Image: New studies show only a small percentage of people with hypertension in China receive adequate treatment (Photo courtesy of 123rf.com).
Nearly half of Chinese adults have hypertension, fewer than one-third are being treated, and fewer than one in twelve are in control of their blood pressure (BP), warn two new studies.
Conducted by researchers at Yale University (New Haven, CT, USA), Fuwai Hospital (Beijing, China), and the Chinese National Center for Cardiovascular Disease (NCCD), located in Peking Union Medical College (PUMC; China), the two studies are part of the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project, an ongoing initiative to study and improve cardiovascular disease (CVD) risk factors in China.
The first study screened 1,738,886 million people (median age 55.6 years) in all 31 mainland China provinces for hypertension, defined as systolic BP of at least 140 mm Hg, diastolic BP of at least 90 mm Hg, or self-reported antihypertensive medication. The results revealed that 37% had high BP, but only 5.7% have it under control. Treatment rates were low, with only 22.9% of hypertensive patients taking any medication, and were mostly ineffective or inappropriate. Of the patients who were treated, most were only taking one medication. The second study analyzed antihypertensive medication prescription rates at 3,362 primary health care sites in China.
The results showed that 88.7% sites stocked at least one class of anti-hypertensive medications, but only one in three stocked all four classes; 8% of sites did not stock any BP medication at all. Moreover, only 32.7% of sites stocked high-value medications, and few of them were prescribed. The data revealed that higher cost medications were more likely to be prescribed than lower cost ones. The authors suggest that medicine policy will need to be refined in order to ensure low-cost, high value medications are prescribed as a priority. The studies were published on October 25, 2017, in a special issue on China of The Lancet.
“The small number of people in China who have this disease under control, even among those who receive medication, is quite alarming,” said co-senior author of both studies Professor Harlan Krumholz, MD, director of the Yale Center for Outcomes Research and Evaluation (CORE). “This remarkable collaboration has revealed substantial opportunities for improvement, with the prospect of preventing millions of events over the next decade if we can succeed in improving the control of hypertension in China.”
“Stroke is the leading cause of death in China, causing one in five deaths every year, and uncontrolled hypertension is a significant risk factor. Blood pressure levels in China are also increasing, likely because of an ageing population, urbanization, dietary changes, and obesity,” said co-senior author Professor Lixin Jiang, MD, PhD, of Fuwai Hospital. “The alarmingly low control rate, even among the minority of people who receive treatment, highlights the need for a national strategy on the prevention and treatment of hypertension.”
Peking Union Medical College