Hypertension is the main risk factor for cardiovascular disease (CVD), accounting for nearly 45% of global CVD morbidity and mortality [1]. Based on previous national survey data in China, the prevalence of hypertension in adults has increased from 5% in 1959 to 11.3% in 1991 and 18% in 2002 [2–4]. Although many studies have suggested that the control of hypertension is an effective strategy to prevent CVD [5], only a small percentage of hypertensive patients achieved the goal of systolic and diastolic blood pressure (SBP/DBP)<140/90 mm Hg. The control rate of hypertension in China was only 3% in 1991 and 5% in 2002[3,4].
Recently, three studies from China have investigated the prevalence, awareness, treatment, and control of hypertension in three urban populations [6], and two rural populations [7,8]. Recent trends in hypertension prevalence and control in China on a national level, however, are still unknown.
The China Health and Nutrition Survey (CHNS) is a large-scale, national and successive cross-sectional survey that was designed to explore how the health and nutritional status of the Chinese population has been affected by social and economic changes [9]. A multistage, random cluster process was used to draw study sample from nine provinces (Liaoning, Heilongjiang, Jiangsu, Shandong, Henan, Hubei, Hunan, Guangxi and Guizhou). Participants aged 18 years and older were included in the analysis. Information on age, gender, region (the urban and rural regions were clarified according to their characteristics of economy and social development using data from the China National Bureau of Statistics and China Ministry of Health Statistics), body mass index (BMI), and BP measurements were collected. A total of 8426, 7905, 8509, 9469, 8847, 8980 and 8503 participants were included in the analyses across the seven study periods (1991, 1993, 1997, 2000, 2004, 2006, 2009). Gender distributions across the seven survey periods were homogeneous (P=0.49).
BP was measured by trained examiners using a mercury sphygmomanometer according to a standard protocol [10]. The three BP values were measured on one visit, and the last two of three readings were averaged as the BP values in this study. Prevalent pre-hypertension was defined as SBP/DBP of 120/80 to 140/90 mm Hg and hypertension was defined as SBP/DBP≥140/90 mm Hg or on antihypertensive medications [10]. The same criteria were used for both diabetic and nondiabetic participants [11]. Awareness of hypertension was determined as self-reported diagnosis of hypertension by a physician or other healthcare professional. Treatment of hypertension was defined as self-report use of antihypertensive medications. Treated participants were considered to have their hypertension controlled if their SBP/DBP was less than 140/90 mm Hg. Trends in BP values and the estimated percentages (prevalence, awareness, treatment, and control of hypertension) from 1991 to 2009 were assessed with a multiple linear regression (continuous outcomes) or logistical regression (dichotomous outcomes) model [12] with the adjustment for gender, age, region, and BMI. Since age distributions in the seven study periods varied, the estimated percentages were age-standardized to the China Census population in 2000. A p value<0.05 was considered statistically significant. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [13].
Overall, both mean SBP and DBP values increased significantly across seven study visits (Table 1). Mean SBP values increased by 5.4 mm Hg and mean DBP increased by 4.1 mm Hg. Similar significant trends were observed in all subgroups defined by age, sex and region groups (all p<0.05), except for the group older than 60 years (p>0.05). Notably, mean SBP and DBP values increased more rapidly among subjects aged 40–59 years and among those living in rural regions.
Table 1.
