Control Of Hypertension In China Research Articles

Effect of intelligent hypertension management system on blood pressure: protocol for a randomised controlled multicentre trial

IntroductionHypertension is one of the most serious global health problems, and its prevention and treatment mainly rely on lifestyle intervention and medication. However, the current situation of hypertension control in...

A comparison study of prevalence, awareness, treatment and control rates of hypertension and associated factors among adults in China and the United States based on national survey data

ObjectiveThis study compared the prevalence, awareness, treatment and control of hypertension and associated factors in China and the United States (US). MethodsAdult data from nationally representative samples were derived from the Chronic Disease and Risk Factors Surveillance in 2010 and 2013 in China and the National Health and Nutrition Examination Survey in 2010 and 2013 in the US. Multivariable logistic and Poisson regression analysis were conducted to assess associations of the four outcomes with body weight status and behavioral factors. ResultsAge-standardized prevalence rates of hypertension was 35.7% (95% confidence interval [CI]: 35.4% to 36.1%) in 2010 and 29.8% (95% CI: 29.4% to 30.2%) in 2013 in China, and 35.3% (95% CI: 33.6% to 37.1%) in 2010 and 37.9% (95% CI: 36.0% to 39.7%) in 2013 in the US. Among hypertensive participants, the age-standardized rates of treatment were 18.4% (95% CI: 17.9% to 18.9%) in 2010 and 23.8% (95% CI: 23.1% to 24.6%) in 2013 in China and 54.5% (95% CI: 50.3% to 58.7%) in 2010 and 50.9% (95% CI: 46.5% to 55.3%) in 2013 in the US; the age-standardized hypertension control rates were 3.2% (95% CI: 3.0% to 3.5%) and 5.7% (95% CI: 5.3% to 6.0%) in 2010 and 2013 in China and 50.6% (95% CI: 46.2% to 55.0%) and 55.3% (95% CI: 50.3% to 60.3%) in the US. Obesity was significantly associated with prevalence, awareness and control rates in both countries. Different from the US, obesity was negatively associated with hypertension control in China. ConclusionHypertension prevalence in China is similar to that in the US, but the control rate in China was significantly lower. Obesity was a critical risk factor for poor hypertension control in China.

Prevalence, awareness, treatment, and control of hypertension in China, 2004-18: findings from six rounds of a national survey

ObjectiveTo assess the recent trends in prevalence and management of hypertension in China, nationally and by population subgroups.DesignSix rounds of a national survey, China.SettingChina Chronic Disease and Risk Factors Surveillance,...

Village doctors managing hypertension in rural China

High blood pressure is the leading attributable risk factor for preventable deaths globally. 1 GBD 2019 Risk Factors CollaboratorsGlobal burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396: 1223-1249 Summary Full Text Full Text PDF PubMed Scopus (1527) Google Scholar About 1·4 billion people have hypertension worldwide, one-quarter of whom live in China where blood pressure control rates are poor, especially in rural areas (<10% among those with hypertension). 2 Li Y Yang L Wang L et al. Burden of hypertension in China: a nationally representative survey of 174 621 adults. Int J Cardiol. 2017; 227: 516-523 Summary Full Text Full Text PDF PubMed Scopus (143) Google Scholar , 3 Lu J Lu Y Wang X et al. 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). Lancet. 2017; 390: 2549-2558 Summary Full Text Full Text PDF PubMed Scopus (521) Google Scholar , 4 Qin VM McPake B Raban MZ et al. Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample. BMC Health Serv Res. 2020; 20: 372 Crossref PubMed Scopus (10) Google Scholar A village doctor-led multifaceted intervention for blood pressure control in rural China: an open, cluster randomised trialCompared with enhanced usual care, village doctor-led intervention resulted in statistically significant improvements in blood pressure control among rural residents in China. This feasible, effective, and sustainable implementation strategy could be scaled up in rural China and other low-income and middle-income countries for hypertension control. Full-Text PDF

The role of the Basic Public Health Service program in the control of hypertension in China: Results from a cross-sectional health service interview survey.

