age, lower income, and an absence of previous cardiovascular events, diabetes, obesity, or alcohol use (all p < 0.01). By contrast, the control rate was universally low across all subgroups (<30.0%).

Conclusions:

The investigators concluded that among Chinese adults aged 35-75 years, nearly one-half have HTN, less than one-third are being treated, and fewer than one in twelve are in control of their blood pressure. The low number of people in control is ubiquitous in all subgroups of the Chinese population and warrants a broad-based, global strategy such as greater efforts in prevention, as well as better screening and more effective and affordable treatment.

Perspective:

These data support public health programs to improve awareness and diagnosis of HTN among Chinese adults. Studies such as these are an important means for countries to understand rates of cardiovascular risk factors such as HTN, and to monitor current management of modifiable risk factors such as HTN.


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