Trends in mean SBP and DBP values (mm Hg) among Chinese Adults: the CHNS 1991–2009
| Age, y | 1991 | 1993 | 1997 | 2000 | 2004 | 2006 | 2009 | ptrenda | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| N | Mean(SE) | N | Mean(SE) | N | Mean(SE) | N | Mean(SE) | N | Mean(SE) | N | Mean(SE) | N | Mean(SE) | ||
| SBP | |||||||||||||||
| Total | 8426 | 114.7 (0.2) | 7905 | 115.1 (0.2) | 8509 | 117.6 (0.2) | 9469 | 118.0 (0.2) | 8847 | 119.5 (0.2) | 8980 | 118.5 (0.2) | 8503 | 120.1 (0.2) | <0.001 |
| Age, y | |||||||||||||||
| 18–39 | 4517 | 108.7 (0.2) | 3953 | 109.7 (0.2) | 3788 | 112.1 (0.2) | 3869 | 112.4 (0.2) | 2841 | 114.1 (0.2) | 2551 | 113.4 (0.2) | 2202 | 113.8 (0.3) | <0.001 |
| 40–59 | 2657 | 117.3 (0.4) | 2712 | 117.2 (0.3) | 3192 | 119.7 (0.3) | 3796 | 120.7 (0.3) | 3962 | 122.2 (0.3) | 4175 | 121.4 (0.3) | 3868 | 124.1 (0.3) | <0.001 |
| ≥60 | 1252 | 132.1 (0.7) | 1240 | 131.0 (0.7) | 1529 | 133.4 (0.6) | 1804 | 133.6 (0.5) | 2044 | 134.1 (0.5) | 2254 | 131.9 (0.4) | 2433 | 135.4 (0.4) | 0.421 |
| Sexes | |||||||||||||||
| Men | 3987 | 116.8 (0.3) | 3742 | 117.1 (0.3) | 4111 | 119.4 (0.3) | 4508 | 120.0 (0.2) | 4195 | 121.7 (0.3) | 4218 | 121.0 (0.3) | 4007 | 122.3 (0.3) | <0.001 |
| Women | 4439 | 112.8 (0.3) | 4163 | 113.3 (0.3) | 4398 | 115.7 (0.3) | 4961 | 116.0 (0.3) | 4652 | 117.3 (0.3) | 4762 | 116.3 (0.3) | 4496 | 118.0 (0.3) | <0.001 |
| Regions | |||||||||||||||
| Urban | 2817 | 115.4 (0.4) | 2422 | 115.7 (0.4) | 2880 | 116.9 (0.3) | 3209 | 117.4 (0.3) | 3070 | 119.2 (0.3) | 3041 | 118.3 (0.3) | 2743 | 118.9 (0.3) | 0.028 |
| Rural | 5609 | 114.2 (0.2) | 5483 | 114.7 (0.2) | 5629 | 117.7 (0.2) | 6260 | 118.2 (0.2) | 5777 | 119.4 (0.2) | 5939 | 118.6 (0.2) | 5760 | 120.5 (0.3) | <0.001 |
| DBP | |||||||||||||||
| Total | 8426 | 74.3 (0.1) | 7905 | 75.4 (0.1) | 8509 | 76.5 (0.1) | 9469 | 76.9 (0.1) | 8847 | 77.7 (0.1) | 8980 | 77.6 (0.1) | 8503 | 78.4 (0.1) | <0.001 |
| Age, y | |||||||||||||||
| 18–39 | 4517 | 71.4 (0.1) | 3953 | 72.8 (0.1) | 3788 | 74.0 (0.1) | 3869 | 74.4 (0.2) | 2841 | 75.6 (0.2) | 2551 | 75.4 (0.2) | 2202 | 75.6 (0.2) | <0.001 |
| 40–59 | 2657 | 76.5 (0.2) | 2712 | 77.4 (0.2) | 3192 | 78.2 (0.2) | 3796 | 79.1 (0.2) | 3962 | 79.8 (0.2) | 4175 | 79.8 (0.2) | 3868 | 81.4 (0.2) | <0.001 |
| ≥60 | 1252 | 80.6 (0.4) | 1240 | 81.2 (0.4) | 1529 | 82.4 (0.3) | 1804 | 81.9 (0.3) | 2044 | 81.2 (0.3) | 2254 | 81.4 (0.3) | 2433 | 82.2 (0.2) | 0.121 |