ObjectivesNon-communicable diseases (NCDs) have become the main cause of mortality in China. In 2009, the Chinese government introduced the Basic Public Health Service (BPHS) program to relieve the rising burden of NCDs through public health measures and delivery of essential medical care. The primary aim of this study was to evaluate the impact of the BPHS program on hypertension control.MethodsThe China National Health Development Research Center (CNHDRC) undertook a Cross-sectional Health Service Interview Survey (CHSIS) of 62,097 people from primary healthcare reform pilot areas across 17 provinces from eastern, central, and western parts of China in 2014. The current study is based on responses to the CHSIS survey from 7,867 participants, who had been diagnosed with hypertension. Multi-variable mixed logit regression analysis was used to estimate the association between BPHS management and uncontrolled hypertension. In a follow-up analysis, generalized structural equation modelling (GSEM) was used to test for mediation of the BPHS program effect through patient compliance with medication.FindingsThe estimated proportion of patients with uncontrolled hypertension was 30% lower (23.2% vs 31.5%) in those participants who were adequately managed under the BPHS program. Other predictors of hypertension control included compliance with medication, self-reported wellbeing, income, educational attainment and exercise; smoking was associated with reduced hypertension control. The significant inverse association between uncontrolled hypertension and age indicates poor outcomes for younger patients. Additional testing suggested that nearly 40% of the effect of BPHS management (95% CI: 28.2 to 51.7) could be mediated by improved compliance with medication; there was also an indication that the effect of management was 30% stronger in districts/counties with established digital information management systems (IMS).ConclusionHypertension control improved markedly following active management through the BPHS program. Some of that improvement could be explained by greater compliance with medication among program participants. This study also identified the need to tailor the BPHS program to the needs of younger patients to achieve higher levels of control in this population. Future investigations should explore ways in which existing healthcare management influences the success of the BPHS program.

Rationale and Design of a Cluster Randomized Trial of a Village Doctor-Led Intervention on Hypertension Control in China.

In China, hypertension prevalence is high and increasing while the control rate is low, especially in rural areas. Traditionally, village doctors play an important role in infectious disease control and delivering essential health services to rural residents. We aim to test the effectiveness of a village doctor-led multifaceted intervention compared with usual care on blood pressure (BP) control and cardiovascular disease (CVD) among rural residents with hypertension in China. In the China Rural Hypertension Control Project (CRHCP), a cluster randomized trial, 163 villages were randomly assigned to the village doctor-led intervention and 163 villages to control. A total of 33,995 individuals aged ≥40 years with an untreated BP ≥140/90 mm Hg or treated BP ≥130/80 mm Hg or with an untreated BP ≥130/80 mm Hg and a history of clinical CVD were recruited into the study. The village doctor-led multifaceted intervention is designed to overcome barriers at the healthcare system, provider, patient, and community levels. Village doctors receive training on standard BP measurement, protocol-based hypertension treatment, and health coaching. They also receive technical support and supervision from hypertension specialists/primary care physicians and performance-based financial incentives. Study participants receive health coaching on home BP monitoring, lifestyle changes, and adherence to medications. The primary outcome is BP control (<130/80 mm Hg) at 18 months in phase 1 and CVD events over 36 months in phase 2. The CRHCP will provide critically important data on the effectiveness, implementation, and sustainability of a hypertension control strategy in rural China for reducing the BP-related CVD burden. Trial Number NCT03527719.

Effectiveness of a pathway-driven eHealth-based integrated care model (PEICM) for community-based hypertension management in China: study protocol for a randomized controlled trial

