Hypertension awareness, treatment not prominent in China

Many adults in China have low rates of hypertension awareness, treatment and control, in addition to deficiencies in the cost and availability of antihypertensive medications, according to two studies published in The Lancet.

“Stroke is the leading cause of death in China, causing 1 in 5 deaths every year, and uncontrolled hypertension is a significant risk factor,” Lixin Jiang, MD, PhD, of Fuwai Hospital in Beijing, said in a press release. “Blood pressure levels in China are also increasing, likely because of an aging population, urbanization, dietary changes and obesity. The alarmingly low control rate, even among the minority of people who receive treatment, highlights the need for a national strategy on the prevention and treatment of hypertension.”

BP prevalence in China

Jiapeng Lu, MD, PhD, of the National Clinical Research Center for Cardiovascular Diseases in China, and colleagues analyzed data from 1,738,886 participants (mean age, 56 years; 60% women) from the China PEACE Million Persons Project aged 35 to 75 years who live in one of the 31 provinces in mainland China.

An in-person interview was conducted, in which BP and physical measurements were taken and participants were asked about their use of prescription drugs for BP, antiplatelet, glucose or lipid control, their awareness of hypertension, sociodemographic characteristics, medical history and health behaviors.

Hypertension was seen in 44.7% (95% CI, 44.6-44.8) of the cohort, of whom 44.7% were aware of their diagnosis (95% CI, 44.6-44.8). Medications to lower BP were taken by 30.1% (95% CI, 30-30.2) of participants with hypertension, and 7.2% (95% CI, 7.1-7.2) were able to control their BP.

Rates of hypertension prevalence (37.2%; 95% CI, 37.1-37.3), awareness (36%; 95% CI, 35.8-36.2), treatment (22.9%; 95% CI, 22.7-23) and control (5.7%; 95% CI, 5.6-5.7) were lower after adjustment for age and sex.

The majority of participants with uncontrolled hypertension (81.1%) were using one medication (95% CI, 81-81.3). Calcium-channel blockers were the most common class of medication used by of participants with hypertension (55.2%; 95% CI, 55-55.4).

Participants who were younger, male, without prior CV events, lower income and without coexisting conditions were less likely to be aware of hypertension, in addition to being treated for and controlling it (P < .01 for all).

The rate of controlled hypertension was less than 30% across all subgroups.

“Ultimately, differences in awareness and treatment are not translating into control, and thus improving both are necessary, but not sufficient, to achieve better control,” Lu and colleagues wrote. “There is no evidence of any population subgroup excelling in hypertension control and no evidence that a particular biological or societal factor is associated with achieving high control. This suggests a fundamental structural change is needed to address hypertension in China, and education and screening will not be sufficient without parallel efforts to improve treatments.”

Availability, cost of prescriptions

In another study, Meng Su, MD, PhD, of the National Clinical Research Center for Cardiovascular Diseases, and colleagues reviewed data from 3,362 primary health care sites in rural (82%) and urban areas (18%) of China and 1.09 million people from the China PEACE Million Persons Project from November 2016 to May 2017.

Information on 62 oral medications in stock at the primary health care sites were analyzed, including brand name, generic name, specification, dosage form, retail price per sale unit and manufacturer. A survey was used to gather characteristics of each primary health care site.

Health care sites included township health centers (8.4%), community health centers (6%), village clinics (73.6%) and stations (11.9%).

No antihypertensive medications were stocked in 8.1% of primary health care pharmacies (95% CI, 7.2-9.1), and 33.8% (95% CI, 32.2-35.4) had all four classes of antihypertensive medications.

Sites in the western region of China and village clinics were less likely to have all four classes of antihypertensive medications.

High-value medications were stocked in 32.7% of all health care sites (95% CI, 32.2-33.3), although only 11.2% (95% CI, 10.9-11.6) of those medications were prescribed.

High-cost medications were prescribed more in primary health care sites compared with low-cost medications.

“With respect to drug-prescribing patterns, there has been an increase in the use of expensive medications since implementation of the Chinese National Essential Medicine Program,” Su and colleagues wrote. “Refinements to this policy might provide stronger incentives for the use of low-cost medications.”

“[Promoting primary prevention of hypertension] should include education about the dangers of hypertension, the need for lifelong treatment if diagnosed and the importance of lifestyle for prevention and treatment,” Therese Hesketh, PhD, professor at the Institute for Global Health at University of London, and Xudong Zhou, PhD, of the Zhejiang University School of Public Health in Hangzhou, China, wrote in a related editorial. “Especially relevant for China is the need for salt reduction in the diet. The average daily salt intake in northern China is 12 g to 18 g per day, compared with the globally recommended limit of no more than 5 g per day. Awareness about the dangers of dietary salt is low and doctors do not emphasize salt reduction when advising patients.” – by Darlene Dobkowski

References:

Hesketh T, et al. Lancet. 2017;doi:10.1016/S0140-6736(17)32743-5.
Lancet. 2017;doi:10.1016/S0140-6736(17)32478-9.
Lancet. 2017;doi:10.1016/S0140-6736(17)32476-5.

Disclosure s : Lu, Su, Jiang, Hesketh and Zhou report no relevant financial disclosures. Please see the studies for all other authors’ relevant financial disclosures.