Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project)

Cardiovascular disease (CVD) is the leading cause of death in China. To develop effective and timely strategies to cope with the challenges of CVD epidemics, we need to understand the current epidemiological features of the major types of CVD and the implications of these features for the prevention and treatment of CVD. In this Review, we summarize eight important features of the epidemiology of CVD in China. Some features indicate a transition in CVD epidemiology owing to interrelated changes in demography, environment, lifestyle, and health care, including the rising burden from atherosclerotic CVD (ischaemic heart disease and ischaemic stroke), declining mortality from haemorrhage stroke, varied regional epidemiological trends in the subtypes of CVD, increasing numbers of patients with moderate types of ischaemic heart disease and ischaemic stroke, and increasing ageing of patients with CVD. Other features highlight the problems that need particular attention, including the high proportion of out-of-hospital death of patients with ischaemic heart disease with insufficient prehospital care; the wide gaps between guideline-recommended goals and levels of lifestyle indicators; and the huge number of patients with undiagnosed, untreated, or uncontrolled hypertension, hypercholesterolaemia, or diabetes mellitus.

Epidemiology of cardiovascular disease in China: current features and implications.

Revision Committee Members Chair: Li–Sheng LIU* Deputy Chairs: Zhao–Su WU, Ji–Guang WANG, Wen WANG Members (Listed in alphabetic order by last name in Chinese Pinyin) Yu–Jing BAO, Jun CAI, Lu–Yuan CHEN, Wei–Wei CHEN, Shao–Li CHU, Ying–Qing FENG, Ping–Jin GAO, Ting–Rui GUAN, Zi–Hong GUO, Qi HUA, Jun HUANG, Yong HUO, Wei–Ping JIA, Xiong–Jing JIANG, Yi–Nong JIANG, Li LI, Li–Huan LI, Nan–Fang LI, Wei LI, Xiao–Ying LI, Xue–Wang LI, Yan LI, Yong LI, Jin–Xiu LIN, Li–Sheng LIU, Xin–Zheng LU, Ji–Xiang MA, Jie MI, Jian-Jun MU, Chang–Yu PAN, Gang SUN, Ning–Ling SUN, Ying–Xian SUN, Jun TAO, Hao WANG, Ji–Guang WANG, Wen WANG, Wen–Zhi WANG, Yong–Jun WANG, Yu WANG, Zeng–Wu WANG, Hai–Ying WU, Zhao–Su WU, Liang–Di XIE, Zhang–Rong XU, Xiao–Wei YAN, Yan–Min YANG, Chong–Hua YAO, Zheng–Pei ZENG, Jian ZHANG, Wei–Zhong ZHANG, Xin–Hua ZHANG, Xin–Jun ZHANG, Yu–Qing ZHANG, Ding–Liang ZHU, Jun ZHU, Zhi–Ming ZHU

2018 Chinese Guidelines for Prevention and Treatment of Hypertension—A report of the Revision Committee of Chinese Guidelines for Prevention and Treatment of Hypertension

Background The appropriate target for systolic blood pressure to reduce cardiovascular risk in older patients with hypertension remains unclear. Methods In this multicenter, randomized, co...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa2111437

Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension.

Aims To quantify the association of combined sleep behaviours and genetic susceptibility with the incidence of cardiovascular disease (CVD). Methods and results This study included 385 292 participants initially free of CVD from UK Biobank. We newly created a healthy sleep score according to five sleep factors and defined the low-risk groups as follows: early chronotype, sleep 7-8 h per day, never/rarely insomnia, no snoring, and no frequent excessive daytime sleepiness. Weighted genetic risk scores of coronary heart disease (CHD) or stroke were calculated. During a median of 8.5 years of follow-up, we documented 7280 incident CVD cases including 4667 CHD and 2650 stroke cases. Compared to those with a sleep score of 0-1, participants with a score of 5 had a 35% (19-48%), 34% (22-44%), and 34% (25-42%) reduced risk of CVD, CHD, and stroke, respectively. Nearly 10% of cardiovascular events in this cohort could be attributed to poor sleep pattern. Participants with poor sleep pattern and high genetic risk showed the highest risk of CHD and stroke. Conclusion In this large prospective study, a healthy sleep pattern was associated with reduced risks of CVD, CHD, and stroke among participants with low, intermediate, or high genetic risk.

