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Hypertension in China: a large and increasing public health challenge

He, Jiang

doi: 10.1097/HJH.0000000000000818
EDITORIAL COMMENTARIES

Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA

Correspondence to Jiang He, MD, PhD, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA 70112, USA. Tel: +1 504 988 5165; fax: +1 504 988 1568; 1 504 988 7448; e-mail: jhe@tulane.edu

Hypertension is the leading preventable risk factor for cardiovascular disease and premature death in China [1,2]. The prevalence of hypertension is high and increasing in China in recent years [3–5]. For example, the 2002 China National Nutrition and Health Survey, conducted in a nationally representative sample of 141 892 Chinese adults aged not less than 18 years, reported 18% (20% in men and 17% in women) or 153 million Chinese adults had hypertension [3]. In 2010, the prevalence of hypertension increased to 33.6% (35.3% in men and 32.0% in women) or 335.8 million Chinese adults based on the China Noncommunicable Disease Surveillance 2010, which was conducted in a nationally representative sample of 98 658 Chinese adults aged at least 18 years [4,5]. Both surveys used the same sampling method to select a nationally representative sample covering major geographic areas of all 31 provinces, autonomous regions, and municipalities in mainland China.

Recently, several other national surveys in China also reported the prevalence of hypertension in the Chinese general population (Table 1) [6,7]. The China National Diabetes and Metabolic Disorders Study reported an age-standardized prevalence of hypertension of 26.6% in a nationally representative sample of 46 239 adults aged not less than 20 years in 2007–2008 [6]. Likewise, the China National Survey of Chronic Kidney Disease reported an age-standardized prevalence of hypertension of 29.6% in a nationally representative sample of 50 171 adults aged at least 18 years in 2009–2010 [7]. The differences in the prevalence of hypertension among these studies might be partially due to measurement methods. Whereas the China National Diabetes and Metabolic Disorders Study and the China National Survey of Chronic Kidney Disease used a standardized mercury sphygmomanometer, the China Noncommunicable Disease Surveillance 2010 used an automatic device [4–7].

TABLE 1

TABLE 1

In this issue, Li and colleagues reported that the prevalence of hypertension was 41.9% among 45 108 study participants aged 35–70 years from the Prospective Urban Rural Epidemiology (PURE)-China subcohort [8]. The prevalence of hypertension in the Chinese subcohort was higher than the average of 40.8% in the entire PURE cohort [9]. We cannot directly compare the prevalences from the PURE-China subcohort to several published national studies in China because of differences in age range, blood pressure measurement method, and, especially, sampling method. The PURE study participants are not a representative random sample from the general population. However, the PURE study did provide additional evidence that hypertension is highly prevalent in the Chinese adult population.

The PURE-China study indicated that the age-adjusted prevalence of hypertension was higher in rural compared with urban residents [8]. In previously published national surveys, the age-adjusted prevalence of hypertension was similar between rural and urban residents [4–6] or higher in urban residents [7]. These observed differences could be due to sampling methods or age ranges of participants. Interestingly, the PURE-China study showed that prevalence of hypertension was highest in eastern, intermediate in central, and lowest in western regions [8]. Although the authors did not discuss the reasons for a higher prevalence in the eastern regions, higher economic development in these regions might play an important role [10]. A north–south gradient with a higher prevalence of hypertension in northern China has been documented in many studies and a higher dietary sodium intake in the north is most likely contributing to this geographic variation [11–13].

The authors reported that the proportions of awareness, treatment, and control were 41.6, 34.4, and 8.2%, respectively, among patients with hypertension in the PURE-China subcohort [8]. These findings are consistent with those from previous published national surveys, in which the proportion of hypertension control varied from 3.9 to 11.1%. Hypertension control was even worse in rural residents, who are facing a double burden of infectious and chronic diseases. Under-diagnosis and under-treatment of hypertension is a major public health problem in China. Clinical trials have demonstrated the substantial benefits of any antihypertensive treatment on cardiovascular disease and total mortality [14]. The current challenge is to develop and implement effective, practical, and sustainable intervention strategies, which must intensify blood pressure detection and treatment programs, for hypertension control in China. The prevention and treatment of hypertension is cost-effective and could save millions of lives in China [2,15].

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ACKNOWLEDGEMENTS

Conflicts of interest

There are no conflicts of interest.

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