[Prevalence and control of hypertension in adults in China, 2018]

Objective: To describe and compare the prevalence, sick status awareness, treatment and control of hypertension in adults aged 18 years and above in China. Methods: National Chronic Disease and Risk Factor Surveillance was conducted in 298 counties/districts in China in 2018, which covered 31 provinces (autonomous regions, municipalities). A multi-stage stratified cluster random sampling method was used to select 194 779 permanent residents aged 18 years and above. Face to face questionnaire surveys were conducted to collect the information about their demographic characteristics, hypertension diagnosis and treatment as well as the blood pressures measurement. The systolic and diastolic blood pressure were measured using certified medical upper arm electronic sphygmomanometer for the adults. After excluding those with abnormal blood pressure, 179 873 adults were included in the final analyses. Gender, age and area or region specific mean blood pressure, the prevalence, sick status awareness, control and treatment rates of hypertension, and blood pressure measurement were evaluated for the adults surveyed. All the results were weighted according to complex sampling scheme and had post-stratification to represent the whole adult population in China. Results: The average systolic blood pressure was (127.7±18.8) mmHg (1 mmHg=0.133 kPa) and the average diastolic blood pressure was (76.8±11.2) mmHg in the adults aged 18 years and above in China in 2018. Among the adults without history of hypertension, 50.9%(95%CI:49.9%-51.9%) had prehypertension. The prevalence rate of hypertension in adults in China was 27.5% (95%CI: 26.6%-28.4%). In men, 30.8% (95%CI: 29.8%-31.9%) had hypertension, compared with 24.2% (95%CI: 23.3%-25.1%) in women. The rural adults had higher hypertension prevalence rate [29.4% (95%CI: 28.4%-30.3%)] compared with urban adults [25.7% (95%CI: 24.4%-27.1%), P<0.000 1]. The highest hypertension prevalence rate was observed in adults in northern China [33.3% (95%CI: 31.5%-35.2%)], followed by that in adults in northeastern China [32.7% (95%CI: 28.1%-37.4%)] compared with other regions in China, and with significant differences (P<0.000 1). Among the adults with hypertension, 41.0% (95%CI: 39.7%-42.4%) were aware of their sick status, 34.9% (95%CI: 33.6%-36.1%) were taking antihypertensive medicines, and 11.0% (95%CI: 10.2%-11.8%) had their blood pressure controlled. In the hypertensive patients, women and urban residents were more likely to have higher rates of sick status awareness, treatment and control of hypertension compared with men and rural residents (all P<0.000 1). Among the adults without history of hypertension, 41.9%(95%CI: 40.7%-43.2%) had active or passive measurement of blood pressure in the past 3 months. Conclusions: Given the higher prevalence rate of hypertension and lower blood pressure measurement rate in Chinese adults, as well as unsatisfied status of awareness, treatment and control of hypertension in patients, more efforts should be made in hypertension prevention and control, such as improved risk factor intervention and case management, especially in rural areas.