BackgroundThe prevalence of hypertension is high and increasing in China in recent years. The treatment and control of hypertension calls for long-term management beyond hospital, which is hard to implement in traditional care settings. Integrated care combined with information technology can promote high-quality healthcare services across the life-course. However, few studies have applied a customized integrated care model in community-based hypertension management in China, catering to the emerging “three-manager” mode. This study aims to identify the effectiveness of a pathway-driven eHealth-based integrated model that implemented as a full-featured telehealth system to facilitate standardized management of hypertension in China.MethodsThe trial has been designed as a 1-year, non-blinded superiority trial with two parallel groups. A total of 402 hypertensive patients who meet the eligibility criteria will be recruited and randomized with a 1:1 allocation. All the participants will receive a mobile device for self-management, which is a part of our telehealth system. Participants in the control group will only use the device for BP measurement and receive regular follow-ups from care providers according to the guidelines. Participants in the intervention group will gain full access to the system and receive intervention based on the proposed model (a well-designed coordinated care pathway consisting of 9 tasks). Outcomes will be measured mainly on three occasions (at inclusion, at 6 months, and at 12 months). The primary outcome is mean change in systolic blood pressure over a 12-month period. Secondary outcomes include changes in diastolic blood pressure, biochemical indexes related to hypertension, lifestyles, self-management adherence, and hypertension awareness, as well as work efficiency of care providers.DiscussionThis study aims to investigate whether a pathway-driven eHealth-based integrated care model based on the “three-manager” mode will improve hypertension control in China. Success of the model would help improve the quality of present community-based management procedures and benefit more patients with uncontrolled hypertension.Trial registrationChinese Clinical Trial Registry ChiCTR1900027645. Registered on November 22, 2019.

Temporal Trends and Geographic Disparity in Hypertension Care in China.

BackgroundThis study examines trends and geographic disparities in the diagnosis, treatment, and control of hypertension in China and investigates the association between regional factors and hypertension care.MethodsBlood pressure data and data relating to health care for hypertension were used for this study. The data were sourced from baseline and follow-up surveys of the China Health and Retirement Longitudinal Study, which was conducted in 2011, 2013, and 2015. To estimate the geographical disparities in diagnosis, treatment, and control of hypertension, random-effects models were also applied after controlling for sociodemographic characteristics.ResultsAmong hypertensive individuals in China, the trends showed decreases in undiagnosed, untreated, and uncontrolled hypertension: 44.1%, 51.6%, and 80.7% in 2011; 40.0%, 47.4%, and 77.8% in 2013; and 31.7%, 38.0%, and 71.4% in 2015, respectively. The number of undiagnosed, untreated, and uncontrolled hypertensive residents living in urban areas in 2015 was more than 10% lower than the number in rural areas and among rural-to-urban immigrant individuals in China. The poorest socio-economic regions across China were 8.5 times more likely to leave their residents undiagnosed, 2.8 times more likely to leave them untreated, and 2.6 times more likely to leave hypertension uncontrolled.ConclusionsAlthough China has made impressive progress in addressing regional inequalities in hypertension care over time, it needs to increase its effort to reduce geographic disparities and to provide more effective treatments and higher quality care for patients with hypertension.

The impact of changes in population blood pressure on hypertension prevalence and control in China.

In China, there are approximately 250 million adults who have hypertension with low rates of awareness, treatment and control. Changes in lifestyles at a population level have the potential to enhance or deteriorate the prevention and control of hypertension. We used data from a regional hypertension survey to examine the impact of 2/1mmHg decreases or increases in population blood pressure on hypertension prevalence, and rates of unawareness of the hypertension diagnosis, treatment, and control. The primary analysis was based on the average blood pressure of respondents from three visits and a diagnostic threshold of 140/90mmHg for hypertension. Secondary analyses examined average blood pressure from the first survey visit and also a diagnostic threshold of 130/80mmHg for hypertension. The baseline hypertension prevalence was 33.4%, and rates of unawareness of the hypertension diagnosis, treatment, and control were 74.2%, 25.8%, and 9.7%, respectively. Decreases or increases in blood pressure by 10/5mmHg resulted in changes in hypertension prevalence (22.1% vs 53.4%) and rates of unawareness of the diagnosis (60.9% vs 83.8%), treatment (39.1% vs 16.2%), and control (21.2% vs 3.6%), respectively. Similar trends were seen in the secondary analyses. Population changes in lifestyle could have a very large impact on the prevalence and control of hypertension in China. The results support implementation of programs to improve population lifestyles while implementing health services policies to enhance the clinical management of hypertension.