| Sexes | |||||||||||||||
| Men | 3987 | 75.8 (0.2) | 3742 | 76.9 (0.2) | 4111 | 77.9 (0.2) | 4508 | 78.5 (0.2) | 4195 | 79.4 (0.2) | 4218 | 79.5 (0.2) | 4007 | 80.4 (0.2) | <0.001 |
| Women | 4439 | 72.9 (0.2) | 4163 | 74.0 (0.2) | 4398 | 75.1 (0.2) | 4961 | 75.4 (0.2) | 4652 | 76.1 (0.2) | 4762 | 75.8 (0.2) | 4496 | 76.4 (0.2) | <0.001 |
| Regions | |||||||||||||||
| Urban | 2817 | 74.7 (0.2) | 2422 | 76.2 (0.2) | 2880 | 76.7 (0.2) | 3209 | 76.9 (0.2) | 3070 | 77.7 (0.2) | 3041 | 77.7 (0.2) | 2743 | 78.4 (0.2) | <0.001 |
| Rural | 5609 | 74.0 (0.1) | 5483 | 75.0 (0.1) | 5629 | 76.4 (0.1) | 6260 | 76.9 (0.1) | 5777 | 77.7 (0.2) | 5939 | 77.5 (0.1) | 5760 | 78.4 (0.2) | <0.001 |
The mean SBP and DBP values were age-standardized to the China 2000 Census population
Time trends in mean SBP and DBP from 1991 to 2009 were assessed by multiple linear regression analysis with gender, age, region, and BMI adjustment.
The prevalence of pre-hypertension and hypertension changed significantly from 29.4% and 14.5%, respectively, in 1991, to 38.7% and 21.4%, respectively, in 2009 (both p<0.001), with an absolute increase of 9.3% and 6.9% (Table 2). Similar significant trends were observed in each subgroup defined by age, sex or region (all p<0.05). The prevalence of hypertension increased more rapidly among subjects who were older than 40 years, men, and those who lived in rural regions (Table 2).
Table 2.
Trends in prevalence of pre-hypertension and hypertension among Chinese Adults: the CHNS 1991–2009
| Age, y | 1991 | 1993 | 1997 | 2000 | 2004 | 2006 | 2009 | ptrenda | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| N | %(SE) | N | %(SE) | N | %(SE) | N | %(SE) | N | %(SE) | N | %(SE) | N | %(SE) | ||
| Pre-hypertension | |||||||||||||||
| Total | 8426 | 29.4 (0.5) | 7905 | 33.2 (0.5) | 8509 | 36.6 (0.5) | 9469 | 38.2 (0.5) | 8847 | 40.6 (0.5) | 8980 | 41.0 (0.5) | 8503 | 38.7 (0.5) | <0.001 |
| Age, y | |||||||||||||||
| 18–39 | 4517 | 26.8 (0.7) | 3953 | 31.2 (0.7) | 3788 | 36.2 (0.8) | 3869 | 37.3 (0.8) | 2841 | 41.7 (0.9) | 2551 | 41.4 (1.0) | 2202 | 37.8 (1.0) | <0.001 |
| 40–59 | 2657 | 33.6 (0.9) | 2712 | 37.4 (0.9) | 3192 | 39.0 (0.9) | 3796 | 41.5 (0.8) | 3962 | 42.6 (0.8) | 4175 | 43.7 (0.8) | 3868 | 42.8 (0.8) | <0.001 |
| ≥60 | 1252 | 30.3 (1.3) | 1240 | 32.4 (1.3) | 1529 | 33.0 (1.2) | 1804 | 34.1 (1.1) | 2044 | 32.0 (1.0) | 2254 | 33.8 (1.0) | 2433 | 33.5 (1.0) | <0.001 |
| Sexes | |||||||||||||||
