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Diagnosis, treatment, control levels of hypertension low in China
Approximately one-third of Chinese adults have hypertension, but its diagnosis, treatment and control levels are lower than in Western countries, according to a prospective cohort study.
Researchers analyzed 500,223 Chinese adults (mean age, 52 years; 41% men) from the China Kadoorie Biobank study aged 35 to 74 years.
All participants had BP measurements taken at baseline, with hypertension defined as systolic BP of at least 140 mm Hg, diastolic BP of at least 90 mm Hg or the participant received treatment for hypertension. They were followed for CVD death for a mean of 7.2 years.
Sarah Lewington, DPhil, from the clinical trial service and epidemiological studies units, Nuffield Department of Population Health, University of Oxford, England, and colleagues found that 32.5% of participants had hypertension, and that prevalence increased with age (aged 35-39 years, 12.6%; aged 70-74 years, 58.4%). They also found that hypertension rates varied by region (range, 22.7%-40.7%).
Control rate low
Among those who had hypertension, only 30.5% had been diagnosed by a physician; among those who had been diagnosed, only 46.4% were receiving treatment; and among those who were being treated, only 29.6% had their hypertension controlled, for an overall control rate of 4.2%, according to the researchers.
Of those who had hypertension and prior CVD, only 13% had their hypertension under control, they found.
Across all age groups, uncontrolled hypertension was associated with increased risk for CVD mortality (aged 35-59 years: RR = 4.1; 95% CI, 3.7-4.6; aged 60-69 years: RR = 2.6; 95% CI, 2.4-2.9; aged 70-79 years: RR = 1.9; 95% CI, 1.8-2), Lewington and colleagues wrote.
In 2010, uncontrolled hypertension accounted for approximately one-third of CVD deaths, or approximately 750,000 deaths, for adults aged 35 to 79 years in China, they wrote.
“Public health initiatives are required that focus on the major determinants of BP at a population level, including salt intake (known to be particularly high in China), harmful alcohol consumption, obesity and poor home heating (shown to have a substantial effect on BP in China),” Lewington and colleagues wrote. “Unless concerted efforts are made to lower BP levels in China, rates of death due to CVD are likely to increase further during the next few decades.”
Call to action
In a related editorial, Nathan D. Wong, PhD, and Stanley S. Franklin, MD, wrote that, “Opportunities for improvement include better coordination of efforts among national, provincial and local governments and the health ministry, health care and scientific leaders, and the private sector; in addition, professional education of physicians about hypertension treatment guidelines should be improved.”
Wong and Franklin, both from the Heart Disease Prevention Program, division of cardiology, University of California, Irvine, concluded that the findings support “a call to action to promote proper early screening for hypertension and national campaigns calling for better diagnosis, treatment and control of hypertension through a combination of advocacy, public health and medical approaches.” – by Erik Swain
Disclosure: The researchers, Wong and Franklin report no relevant financial disclosures.