Efficiency and safety of renal denervation via cryoablation (Cryo-RDN) in Chinese patients with uncontrolled hypertension: study protocol for a randomized controlled trial

BackgroundClinical data show that due to the limited effects of lifestyle regulation and unsatisfactory drug adherence, only half of the hypertensive population have their blood pressure (BP) under control. In recent years, catheter-based renal denervation (RDN) has been used as a novel approach for treating uncontrolled hypertension. The safety and efficacy of catheter-based RDN have been confirmed by a number of studies and trials in which the participants were all non-Chinese and RDN was conducted via radiofrequency or ultrasound.Methods/designThis study is a prospective multicenter randomized sham-controlled trial that aims to investigate the safety and efficacy of cryoablation RDN (cryo-RDN) using a novel dedicated cryoablation balloon catheter (Cryofocus, China). A total of 200 Chinese patients who have uncontrolled hypertension despite standard medical treatment will be enrolled. With drug standardization, eligible participants will be randomized in a 1:1 ratio to undergo cryo-RDN treatment or renal angiography alone as a sham treatment.The primary endpoint is defined as the change in 24-h ambulatory systolic blood pressure from baseline to 6 months. Office BP and other 24-h ambulatory BP are included as secondary endpoints. Safety endpoints primarily include any adverse effects.DiscussionThis study was designed to verify the safety and efficacy of cryo-RDN with Cryofocus balloon catheters in uncontrolled hypertensive patients on polypharmacy. The aim is to provide a new way to improve the control of hypertension in China as a complement to drug therapy.Trial registrationChiCTR, ChiCTR1800017707. Registered on 10 August 2018.

Asian management of hypertension: Current status, home blood pressure, and specific concerns in China.

Increasing life expectancy in the population means that the prevalence of hypertension in China will increase over the coming decades. Although awareness and control rates have improved, the absolute rates remain unacceptably low. Cardiovascular disease (CVD) is the biggest killer in China, and sharp increases in the prevalence of CVD risk factors associated with rapid lifestyle changes will contribute to ongoing morbidity and mortality. This highlights the importance of effectively diagnosing and managing hypertension, where home blood pressure monitoring (HBPM) has an important role. Use of HBPM in China is increasing, particularly now that Asia-specific guidance is available, and this out-of-office BP monitoring tool will become increasingly important over time. To implement these recommendations and guidelines, a Web-based and WeChat-linked nationwide BP measurement system is being established in China. Local guidelines state that both HBPM and ambulatory blood pressure monitoring should be implemented where available. In China, hypertension is managed most often using calcium channel blockers, followed by angiotensin receptor blockers or angiotensin-converting enzyme inhibitors. Key barriers to hypertension control in China are low awareness and control rates.

Sex differences in the awareness, treatment, and control of hypertension in China: a systematic review with meta-analyses.

Hypertension is the major cause of preventable disease burden in China. However, limited evidence is available on sex differences in the awareness, treatment, and control of hypertension. We assessed sex differences in the awareness, treatment, and control of hypertension in China. A systematic search of four English language and four Chinese-language databases was conducted to identify studies conducted from 2005 that reported sex-specific data on the awareness, treatment, and control of hypertension in China. Random-effects meta-analysis weighted by the inverse of the variances were used to obtain pooled sex-specific rates and women-minus-men differences, and their 95% confidence intervals (CI). Overall, 57 studies comprising 2,155,829 individuals (55% women) were included. Awareness (53% in women vs. 47% in men), treatment among all (44% vs. 38%), treatment among aware (65% vs. 60%), control among all (17% vs. 14%), and control among treated (27% vs. 27%) were low for both sexes, but more favourable in women than men. The corresponding women-minus men difference was 7% (95% CI: 6; 8%) for awareness, 6% (5; 8%) for treatment among all, 6% (2; 9%) for treatment among aware, 3% (2; 3%) for control among all, and 0% (-2; 1%) for control among treated. Awareness, treatment, and control of hypertension in China is low in both sexes, but greater in women than men. Sex-specific interventions may be needed to efficiently combat the burden of hypertension.

