Hypertension survey in China demonstrated high prevalence, low rates of control

1. In this prospective cohort of Chinese adults, hypertension was found in about one-third of adults, with fewer than one in twenty having control over this condition.

2. The rates of diagnosis, treatment, and adequate control of hypertension were low compared to western countries.

Evidence Rating Level: 2 (Good)

Study Rundown: Hypertension is a major risk factor for cardiovascular disease (CVD). While treatments have demonstrated clear mortality benefits, certain parts of the world are not has aggressive with diagnosis and treatment as the western countries. This study sought to establish the prevalence, diagnosis, and treatment of hypertension in the Chinese population.

Overall, hypertension (SBP >140 mmHg or DBP >90 mmHg) was present in one-third of adults aged 35 to 74 years, and prevalence was demonstrated to increase with age. Of these, fewer than one in twenty people had control over this condition. Hypertension was associated with increased relative risk of cardiovascular mortality at all ages and was linked to one third of deaths from CVD. The strength of the study was the large cohort size and the rigorous measurements of blood pressure. Limitations included the inability to generalize statistics to the whole Chinese population as the regions of study were selected for logistical ease rather than attempts at representative samples. Also, data on antihypertensive agents used and prevalence of important comorbidities such as diabetes mellitus were not available.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Prevalence, Awareness, Treatment, and Control of Hypertension in China: Results From a National Survey

In-Depth [prospective cohort]: This study recruited 500,233 adults (41.0% male) aged 35 to 74 years between June 25, 2004 and August 5, 2009 from 5 urban and 5 rural regions of China, and followed participants for a mean of 7.2 years. In addition to demographic data and past history of CVD (stroke, TIA, or ischemic heart disease), all patients underwent blood pressure measurement by averaged results of two digital sphygmomanometer measurements following 5 minutes of rest.

A total of 32.5% of patients were found to have hypertension. Prevalence increased with age and was found to have significant geographic variation. Relative risk of CVD mortality due to hypertension was 4.13 (95%CI 3.72-4.59) from ages 35-59 years, 2.61 (95%CI 2.38-2.85) for ages 60 to 69, and 1.89 (95%CI 1.76-2.03). Of these patients with hypertension, 30.5% had a formal diagnosis from a physician, of whom only 46.4% were being treated. Only 29.6% of patients being treated had measurements below the hypertensive limit leading to an overall control rate of 4.2% in the studied cohort.

Image: PD

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