The impact of changes in population blood pressure on hypertension prevalence and control in China

Abstract

In China, there are approximately 250 million adults who have hypertension with low rates of awareness, treatment and control. Changes in lifestyles at a population level have the potential to enhance or deteriorate the prevention and control of hypertension. We used data from a regional hypertension survey to examine the impact of 2/1 mm Hg decreases or increases in population blood pressure on hypertension prevalence, and rates of unawareness of the hypertension diagnosis, treatment, and control. The primary analysis was based on the average blood pressure of respondents from three visits and a diagnostic threshold of 140/90 mm Hg for hypertension. Secondary analyses examined average blood pressure from the first survey visit and also a diagnostic threshold of 130/80 mm Hg for hypertension. The baseline hypertension prevalence was 33.4%, and rates of unawareness of the hypertension diagnosis, treatment, and control were 74.2%, 25.8%, and 9.7%, respectively. Decreases or increases in blood pressure by 10/5 mm Hg resulted in changes in hypertension prevalence (22.1% vs 53.4%) and rates of unawareness of the diagnosis (60.9% vs 83.8%), treatment (39.1% vs 16.2%), and control (21.2% vs 3.6%), respectively. Similar trends were seen in the secondary analyses. Population changes in lifestyle could have a very large impact on the prevalence and control of hypertension in China. The results support implementation of programs to improve population lifestyles while implementing health services policies to enhance the clinical management of hypertension.

Long-term trends and regional variations of hypertension incidence in China: a prospective cohort study from the China Health and Nutrition Survey, 1991–2015

“…With the rapid economic development, people often change their dietary patterns from light diet to high salt and fat diet along with a secondary lifestyle. 30 These changes would significantly impact the prevalence and control of hypertension in China. 30 In addition, due to data limitation, we were unable to introduce several potential risks factors, such as sodium intake or dietary pattern, parental history, psychological status, ambient air pollutants, working hours and household income.…”

“…30 These changes would significantly impact the prevalence and control of hypertension in China. 30 In addition, due to data limitation, we were unable to introduce several potential risks factors, such as sodium intake or dietary pattern, parental history, psychological status, ambient air pollutants, working hours and household income. [31][32][33][34] These factors may explain the residual time effects in the model.…”

Household Air Pollution and Blood Pressure, Vascular Damage, and Subclinical Indicators of Cardiovascular Disease in Older Chinese Adults

“… 1 In China, 250 million people live with hypertension, which is responsible for 24% of China’s deaths and 14% of disability-adjusted life years. 2 Urban air pollution shows strong and consistent associations with high BP and the development of cardiovascular disease in studies mostly conducted in high-income cities. 3 , 4 Less understood is whether household air pollution from biomass and coal (i.e., solid fuel) stoves also contributes to hypertension and vascular damage, their underlying preclinical conditions, and the exposure–response relationships between them.…”

Could the arm blood pressure measured with simultaneous bilateral arm method be used for hypertension diagnosis?

“…Based on our data from an adult population study in rural China based on three BP readings at each of three visits in 1 week, a 2/1 mm Hg overestimation for SBP/DBP may induce a rise of hypertension prevalence increased from 33.4% to 37.3%, and the control rate decreased from 9.7% to 7.5% in 1540 community adults. 22 23 Based on a strict approach, BP should be measured at first with simultaneous bilateral arm method to detect the reference arm, then, the BP reading measured on the reference arm with unilateral arm BP method is used as the final value in clinical practice.…”