Unique approaches to hypertension control in China

According to the China nationwide hypertension survey in 2012-2015, the prevalence of hypertension in adults (≥18 years) was 27.9%, which increased approximately by 50% from 2002 (18.8%). The management of hypertension was improved, but still at low level, with the awareness, treatment and control rates of 46.9%, 40.7% and 15.3%, respectively. The challenge was still the low awareness and the low control rate in treated hypertension (37.5%). Several actions are currently being taken to improve hypertension control in China. In collaboration with the International Society of Hypertension May Measurement Month (MMM) Program, hundreds of volunteers across the country measured blood pressure in a large number of people in summer since 2017. In addition, a nationwide Web-based and WeChat-linked blood pressure measurement system is being built, with thousands of devices installed in public places within easy-reach of people. To improve blood pressure control in treated hypertension, two initiatives are being undertaken. One is the expanding use of ambulatory blood pressure monitoring to guide antihypertensive treatment. Another is primary aldosteronism screen in resistant hypertension. It is hoped that in the framework of the Healthy China 2030 Program the control rate of hypertension may increase in the next 10 years to 50% or higher by increasing both the awareness rate in the population and control rate in treated hypertensive patients to 70% or higher.

Cost-effectiveness analysis of intensive hypertension control in China

China has the largest population of adults with hypertension in the world. Recent clinical trials have shown that intensive hypertension control can help patients achieve lower blood pressure and reduce the incidence of major cardiovascular disease (CVD) events, but this level of hypertension control also incurs additional costs to patients and society and may result in a substantial increase in adverse events. The objective of this study is to assess the cost-effectiveness of intensive hypertension control to inform health policymakers and health care delivery systems in China in their decision-making regarding hypertension treatment strategies. We developed a Markov based simulation model of hypertension to assess the impact of intensive and standard hypertension control strategies for the Chinese population who are diagnosed with hypertension. Model parameters were estimated based on the best available data and the literature. We projected that intensive hypertension control would avert about 2.2 million coronary heart disease events and 4.4 million stroke events for all hypertensive patients in China in 10 years compared to standard hypertension control. The incremental cost-effectiveness ratio (ICER) for intensive hypertension control was estimated at 7876 CNY per quality-adjusted life year (QALY) compared to standard hypertension control. Intensive hypertension control would be more cost-effective than standard hypertension control in China. Our findings indicated that China should consider expanding intensive hypertension control among hypertensive patients given its great potential in preventing CVD.

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)

Hypertension is common in China and its prevalence is rising, yet it remains inadequately controlled. Few studies have the capacity to characterise the epidemiology and management of hypertension across many heterogeneous subgroups. We did a study of the prevalence, awareness, treatment, and control of hypertension in China and assessed their variations across many subpopulations. We made use of data generated in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project from Sept 15, 2014, to June 20, 2017, a population-based screening project that enrolled around 1·7 million community-dwelling adults aged 35-75 years from all 31 provinces in mainland China. In this population, we defined hypertension as systolic blood pressure of at least 140 mm Hg, or diastolic blood pressure of at least 90 mm Hg, or self-reported antihypertensive medication use in the previous 2 weeks. Hypertension awareness, treatment, and control were defined, respectively, among hypertensive adults as a self-reported diagnosis of hypertension, current use of antihypertensive medication, and blood pressure of less than 140/90 mm Hg. We assessed awareness, treatment, and control in 264 475 population subgroups-defined a priori by all possible combinations of 11 demographic and clinical factors (age [35-44, 45-54, 55-64, and 65-75 years], sex [men and women], geographical region [western, central, and eastern China], urbanity [urban vs rural], ethnic origin [Han and non-Han], occupation [farmer and non-farmer], annual household income [< ¥10 000, ¥10 000-50 000, and ≥¥50 000], education [primary school and below, middle school, high school, and college and above], previous cardiovascular events [yes or no], current smoker [yes or no], and diabetes [yes or no]), and their associations with individual and primary health-care site characteristics, using mixed models. The sample contained 1 738 886 participants with a mean age of 55·6 years (SD 9·7), 59·5% of whom were women. 44·7% (95% CI 44·6-44·8) of the sample had hypertension, of whom 44·7% (44·6-44·8) were aware of their diagnosis, 30·1% (30·0-30·2) were taking prescribed antihypertensive medications, and 7·2% (7·1-7·2) had achieved control. The age-standardised and sex-standardised rates of hypertension prevalence, awareness, treatment, and control were 37·2% (37·1-37·3), 36·0% (35·8-36·2), 22·9% (22·7-23·0), and 5·7% (5·6-5·7), respectively. The most commonly used medication class was calcium-channel blockers (55·2%, 55·0-55·4). Among individuals whose hypertension was treated but not controlled, 81·5% (81·3-81·6) were using only one medication. The proportion of participants who were aware of their hypertension and were receiving treatment varied significantly across subpopulations; lower likelihoods of awareness and treatment were associated with male sex, younger age, lower income, and an absence of previous cardiovascular events, diabetes, obesity, or alcohol use (all p<0·01). By contrast, control rate was universally low across all subgroups (<30·0%). Among Chinese adults aged 35-75 years, nearly half have hypertension, fewer than a third are being treated, and fewer than one in twelve are in control of their blood pressure. The low number of people in control is ubiquitous in all subgroups of the Chinese population and warrants broad-based, global strategy, such as greater efforts in prevention, as well as better screening and more effective and affordable treatment. Ministry of Finance and National Health and Family Planning Commission, China.