| Men | 3987 | 34.2 (0.8) | 3742 | 39.1 (0.8) | 4111 | 41.2 (0.8) | 4508 | 44.5 (0.7) | 4195 | 47.1 (0.8) | 4218 | 47.8 (0.8) | 4007 | 44.4 (0.8) | <0.001 |
| Women | 4439 | 25.2 (0.7) | 4163 | 28.1 (0.7) | 4398 | 32.3 (0.7) | 4961 | 32.3 (0.7) | 4652 | 34.6 (0.7) | 4762 | 34.9 (0.7) | 4496 | 33.5 (0.7) | <0.001 |
| Regions | |||||||||||||||
| Urban | 2817 | 29.3 (0.9) | 2422 | 33.6 (1.0) | 2880 | 35.6 (0.9) | 3209 | 38.5 (0.9) | 3070 | 39.0 (0.9) | 3041 | 41.0 (0.9) | 2743 | 38.3 (0.9) | <0.001 |
| Rural | 5609 | 29.6 (0.6) | 5483 | 33.2 (0.6) | 5629 | 37.1 (0.6) | 6260 | 38.1 (0.6) | 5777 | 41.4 (0.6) | 5939 | 41.0 (0.6) | 5760 | 38.9 (0.6) | <0.001 |
| Hypertension | |||||||||||||||
| Total | 8426 | 14.5 (0.4) | 7905 | 15.5(0.4) | 8509 | 17.9(0.4) | 9469 | 18.2(0.4) | 8847 | 19.1(0.4) | 8980 | 17.8(0.4) | 8503 | 21.4(0.4) | <0.001 |
| Age, y | |||||||||||||||
| 18–39 | 4517 | 4.6 (0.3) | 3953 | 6.0 (0.4) | 3788 | 7.2 (0.4) | 3869 | 7.4 (0.4) | 2841 | 8.2 (0.5) | 2551 | 7.2 (0.5) | 2202 | 8.6 (0.6) | <0.001 |
| 40–59 | 2657 | 18.2 (0.7) | 2712 | 18.8 (0.7) | 3192 | 21.9 (0.7) | 3796 | 23.0 (0.7) | 3962 | 24.4 (0.7) | 4175 | 23.3 (0.7) | 3868 | 29.3 (0.7) | <0.001 |
| ≥60 | 1252 | 43.9 (1.4) | 1240 | 44.8 (1.4) | 1529 | 49.4 (1.3) | 1804 | 48.4 (1.2) | 2044 | 49.0 (1.1) | 2254 | 46.4 (1.1) | 2433 | 53.0 (1.0) | 0.014 |
| Sexes | |||||||||||||||
| Men | 3987 | 16.0 (0.6) | 3742 | 16.9 (0.6) | 4111 | 20.0 (0.6) | 4508 | 20.3 (0.6) | 4195 | 21.7 (0.6) | 4218 | 20.4 (0.6) | 4007 | 24.5 (0.7) | <0.001 |
| Women | 4439 | 13.1 (0.5) | 4163 | 14.3 (0.5) | 4398 | 15.8 (0.5) | 4961 | 16.2 (0.5) | 4652 | 16.8 (0.5) | 4762 | 15.5 (0.5) | 4496 | 18.7 (0.6) | <0.001 |
| Regions | |||||||||||||||
| Urban | 2817 | 16.4 (0.7) | 2422 | 17.8 (0.8) | 2880 | 18.0 (0.7) | 3209 | 18.6 (0.7) | 3070 | 19.7 (0.7) | 3041 | 17.7 (0.7) | 2743 | 20.5 (0.8) | 0.019 |
| Rural | 5609 | 13.2 (0.5) | 5483 | 14.3 (0.5) | 5629 | 17.5 (0.5) | 6260 | 17.7 (0.5) | 5777 | 18.5 (0.5) | 5939 | 17.7 (0.5) | 5760 | 21.6 (0.5) | <0.001 |
Prevalent pre-hypertension was defined as SBP/DBP of 120/80 to 140/90 mm Hg and hypertension was defined as SBP/DBP≥140/90 mm Hg or on antihypertensive medications
Prevalence were age-standardized to the China 2000 Census population
Time trends in pre-hypertension and hypertension from 1991 to 2009 were assessed by multiple logistical regression analysis with gender, age, region, and BMI adjustment.
