Comprehensive treatment of hypertension middle-aged and elderly people: cross-sectional survey data from the China Health and Retirement Longitudinal Study (CHARLS)

Abstract

BackgroundBoth drug treatment and non-drug treatment were definitely recommended in the 2010 Guidelines for Prevention and Treatment of Hypertension in China. This study aims to provide reliable estimates of both treatments of hypertension and their distribution and related influencing factors in the middle-aged and elderly population in China. MethodsThe China Health and Retirement Longitudinal Study (CHARLS) is a cross-sectional survey of the prevalence, awareness, and treatment of hypertension from 2011∼2012. Eligible individuals (Chinese people aged 45 years or more) were selected through four-stage, stratified, cluster sampling. Hypertension was considered as a mean systolic blood pressure of 140 mm Hg or higher, a mean diastolic blood pressure of 90 mm Hg or higher or was assumed for participants taking anti-hypertensive medication. The primary outcome of this study is the control of hypertension, which was defined as blood pressure less than 140/80 mm Hg. Multivariable logistic regressions were used to estimate odds ratios (ORs). The ethics committee of Peking University Health Science Center approved this study, and all participants gave written informed consent before participation. Findings12 981 people participated in the study, of whom 5371 (33% [95% CI 32·3–33·9%]. 59% of participants with hypertension were aware of the diagnosis. Of those people who were aware of their hypertension, 2440 (77%) were receiving treatment with drugs, and 1838 (58%) were receiving at least one non-drug treatment (of whom 25·4% were receiving health education on weight control, 35% on exercise, 49% on diet, and 22% on smoking control). Patients who received either treatment were more likely to be men living in urban areas with higher social status. 31% of the patients were controlled with an average systolic blood pressure less than 140 mmHg and an average diastolic blood pressure less than 90 mmHg. Compared with the population that received no treatment for hypertension, both drug treatment and non-drug treatment improved the control rate of hypertension (all ORs >7·0) after adjusting for sex, age, gross domestic product, education level, drinking, smoking, body-mass index, diabetes, and cardiovascular diseases. InterpretationThe prevalence of hypertension in the Chinese middle-aged and elderly population is surprisingly high, with disproportionately low awareness and drug treatment. Practical guidelines to non-drug approaches have been provided but are inadequately used. Future studies should address the cause of the discrepancy between recommendations and clinical practice. FundingPhD Programs Foundation of Ministry of Education of China (Grant No. 20130001120041).