Abstract
BackgroundTibet is an autonomous region in China located around an average altitude of 4500 m above sea level. Since 2012 the local government of Tibet has been providing free physical examinations, including screening for hypertension. However, the coverage and effectiveness of this free program have not been uncovered. This study aims to assess the coverage and effectiveness of hypertension screening and management program in 3 altitude levels of Tibet, and also the determinants of the success of the screening program.MethodsA stratified cluster survey was conducted among 1636 residents aged 18 years or over in three different altitude areas in Tibet. We adjusted for age and sex based on national census data and used weighted logistic regression models to find factors associated with hypertension screening.ResultsThe coverage of the hypertension screening program evaluated by participation rate in the previous screening was 94.9%, while 24.7% (95% CI: 22.1–27.3%) of them were diagnosed with hypertension. Females and alcohol drinkers were more likely to be screened. Among those diagnosed with hypertension, 28.7% had it under control. High altitude areas had a high proportion of controlled hypertension. The overall rate of controlled hypertension in high, moderate and low altitude areas was 35.1% (95% CI: 24.8–45.3%), 32.7% (95% CI: 22.2–43.2%) and 23.7% (95% CI: 14.7–32.6%), respectively. Younger aged persons were more likely to have better control of their hypertension.ConclusionsThe coverage of hypertension screening in Tibet was high, especially in the low altitude areas. However, the effectiveness of hypertension control was low, indicating a need to implement the treatment adherence routines into the current screening interventions.
Highlights
Tibet is an autonomous region in China located around an average altitude of 4500 m above sea level
The un-weighted characteristics of participants by the status of hypertension screening in the past are shown in Supplementary Table 2
Local health workers screened a total of 1539 (94.1%) participants from the screening program, of which 37.4% were diagnosed with hypertension
Summary
Tibet is an autonomous region in China located around an average altitude of 4500 m above sea level. China initiated the community-based prevention of CVD project in 1969 as a comprehensive intervention program that focused on the prevention and treatment of hypertension. According to the results of past national hypertension screening surveys, the prevalence of hypertension among the general population aged 18 years or older in China increased from 7.7% in 1979 to 18.0% in 2002 and 38.0% in 2010 [5,6,7] In 2009, the fourth new medical reform policies brought community-based prevention of hypertension and diabetes into the agenda of national public health services [8, 9]. The intervention program has extended from the treatment of individuals with hypertension to large-scale management in communities and the prevention of comorbidities [4]
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