Abstract 095: Digital Solution Assisted Retail Pharmacists in Community Hypertension Control in China: A Real World Study of Large Samples

Objective: To identify the effects of a digital healthcare solution for hypertension management at retail pharmacies by pharmacists. Methods: We developed a digital healthcare solution that includes BP telemonitor, an App, and a cloud database with algorithms to assist: 1) CVD risk screening, 2) personalized meal planning, 3) personalized health coaching, and 4) medication guidance and compliance during the pharmacy consultation service. This solution has been implemented in 5,067 retail pharmacies in 141 cities in China as a decision support system to help pharmacists manage their hypertensive members. During Jan 1 st 2015 to Dec 31 st 2016, a total of 1,817,594 patients received in-store hypertension care and 23,024 of them were selected in this analysis following 4 inclusion criteria: 1) baseline BP was hypertensive (≥ 140/90 mm Hg), 2) the frequency of in-store hypertensive care was ≥ 1 time per month, 3) the intervention duration between the first- and last-time hypertensive care was ≥ 1 month, and 4) baseline characteristics were complete. Dynamic changes of SBP, DBP, disease staging, and population distribution over time were the major end points in this real-world, retrospective analysis. Results: SBP and DBP of the study population (n=23,024) were reduced on average by 11.2 mm Hg (baseline: 151.7 ± 14.8 mm Hg, last time: 140.5 ± 18.8 mm Hg, P&lt; 0.001) and 6.3 mm Hg (baseline: 91.2 ± 11.9 mm Hg, last time: 84.9 ± 12.7 mm Hg, P&lt;0.001), respectively. A total of 13,001 (56.5%) patients demonstrated improved hypertension stages by the last time BP measures with 9,625 (41.8%) of them returning to the normal range. The principal BP control effect took place after the first-time intervention, followed by gradual BP reduction over time. Simulation analysis revealed linear descending relationship of both SBP and DBP to time, and the concentration distributions were moving towards the normal BP level. The linear fitting functions were: SBP, Y = -0.103x + 140.278; DBP, Y = -0.060x + 84.799. Conclusion: Digital healthcare solution is effective in assisting retail pharmacists to deliver community hypertension care in real world.

Impact of the National Essential Public Health Services Policy on Hypertension Control in China.

Hypertension remains a severe challenge to population health worldwide. This study assessed the impact of a nationwide program in China-Essential Public Health Services (EPHS) on improvement of hypertension treatment and control. A cohort of hypertensive patients was identified from the 2011-2013 China Health and Retirement Longitudinal Study. Hypertension was defined based on: (i) an average systolic blood pressure of ≥140 mm Hg, and/or an average diastolic blood pressure of ≥90 mm Hg; and/or (ii) currently taking antihypertensive medications. Outcomes assessed included the rate of hypertension control, medication use, and blood pressure monitoring at a doctor's office. The key independent variable was defined as whether one received services from the EPHS-covered physical examination by 2013. Probit regression models with a difference-in-difference approach were performed for each of the 3 outcomes. Data were analyzed in 2017. Among the 4,958 hypertensive patients, 404 (8.1%) received the EPHS-covered service by 2013. Coverage by the EPHS program was associated with an increase of 7.9% in hypertension control rate (SE = 2.9%, P = 0.020), an increase of 10.3% in the rate of medication use (SE = 2.5%, P < 0.001), and an increase of 10.5% in the rate of blood pressure monitoring (SE = 2.5%, P < 0.001). Results also showed that the EPHS program helped mitigate the geographic disparities in access to health services such as blood pressure monitoring. The National EPHS program improved the treatment and control among hypertension patients. Expanding its program reach could further benefit the cardiovascular health of the population.

