Barriers to blood pressure control in China in a large opportunistic screening

Abstract

We investigated the prevalence, awareness, treatment, and control of hypertension in a large opportunistic screening study in China. Our study participants had to be ≥18 years of age and had ideally not taken blood pressure (BP) for ≥1 year. BP was measured three times consecutively in the sitting position with a 1-minute interval, using a validated electronic BP monitor or mercury sphygmomanometer. Trained volunteer investigators administered a questionnaire to collect information on medical history, lifestyle, and use of medications. The 364 000 participants (52.6% women, and mean age 53.4 years) had a mean systolic/diastolic BP of 124.2/76.4 mm Hg. The proportion of hypertension was 24.7%. In all hypertensive subjects (n = 89 925), the awareness, treatment, and control rates of hypertension were 60.1%, 42.5%, and 25.4%, respectively. In multiple stepwise logistic regression analyses, the odds for unawareness vs awareness of hypertension was higher in men and lower with age advancing, current smoking, and the presence of diabetes mellitus, coronary heart disease, and stroke or transient ischemic attack (P < .0001). The odds for uncontrolled vs controlled hypertension was higher with age advancing and current smoking, and lower with the presence of diabetes mellitus and coronary heart disease (P ≤ .03) in 38 207 treated hypertensive patients, and it was also higher with the use of antihypertensive monotherapy (odds ratio 1.13, P = .0003) in 19 523 treated hypertensive patients with specific antihypertensive drugs. Our study identified several factors as barriers to BP control in China, such as male gender, younger age, current smoking, and the under-use of combination therapy. | INTRODUC TI ONAccording to the most recent China nationwide hypertension survey in 2012-2015, the crude prevalence of hypertension was 27.9%, and the awareness, treatment and control rates of hypertension were 46.9%, 40.7%, and 15.3%, respectively. 1 If this survey would be compared with the previous one in 2002, 2 the prevalence was substantially increased by an absolute percentage of 9.1% from 18.8%,

Risk Prediction Model for Uncontrolled Hypertension in Chinese Community

“…This study found the uncontrolled hypertension rate was 43.5% (in 2008), in the developed region in South China, in line with recent trends of the United States, where near half of patients achieved hypertension control across 20 American primary care centers, and the hypertension control increased from 27.3% in 1988–1994 to 50.1% in 2007–2008 in recent NHANES survey ( 10 – 12 ). Wang et al conducted MMM China project among 364,000 participants in 394 inside hospitals or community health centers and found that the awareness, treatment, and control rates of hypertension were 60.1, 42.5, and 25.4%, respectively, with the rate of uncontrolled hypertension (59.8%) moderately higher than our study ( 13 ). We only investigated the patients receiving antihypertensive treatment in the community, not patients in hospitals, which might present with higher control proportion.…”

“…Our analysis also showed that the independent risk factors of uncontrolled hypertension are full-time work, self-financed medical care, non-marital status, poor cognition of hypertension diagnosis, poor cognition of hypertension treatment, poor drug compliance, and unwillingness for blood pressure measurement information reminder among patients in the community receiving antihypertensive treatment. MMM China project also showed that current smoking, no diabetes, no coronary heart disease, and older were independent risk factors of uncontrolled hypertension ( 13 ), while the above variables were not collected in our study. A recent review highlighted the important role of an education intervention on healthy behaviors and showed a moderate effect in the adherence to dietary recommendations and physical activity recommendations ( 7 ).…”

“…A combination of antihypertensive therapy would be a choice of approaches for improving control of hypertension in China. ( 13 ). Wang et al established a web-based and WeChat-linked blood pressure measuring system in China mainly in public areas, such as office buildings, shopping malls, airports, railway stations, and so on, where younger people often walk around ( 15 ).…”

Telemedicine in the management of hypertension: Evolving technological platforms for blood pressure telemonitoring

“…This system was used to measure blood pressure in a large number of people who had not measured their blood pressure in the previous year in the framework of the international May Measurement Month (MMM) project. [14][15][16] The system is now used by hundreds of people every day in various public places, such as airports, shopping malls, and office buildings. It is hoped that with a sufficiently large number of blood pressure monitors deployed in the next few years, the system will substantially improve detection and management of hypertension in China.…”

China nationwide screening and registry of primary aldosteronism in hypertensive patients

“…However, as shown by the current initial endeavour, it will not be an easy task. First, the awareness of hypertension in China is still low, especially in the young [15]. That at least partially explains why in the present study the registered patients were relatively old.…”