Burden of hypertension in China: A nationally representative survey of 174,621 adults
Introduction
Hypertension is a leading cause of mortality and disability, causing almost 10 million deaths globally in 2013 [1]. In China, it accounted for 2.5 million deaths (28% of total deaths) and 15% of total disability-adjusted life-years in 2013, mainly from stroke and ischaemic heart disease [1], [2]. It is well-established that appropriate control of hypertension, through drug therapy and/or lifestyle changes, can result in a significant reduction in cardiovascular morbidity and mortality [3], [4], [5].
Over the last several decades, large population surveys of hypertension, either nationwide [6], [7], [8] or in specific regions [9], [10], [11], [12], [13], [14], have been undertaken in China. These surveys showed consistently a rapid increasing trend in the hypertension prevalence, from 5.1% in 1959 to 18.0% in 2002 at national level [6], [7], [8]. Despite this, few studies have provided reliable estimates about prevalence and management of hypertension in the current decade. Moreover, there is still limited data about the current burden of hypertension in certain population subgroups, e.g., by region, and by different socioeconomic status. Appropriate understanding of these issues would be of particular relevance for development of cost-effective and targeted control strategies in China, where the patterns of dietary, physical activity and other lifestyle factors are also changing rapidly [15], [16], [17], [18].
We reported relevant findings from a large-scale nationally representative survey of 174,621 adults aged > 18 years who were surveyed during 2013–14, as part of the China Chronic Disease and Risk Factors Surveillance (CCDRFS) survey, which covered all 31 provinces in the mainland China. The aims of the present report were to (i) examine the prevalence of hypertension, both overall and in certain population subgroups (e.g. by age, sex, region, and socioeconomic ); (ii) assess, among those with hypertension, levels of awareness, treatment and control rate; and (iii) estimate the number of hypertension in China.
Section snippets
Survey methods
The 2013–14 China Chronic Disease and Risk Factors Surveillance (CCDRFS) survey was based at Chinese Center for Disease Control and Prevention's Disease Surveillance Points (DSP) system and organized by the National Center for Chronic and Non-communicable Disease Control and Prevention in Chinese Center for Disease Control and Prevention, and conducted between August 2013 and July 2014. Data were recorded by face-to-face interview, using a standardized questionnaire, on demographic
Results
Of the 174,621 participants, 57% were women, 54% were from rural areas and mean age was 51.6 (SD: 14.7) years for men and 51.5 (13.8) for women (Table 1). Among men 52.9% smoked and 18.0% drank too much alcohol, as opposed to only 3.0% and 1.4% in women. Men tended to be better educated, and to have higher means of SBP and DBP and prevalence of CVD.
Overall, the population weighted mean of SBP was 127.8 (SD: 20.0) mm Hg and DBP was 76.5 (SD: 11.4) mm Hg, higher in men than women (SBP: 129.8 vs.
Discussion
This large nationwide survey showed that more than one fourth of Chinese adults aged 18 years and above were hypertensive in 2013–2014, and that despite the high prevalence, about 3 out of 5 hypertensive individuals were not aware of their condition, about two third were not receiving anti-hypertensive medication, resulting in less than 10% of hypertensive individuals not properly controlled. In 2013 almost 300 million Chinese adults had hypertension, among whom 264 million were not controlled,
Conclusions
In general, hypertension prevalence in China has increased rapidly during the last decade. Although awareness and treatment of hypertension improved over the time, BP control was still unacceptably low among hypertensive individuals, leaving hundreds of millions of individuals at risk of CVD.
Authors' contribution
Prof. Linhong Wang had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Prof. Z. Chen, Prof. M. Zhou, Y. Li and L. Yang conceived the study design and the analytical plan. Y. Li performed statistical analysis. Y. Li and L. Yang prepared the first draft. Y. Li, L. Yang and Prof. Z. Chen finished the draft based on comments from other authors. Prof. Linhong Wang, Prof. Limin Wang, Y. Li, M. Zhang, Q. Deng, Z.
Funding
This work was supported by the Central Finance of the Chinese Government and the National Natural Science Foundation of China [grant number 81202287].
Conflict of interest statement
The authors report no relationships that could be construed as a conflict of interest.
Acknowledgment
We thank all involved provincial and local health administrative departments, the Centers for Disease Control and Prevention, and all field investigators for their support and effort during the survey.
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- 1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
- 2
Drs. Li and Yang contributed equally.