Improved but still poor status of hypertension control in China: a cross-sectional analysis of screening data from 183 478 patients in tertiary hospitals

Abstract

BackgroundThe population with hypertension is large in China, but the control rate is poor, even for those treated in tertiary hospitals. iSTATUS is an ongoing blood pressure screening project aiming to improve hypertension control. This study reports the status from patients' first visit. MethodsIn 2014, iSTATUS recruited 614 physicians from 266 tertiary hospitals in 56 cities. Patients invited had previously diagnosed hypertension and had visited the physicians in outpatient clinics, mostly (73%) cardiology clinics. Blood pressure was measured onsite using automatic devices and transferred directly to the data management system. An online questionnaire was used to record patients' ongoing blood pressure control information. The screening project was approved by the ethics committee of the First Affiliate Hospital of Peking University, Beijing, China. Verbal informed consent was obtained from the participants or their guardians. As no paper forms were used, all data, including consent, were collected and recorded electronically. FindingsAmong 183 478 patients with hypertension at their first visit (88 069 [48%] men, 95 409 [52%] women; mean age 59·3 years [SD 12·1]), 74 125 (40·4%) reached the general blood pressure control goal (<140/90 mmHg), 62 016 (33·8%) had 140–159/90–99 mmHg, and 47 337 (25·8%) had ≥160/100 mmHg. Only 2936 (1·6%) patients had resistant hypertension (those who took three or more antihypertensive drugs, including a diuretic, and had ≥140/90 mmHg). Regarding use of antihypertensive drugs, 18 531 (10·1%) patients did not take their drugs, 108 252 (59·0%) were on single-drug therapy, 46 970 (25·6%) took two drugs, and 9724 (5·3%) took three or more drugs. The control rate was higher for combined antihypertensive treatment (45·1%) than for monotherapy (39·7%). The preferred drugs were calcium-channel blockers (35·3%), angiotensin II receptor blockers (31·2%), angiotensin-converting enzyme inhibitors (15·8%), β blockers (5·1%), and diuretics (2·6%), as monotherapy or in combination with other antihypertensive drugs. InterpretationAlthough the control rate (40·4%) improved for treated hypertension compared with that (31·6%) in 2010, most patients did not reach their blood pressure goal. Increasing the treatment rate and combination therapy could substantially improve blood pressure control in China. FundingBeijing Lisheng Cardiovascular Health Foundation and Beijing Novartis Pharma.