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Hypertension: its prevalence and population-attributable fraction for mortality from cardiovascular disease in the Asia-Pacific region

Martiniuk, Alexandra LCa; Lee, Crystal MYa; Lawes, Carlene MMb; Ueshima, Hirotsuguc; Suh, Ild; Lam, Tai Hinge; Gu, Dongfengf; Feigin, Valeryb; Jamrozik, Konradg; Ohkubo, Takayoshih; Woodward, Markafor the Asia-Pacific Cohort Studies Collaboration

doi: 10.1097/HJH.0b013e328010775f
Original papers: Epidemiology

Objective About half of the world's burden of cardiovascular disease is carried by countries in the Asia-Pacific region. This study aimed to quantify the contribution of hypertension to cardiovascular diseases (CVD) at the country level, by calculating the sex-specific, population-attributable fractions (PAFs) for fatal ischaemic heart disease (IHD) and stroke (haemorrhagic and ischaemic) for the World Health Organization Western Pacific and South-east Asian regions.

Methods The most recent sex-specific prevalence data on hypertension were sought. Age-adjusted hazard ratio (HR) estimates for fatal IHD and stroke associated with hypertension were obtained using Cox analyses of individual participant cohort data from 600 000 adult participants in the Asia-Pacific Cohort Studies Collaboration. HR estimates and prevalence were then used to calculate sex-specific PAFs for fatal IHD and stroke, by country.

Results In 15 countries with available data, the prevalence of hypertension ranged from 5–47% in men and from 7–38% in women. Overall, the fraction of IHD attributable to hypertension ranged from 4–28% in men and from 8–39% in women. Corresponding ranges for haemorrhagic stroke were 18–66% and 15–49%, and for ischaemic stroke were 8–44% and 12–45%.

Conclusions In the Asia-Pacific region, up to 66% of some subtypes of CVD can be attributed to hypertension, underscoring the immense impact that blood pressure- lowering strategies could have in this populous region.

aThe George Institute for International Health, Sydney, Australia

bUniversity of Auckland, Auckland, New Zealand

cShiga University of Medical Science, Shiga, Japan

dYonsei University College of Medicine, Seoul, Korea

eUniversity of Hong Kong, Hong Kong

fChinese Academy of Medical Sciences, Beijing, China

gUniversity of Queensland, Brisbane, Australia

hTohoku University, Sendai, Japan

*Details of the Asia-Pacific Cohort Studies Collaboration are given in the Appendix.

Received 19 April, 2006

Revised 1 September, 2006

Accepted 4 September, 2006

Correspondence and requests for reprints to Alexandra Martiniuk, The George Institute for International Health at the University of Sydney, PO Box M201 Missenden Road; Camperdown, NSW; 2050, Australia Tel: +61 2 9993 4500; fax: +61 2 9993 4501; e-mail:

Sponsorship: This project was supported through a program grant from the National Health and Medical Research Council of Australia and an unrestricted educational grant from Pfizer Inc. A.L.C.M. received support from a Rotary International Ambassadorial Scholarship. C.M.Y.L. is supported by a postgraduate scholarship from the National Health and Medical Research Council. C.M.M.L. is supported by a National Heart Foundation (New Zealand) Fellowship. The sponsors had no influence on design, analysis or interpretation of results.

Conflict of interest: none.

© 2007 Lippincott Williams & Wilkins, Inc.