Health Insurance Coverage and Hypertension Control in China: Results from the China Health and Nutrition Survey.

BackgroundChina has rapidly expanded health insurance coverage over the past decade but its impact on hypertension control is not well known. We analyzed factors associated with hypertension and the impact of health insurance on the management of hypertension in China from 1991 to 2009.Methods and FindingsWe used individual-level data from the China Health and Nutrition Survey (CHNS) for blood pressure, BMI, and other socio-economic variables. We employed multi-level logistic regression models to estimate the factors associated with prevalence and management of hypertension. We also estimated the effects of health insurance on management of hypertension using propensity score matching. We found that prevalence of hypertension increased from 23.8% (95% CI: 22.5–25.1%) in 1991 to 31.5% (28.5–34.7%) in 2009. The proportion of hypertensive patients aware of their condition increased from 31.7% (28.7–34.9%) to 51.1% (45.1–57.0%). The proportion of diagnosed hypertensive patients in treatment increased by 35.5% in the 19 years, while the proportion of those in treatment with controlled blood pressure remained low. Among diagnosed hypertensives, health insurance increased the probability of receiving treatment by 28.7% (95% CI: 10.6–46.7%) compared to propensity-matched individuals not covered by health insurance.ConclusionsHypertension continues to be a major health threat in China and effective control has not improved over time despite large improvements in awareness and treatment access. This suggests problems in treatment quality, medication adherence and patient understanding of the condition. Improvements in hypertension management, quality of medical care for those at high risk, and better health insurance packages are needed.

To Live Long, Eat Less Salt: Salt Intake Reduction Promotion and Hypertension Control in China

During the past decade, the prevalence of hypertension in Chinese adult population has increased dramatically. It's well accepted that hypertension is the main risk factor for the development of cardiovascular diseases (CVD). In order to control hypertension and CVD in China, addressing the behaviour risk factors in Chinese population is a cost-effective way. Among the known behaviour risk factors, salt intake reduction is one of the most cost-effective ways to control hypertension and CVD. Ecological Model was used in this review to analyse the pieces of evidence based determinants and barriers of salt consumption in China, which includes public policy, community, institutional, interpersonal and intrapersonal determinants. Aiming to prevent and control hypertension in China, efforts are needed to overcome these barriers. Some of the barriers are less or not at all modifiable (such as policy and culture), but most of them are possible to modify by behaviours changes. Recommendations for reducing population's salt consumption also be given based on Ecological Model. However, salt intake reduction would be more effective with the combined efforts of multi levels rather than individually.

Burden of hypertension in China over the past decades: Systematic analysis of prevalence, treatment and control of hypertension.

To review comprehensively the prevalence, treatment and control of hypertension; and to estimate the burden of hypertension in China, thereby aiding Chinese health policies for better prevention and control of this condition. PubMed, EMbase, China National Knowledge Infrastructure, Wanfang and Chongqing VIP databases were searched for population-based studies published in English and Chinese that described prevalence, treatment and control of hypertension in China, as well as deaths and disabilities attributed to hypertension. All research papers were published between January 1999 and May 2014. Data from 178 studies involving over 2,901,464 participants covering 30 provinces were pooled. Overall, rates of prevalence, treatment and control of hypertension were 28.9%, 35.3% and 13.4% in China. A statistically significant association was observed between temperature gradient and the prevalence of hypertension. There were 10,667 (95% confidence interval 8063-13,345) disability-adjusted life years per 100,000 people. In total, 78.3% of disability-adjusted life years were from years lived with disability and 21.7% from years of life lost due to premature mortality. Although there has been a slight improvement in rates for the treatment and control of hypertension, these rates were still suboptimal, especially for men and people living in rural areas. Low and middle-income provinces had a comparatively huge burden of hypertension, which is a considerable risk factor for reducing life expectancy. Our analysis may be helpful in generating a current overview of hypertension in China.