The awareness and treatment of hypertension decreased significantly from 22.4% and 12.0% respectively, in 1991, to 13.0% and 9.6%, respectively, in 1997 (all p<0.05). However, there was no clear trend in the BP control rates among hypertensive patients and among those treated over time (both p>0.05) (Table 3). During the periods of 1997–2009, the awareness, treatment, and control of hypertension in all hypertensive patients and those treated increased significantly from 13.0%, 9.6%, 1.7% and 17.4% in 1997, respectively, to 26.1%, 22.8%, 6.1%, and 33.1% in 2009 (all p<0.05). In stratified analysis, during the periods of 1997–2009, the rates of awareness, treatment, and control of hypertension in all hypertensive patients and in those treated increased more rapidly in those aged 60 years or older. In addition, the rates of hypertension control in all hypertensive patients and in those treated increased more rapidly in urban regions (Table 3).
Table 3.
Trends in awareness, treatment, and control among Chinese hypertensive adults: the CHNS 1991–2009
| Age, y | 1991 | 1993 | 1997 | 2000 | 2004 | 2006 | 2009 | ptrenda | ptrendb |
|---|---|---|---|---|---|---|---|---|---|
| %(SE) | %(SE) | %(SE) | %(SE) | %(SE) | %(SE) | %(SE) | |||
| Awareness | |||||||||
| Total | 22.4 (1.3) | 18.6 (1.1) | 13.0 (0.8) | 19.5 (0.9) | 21.5 (0.9) | 25.6 (0.9) | 26.1 (0.9) | <0.001 | <0.001 |
| Age, y | |||||||||
| 18–39 | 15.0 (2.7) | 7.1 (1.8) | 4.4 (1.2) | 8.5 (1.7) | 8.6 (1.8) | 12.1 (2.4) | 11.6 (2.3) | <0.001 | <0.001 |
| 40–59 | 30.5 (2.2) | 30.0 (2.1) | 20.3 (1.5) | 29.9 (1.6) | 34.1 (1.5) | 37.7 (1.6) | 38.7 (1.4) | <0.001 | <0.001 |
| ≥60 | 33.3 (2.2) | 37.4 (2.2) | 29.7 (1.7) | 38.7 (1.7) | 43.5 (1.6) | 51.3 (1.6) | 54.3 (1.4) | 0.002 | 0.002 |
| Sexes | |||||||||
| Men | 17.6 (1.6) | 16.7 (1.5) | 11.0 (1.0) | 16.4 (1.1) | 18.1 (1.1) | 24.3 (1.3) | 24.3 (1.2) | <0.001 | <0.001 |
| Women | 29.7 (2.0) | 20.7 (1.7) | 16.1 (1.3) | 23.0 (1.4) | 26.3 (1.4) | 26.3 (1.3) | 27.9 (1.2) | <0.001 | <0.001 |
| Regions | |||||||||
| Urban | 24.0 (2.0) | 23.3 (1.9) | 17.7 (1.5) | 20.7 (1.5) | 24.1 (1.5) | 30.0 (1.6) | 30.2 (1.5) | 0.001 | <0.001 |
| Rural | 20.8 (1.6) | 15.4 (1.4) | 10.1 (0.9) | 18.3 (1.1) | 19.5 (1.1) | 22.8 (1.1) | 23.6 (1.0) | <0.001 | <0.001 |
| Treatment | |||||||||
| Total | 12.0 (1.0) | 10.1 (0.9) | 9.6 (0.7) | 13.6 (0.8) | 16.6 (0.8) | 19.0 (0.8) | 22.8 (0.8) | 0.027 | <0.001 |
| Age, y | |||||||||
| 18–39 | 7.3 (1.9) | 3.4 (1.2) | 3.7 (1.1) | 4.9 (1.3) | 5.6 (1.5) | 7.1 (1.9) | 10.5 (2.2) | 0.073 | 0.052 |
| 40–59 | 17.1 (1.8) | 15.3 (1.7) | 14.1 (1.3) | 21.0 (1.4) | 26.9 (1.4) | 28.8 (1.5) | 32.3 (1.4) | 0.025 | <0.001 |
| ≥60 | 19.3 (1.8) | 24.1 (1.9) | 22.6 (1.5) | 30.5 (1.6) | 36.2 (1.5) | 43.3 (1.5) | 49.0 (1.4) | 0.812 | <0.001 |
| Sexes | |||||||||
| Men | 8.8 (1.2) | 9.1 (1.2) | 8.1 (0.9) | 10.9 (1.0) | 13.4 (1.0) | 17.2 (1.1) | 20.6 (1.1) | 0.468 | <0.001 |
