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Severe hypertension in China: results from the China PEACE million persons project
Insights
Millions of Chinese adults have severe hypertension, with most unaware and undertreated. This highlights significant opportunities for improving health outcomes in this high-risk population.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Severe hypertension poses a significant risk for target organ damage.
- Few studies have specifically investigated severe hypertension in middle-aged Chinese adults.
Purpose of the Study:
- To assess the characteristics, prevalence, awareness, and treatment patterns of severe hypertension among middle-aged adults in China.
Main Methods:
- A cross-sectional study of 2,618,757 participants aged 35-75 years in China (2014-2018).
- Severe hypertension defined as systolic blood pressure (SBP) ≥160 mmHg or diastolic blood pressure (DBP) ≥100 mmHg.
- Awareness and treatment defined by self-reported diagnosis and antihypertensive medication use.
Main Results:
- 14.5% of participants had severe hypertension, with a standardized rate of 11.6%.
- 58.8% of those with severe hypertension were untreated, and only 27.1% were aware of their condition.
- Risk factors included advanced age, female sex, drinking, obesity, low income, diabetes, and prior cardiovascular events. Treatment often involved single-drug therapy, with only 15% receiving guideline-recommended combination therapy.
Conclusions:
- A substantial number of middle-aged adults in China suffer from severe hypertension, largely undiagnosed and undertreated.
- Significant potential exists to improve cardiovascular outcomes through better detection and management strategies.
- Targeted interventions are crucial for this high-risk population.
Introduction:
People with severe hypertension have high risk of target organ damage, yet few studies focus specifically on this population. We sought to assess the characteristics, prevalence, awareness, and treatment patterns of severe hypertension among middle-aged adults in China.
Methods:
We enrolled 2 660 666 participants aged 35-75 years from 31 provinces between 2014 and 2018 in the cross-sectional China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project. Severe hypertension was defined as SBP of at least 160 mmHg or DBP of at least 100 mmHg. Awareness and treatment were defined as self-reported diagnosis of hypertension and current use of antihypertensive medication, respectively. Analyses were completed in 2019.
Results:
Our sample included 2 618 757 adults with a mean age of 55.6 years (SD 9.8), 59.6% of whom were women. A total of 378 457 (14.5%) participants had severe hypertension, of whom 222 533 (58.8%) were untreated. The age--sex-standardized rate of severe hypertension was 11.6% based on the 2010 Chinese Census data. Advanced age, female sex, current drinking, obesity, lower income, diabetes, and prior cardiovascular events were associated with higher risk of severe hypertension (all P < 0.01). Of untreated participants with severe hypertension, only 60 484 (27.1%) were aware of their conditions. Among participants with severe hypertension despite treatment, 84.7% reported taking one class of antihypertensive medication; only 15% reported taking guideline-recommended combination therapy.
Conclusion:
Many millions of people in China have severe hypertension and the vast majority are unaware of their condition and undertreated. There are immense opportunities to improve outcomes in this high-risk group.