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Sleep patterns, genetic susceptibility, and incident cardiovascular disease: a prospective study of 385 292 UK biobank participants.

Importance Hypertension is a leading cause of premature death in China, but limited evidence is available on the prevalence and management of hypertension and its effect on mortality from cardiovascular disease (CVD). Objectives To examine the prevalence, diagnosis, treatment, and control of hypertension and to assess the CVD mortality attributable to hypertension in China. Design, Setting and Participants This prospective cohort study (China Kadoorie Biobank Study) recruited 500 223 adults, aged 35 to 74 years, from the general population in China. Blood pressure (BP) measurements were recorded as part of the baseline survey from June 25, 2004, to August 5, 2009, and 7028 deaths due to CVD were recorded before January 1, 2014 (mean duration of follow-up: 7.2 years). Data were analyzed from June 9, 2014, to July 17, 2015. Exposures Prevalence and diagnosis of hypertension (systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg, or receiving treatment for hypertension) and treatment and control rates overall and in various population subgroups. Main Outcomes and Measures Cox regression analysis yielded age- and sex-specific rate ratios for deaths due to CVD comparing participants with and without uncontrolled hypertension, which were used to estimate the number of CVD deaths attributable to hypertension. Results The cohort included 205 167 men (41.0%) and 295 056 women (59.0%) with a mean (SD) age of 52 (10) years for both sexes. Overall, 32.5% of participants had hypertension; the prevalence increased with age (from 12.6% at 35-39 years of age to 58.4% at 70-74 years of age) and varied substantially by region (range, 22.7%-40.7%). Of those with hypertension, 30.5% had received a diagnosis from a physician; of those with a diagnosis of hypertension, 46.4% were being treated; and of those treated, 29.6% had their hypertension controlled (ie, systolic BP Conclusions and Relevance About one-third of Chinese adults in this national cohort population had hypertension. The levels of diagnosis, treatment, and control were much lower than in Western populations, and were associated with significant excess mortality.

/pdf/the-burden-of-hypertension-and-associated-risk-for-3efwq9bkg8.pdf

The Burden of Hypertension and Associated Risk for Cardiovascular Mortality in China

Background: Chinese women’s reproductive patterns have changed significantly over the past several decades. However, relatively little is known about the pace and characteristics of these changes either overall or by region and socioeconomic status. Methods: We examined the cross-sectional data from the China Kadoorie Biobank cohort study that recruited 300 000 women born between 1930 and 1974 (mean age: 51 years) from 10 socially diverse urban and rural regions of China. Temporal trends in several self-reported reproductive characteristics, and effect modification of these trends by area and education (as a surrogate for socioeconomic status), were examined. Results: The overall mean age at menarche was 15.4 (standard deviation 1.9) years, but decreased steadily over the 45 birth cohorts from 16.1 to 14.3 years, except for an anomalous increase of � 1 year for women exposed to the 1958-61 famine in early adolescence. Similarly large changes were seen for other characteristics: mean parity fell (urban: 4.9 to 1.1; rural: 5.9 to 1.4); mean age at first birth increased (urban: 19.0 to 25.9

http://ckbiobank.org/site/binaries/content/assets/resources/pdf/publications/ckb/2014temporaltrend-reproductive_sleije.pdf

Jinhuai Meng

Papers

The Burden of Hypertension and Associated Risk for Cardiovascular Mortality in China

Temporal trends of main reproductive characteristics in ten urban and rural regions of China: the China Kadoorie Biobank study of 300 000 women