| Women | 17.0 (1.7) | 11.2 (1.3) | 12.1 (1.2) | 16.6 (1.2) | 20.9 (1.3) | 20.6 (1.2) | 25.4 (1.2) | 0.014 | <0.001 |
| Regions | |||||||||
| Urban | 14.6 (1.6) | 14.6 (1.6) | 14.1 (1.4) | 15.4 (1.3) | 19.5 (1.4) | 22.2 (1.5) | 28.0 (1.5) | 0.318 | <0.001 |
| Rural | 10.1 (1.2) | 7.2 (1.0) | 7.1 (0.8) | 12.0 (0.9) | 14.4 (1.0) | 16.8 (1.0) | 19.8 (1.0) | 0.038 | <0.001 |
| Control Among hypertensive patients | |||||||||
| Total | 3.0 (0.5) | 2.6 (0.5) | 1.7 (0.3) | 3.3 (0.4) | 4.6 (0.4) | 4.5 (0.4) | 6.1 (0.5) | 0.775 | <0.001 |
| Age, y | |||||||||
| 18–39 | 2.9 (1.3) | 2.1 (1.0) | 0.4 (0.4) | 1.7 (0.8) | 1.7 (0.8) | 1.1 (0.8) | 3.2 (1.3) | 0.043 | 0.093 |
| 40–59 | 3.3 (0.9) | 3.0 (0.8) | 3.1 (0.7) | 4.8 (0.7) | 7.4 (0.8) | 7.9 (0.9) | 8.3 (0.8) | 0.819 | <0.001 |
| ≥60 | 2.4 (0.7) | 3.8 (0.9) | 3.7 (0.7) | 6.1 (0.8) | 9.3 (0.9) | 10.1 (0.9) | 12.0 (0.9) | 0.372 | <0.001 |
| Sexes | |||||||||
| Men | 2.3 (0.6) | 2.4 (0.6) | 1.5 (0.4) | 2.4 (0.5) | 3.8 (0.6) | 4.1 (0.6) | 5.4 (0.6) | 0.987 | <0.001 |
| Women | 4.0 (0.9) | 3.1 (0.7) | 2.1 (0.5) | 4.6 (0.7) | 6.0 (0.7) | 4.5 (0.6) | 7.0 (0.7) | 0.653 | <0.001 |
| Regions | |||||||||
| Urban | 3.2 (0.8) | 3.4 (0.8) | 2.3 (0.6) | 4.4 (0.7) | 5.4 (0.8) | 6.1 (0.8) | 9.5 (1.0) | 0.753 | <0.001 |
| Rural | 2.7 (0.7) | 2.3 (0.6) | 1.3 (0.4) | 2.6 (0.5) | 3.8 (0.5) | 3.5 (0.5) | 4.4 (0.5) | 0.542 | <0.001 |
| Among those treated | |||||||||
| Total | 29.7 (3.2) | 42.6 (3.4) | 17.4 (2.4) | 29.7 (2.1) | 32.8 (1.9) | 21.4 (1.5) | 33.1 (1.6) | 0.211 | 0.008 |
| Age, y | |||||||||
| 18–39 | 40.0 (12.6) | 62.5 (17.1) | 12.5 (11.7) | 35.7 (12.8) | 36.4 (14.5) | 16.7 (10.8) | 37.5 (12.1) | 0.349 | 0.247 |
| 40–59 | 19.5 (4.4) | 19.7 (4.6) | 25.6 (4.8) | 23.5 (3.2) | 29.0 (2.9) | 28.5 (2.8) | 28.8 (2.6) | 0.275 | 0.317 |
| ≥60 | 12.7 (3.3) | 16.4 (3.3) | 18.1 (3.2) | 20.2 (2.5) | 27.0 (2.4) | 24.2 (2.1) | 25.9 (1.8) | 0.269 | 0.014 |
| Sexes | |||||||||
| Men | 35.4 (5.4) | 28.6 (4.7) | 12.6 (3.1) | 23.3 (3.1) | 27.9 (2.8) | 23.6 (2.4) | 30.9 (2.3) | 0.267 | 0.295 |
| Women | 26.0 (4.0) | 47.6 (4.9) | 19.9 (3.6) | 37.7 (3.0) | 35.2 (2.6) | 12.1 (1.6) | 39.8 (2.2) | 0.504 | 0.006 |
| Regions | |||||||||
| Urban | 24.5 (4.1) | 34.1 (4.4) | 19.7 (3.5) | 27.1 (3.0) | 27.7 (2.6) | 27.5 (2.4) | 47.3 (2.4) | 0.304 | 0.026 |
| Rural | 34.4 (5.0) | 65.8 (4.9) | 12.5 (3.1) | 28.7 (3.0) | 34.8 (2.8) | 17.9 (2.0) | 26.6 (2.0) | 0.450 | 0.109 |
Definitions of awareness, treatment, and control among Chinese hypertensive adults were presented in the Methods section.
Proportions were age-standardized to the China 2000 Census population
Time trends in estimated percentages from 1991 to 1997 were assessed by multiple logistical regression analysis with gender, age, region, and BMI adjustment.
Time trends in estimated percentages from 1997 to 2009 were assessed by multiple logistical regression analysis with gender, age, region, and BMI adjustment.
