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Invited Commentary
April 2016

Reducing the Burden of Hypertension: China’s Long March Ahead

Author Affiliations
  • 1Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine
JAMA Intern Med. 2016;176(4):532-533. doi:10.1001/jamainternmed.2016.0213

Elevated blood pressure (BP) represents the leading cause of death globally, at approximately 7.5 million deaths or 12.8% of all deaths.1 China bears a significant proportion of the global burden of morbidity and mortality due to hypertension. In this issue of JAMA Internal Medicine, Lewington and colleagues2 describe China’s burden of cardiovascular disease (CVD) mortality due to hypertension from the large prospective China Kadoorie Biobank Study conducted from 2004 to 2008 among 500 223 adults aged 30 to 74 years with 7 years of follow-up throughout 10 major provinces. Not surprisingly, the investigators report that only 30.5% of those with hypertension had received a previous diagnosis; of these, only 46.4% were treated, and among those treated, only 29.6% achieved control of hypertension, resulting in an overall control rate of 4.2%. These rates are roughly concordant with those of the recently reported 17-country Prospective Urban Rural Epidemiology (PURE) Study,3 in which among 45 108 adults in China aged 35 to 70 years, 42% were aware of their hypertension, 34% received treatment, and only 8.2% achieved control. The PURE Study showed treatment and control rates to be worse in western parts of China, and overall among patients receiving documented treatments, more than one-third (37.5%) were only using traditional (non-Western) drugs. A recent pooling of data4 from 178 studies involving 2 901 464 participants in 30 provinces from 1999 to 2014 shows overall prevalence, treatment, and control rates for hypertension to be 28.9%, 35.3%, and 13.4%, respectively.