To our knowledge, although three regional studies have been published [6–8], we firstly reported the recent trends in prevalence, awareness, treatment and control of hypertension among the partially representative Chinese adults from 1991 to 2009, based on the CHNS. The upward trend in mean SBP and DBP values and prevalence of hypertension was observed among Chinese adults from 1991 to 2009, which might be due to decreases in physical activity [14], increases in sedentary behavior, high fat diet, salt intake [15] and obesity [16]. In contrast, the United States National Health and Nutrition Examination Survey (NHNES) conducted for a similar period (1988–2008) showed that the prevalence of hypertension increased from 1988 to 2000, with little change between 2000 and 2008[17]. Better public health education and preventive measures from the government and health professionals might explain the increases in the awareness, treatment and control rates between 1997 and 2009. Similarly, the NHNES in the United States also demonstrated an increase in awareness, treatment and control of hypertension between 1988 and 2008[18].
Two limitations are noted. First, BP measurement at a single visit usually overestimates hypertension prevalence and underestimates control rate. Second, risk factors such as diabetes, hyperlipidemia, smoking, and family history of hypertension and data on treatment medications and prevalence of essential versus non-essential hypertension were unavailable presently.
The overall prevalence of hypertension increased significantly in China between 1991 and 2009. The overall awareness, treatment, and control of hypertension (in hypertensive individuals) increased over time, but are still unacceptably low. Our results suggest an urgent need for a national hypertension education program to improve the prevention, detection, treatment, and control of hypertension in China, with the ultimate goal to lower hypertension-related morbidity and mortality.
Acknowledgments
Funding
This work was supported by the NIH (R01-HD30880, DK056350, R01-HD38700), National “Twelfth Five-Year” Plan for Science & Technology Support Program (2012BAI03B03), the Independent Innovation Foundation of Shandong University (2010GN046), the China Postdoctoral Science Foundation funded project (20100481252) and the Foundation for Outstanding Young Scientist in Shandong Province (BS2011YY026).
Footnotes
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Conflict of interest statement
No conflicts of interest to declare.
Author Contribution
Bo Xi and Weihong Tang designed the study. Bo Xi and Yanjun Liang drafted the manuscript. Bo Xi, Yajun Liang and Yuehua Hu performed the data analysis. Weihong Tang and Kathleen H. Reilly made critical revisions.
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