May Measurement Month 2017: an analysis of blood pressure screening results in China-East Asia

May Measurement Month 2020: An Analysis of Blood Pressure Screening Results From China

We reported the blood pressure data obtained in the May Measurement Month (MMM) China project in 2020 during the COVID-19 control period. The study participants were adults (≥ 18 years), ideally in whom blood pressure had not been measured in the previous year. Blood pressure was measured three times consecutively with a 1-min interval in the sitting position, using a validated automated BP monitor (Omron HEM-7081IT), and transmitted to a central database via a smartphone app. The measurement was performed at 136 sites across 29 China provinces. The 100 728 participants had a mean (±SD) age of 45.6 (±18.3) years and included 56 097 (55.7%) women. The mean systolic/diastolic blood pressure was 120.0/76.9 mm Hg. The proportion of hypertension was 28.9% (n  =  29 135), and the awareness, treatment, and control rates of hypertension were 45.3% (n = 13 212), 39.7% (n =  1573), and 24.4% (n = 7101), respectively. After adjustment for age, gender, and use of antihypertensive medication, systolic/diastolic BP were significantly higher with cigarette smoking (n = 8070, +0.5/+1.0 mm Hg, p < 0.05), mild (n = 4369, +1.2/+1.3 mm Hg, p < 0.001) and moderate or heavy alcohol drinking (n = 3871, +0.4/+0.7 mm Hg, p < 0.05), and overweight (+1.8/+1.4 mm Hg, p < 0.001) and obesity (+2.3/+1.5 mm Hg, p < 0.001). In conclusion, our study provided unique blood pressure data during the COVID-19 period, and suggested that hypertension management might have been even more challenging when the medical professionals had to shift their focus on other urgencies.

May Measurement Month 2021: an analysis of blood pressure screening results from China

We reported findings from participants screened during the May Measurement Month 2021 in China, which aimed to raise awareness of raised blood pressure (BP), and to investigate the risk factors of BP. The study participants were adults (≥18 years), ideally in whom BP had not been measured in the previous year. Blood pressure was measured three times consecutively with 1 min intervals in the sitting position, using a validated upper-arm cuff automated BP monitor (Omron HEM-7081IT), and transmitted to a central cloud database via a smartphone app. The measurement was performed in 218 844 participants in 183 sites across 31 China provinces. The mean (standard deviation) age was 47.0 (15.7) years, and 51.8% (n = 113 466) were women. The mean systolic/diastolic BP was 120.2/77.5 mmHg. Among 57 178 (26.1%) participants with hypertension, the awareness, treatment, and control rates of hypertension were 30.4% (n = 17 354), 28.7% (n = 16 369), and 17.1% (n = 9743), respectively. After adjustment for age, sex, and use of antihypertensive medication, both systolic and diastolic BP were significantly (P ≤ 0.01) higher in current smokers (n = 22 344, +0.4/+0.7 mmHg) and with moderate (n = 4780, +1.4/+4.2 mmHg) or daily alcohol intake (n = 2427, +1.3/+2.5 mmHg). Blood pressure was lower in those reporting regular exercise (n = 32 328, -2.2/-1.4 mmHg). In addition, individuals with previous COVID-19 vaccination had lower systolic and diastolic BP (n = 88 945, -1.8/-1.5 mmHg, P ≤ 0.001). In conclusion, our study showed that long-term large-scale screening for hypertension is feasible, and there is a strong association between BP and major lifestyle factors.

Control status of ambulatory blood pressure and its relationship with arterial stiffness in the China nationwide registry of treated hypertensive patients: the REACTION-ABP study

The control rate of ambulatory blood pressure (BP) is unclear in Chinese hypertensive patients, and whether it would be associated with the ambulatory arterial stiffness indices is also unknown. From June 2018 until December 2022, 4408 treated hypertensive patients (52.8% men, average age 58.2 years) from 77 hospitals in China were registered. Ambulatory BPs were measured with validated monitors and analyzed with a web-based standardized Shuoyun system ( www.shuoyun.com.cn ). The BP control rate was the highest in the office (65.7%), moderate in the daytime (45.0%), low in the morning (34.1%), and the lowest in the nighttime (27.6%, P < 0.001). Only 21.0% had their 24 h BP perfectly controlled. The stepwise regression analyses identified that the factors associated with an imperfect 24 h BP control included male sex, smoking and drinking habits, a higher body mass index, serum total cholesterol and triglycerides, and the use of several specific types of antihypertensive drugs. After adjustment for the above-mentioned factors, the 24 h pulse pressure (PP) and its components, the elastic and stiffening PPs, were all significantly associated with an uncontrolled office and ambulatory BP status with the standardized odds ratios ranging from 1.09 to 4.68 (P < 0.05). The ambulatory arterial stiffness index (AASI) was only associated with an uncontrolled nighttime and 24 h BP status. In conclusion, the control rates of 24 h ambulatory BP, especially that in the nighttime and morning time windows, were low in Chinese hypertensive patients, which might be associated with arterial stiffness in addition to other common risk factors.

Hypertension in China: epidemiology and treatment initiatives

The past two to three decades have seen a steady increase in the prevalence of hypertension in China, largely owing to increased life expectancy and lifestyle changes (particularly among individuals aged 35-44 years). Data from the China hypertension survey conducted in 2012-2015 revealed a high prevalence of grade 3 hypertension (systolic blood pressure ≥180 mmHg and diastolic blood pressure ≥110 mmHg) in the general population, which increased with age to up to 5% among individuals aged ≥65 years. The risk profile of patients with hypertension in China has also been a subject of intense study in the past 30 years. Dietary sodium and potassium intake have remained largely the same in China in the past three decades, and salt substitution strategies seem to be effective in reducing blood pressure levels and the risk of cardiovascular events and death. However, the number of individuals with risk factors for hypertension and cardiovascular disease in general, such as physical inactivity and obesity, has increased dramatically in the same period. Moreover, even in patients diagnosed with hypertension, their disease is often poorly managed owing to a lack of patient education and poor treatment compliance. In this Review, we summarize the latest epidemiological data on hypertension in China, discuss the risk factors for hypertension that are specific to this population, and describe several ongoing nationwide hypertension control initiatives that target these risk factors, especially in the low-resource rural setting.

Telemedicine in the management of hypertension: Evolving technological platforms for blood pressure telemonitoring

The prevalence of hypertension is high and still increasing in almost all communities regardless of high, middle, or low income. The control rate remains low in most countries. Telemedicine offers possibilities to improve blood pressure control. The past two decades witnessed the fast evolving telecommunication from telephone transmission to smart mobile phone technology for telemedicine. There is some evidence from randomized controlled trials that telemonitoring improves blood pressure control. However, it requires co‐interventions. The emerging new technology may offer even more possibilities in telemonitoring and co‐interventions, for instance, an interactive platform between patients and health professionals for the management of hypertension. Telemedicine might ultimately change the situation of the unsatisfactory management of hypertension in many communities. It helps fully utilize antihypertensive treatment, the most effective cardiovascular prevention, to achieve the goal of ending atherosclerosis and arteriosclerosis in humans.

May Measurement Month 2018: an analysis of blood pressure screening results from China

To further improve awareness, treatment, and control of hypertension, the May Measurement Month (MMM) campaign continued in 2018 in China. Study subjects were adults aged 18 years or more, ideally those who had not their blood pressure (BP) measured for at least a year. Blood pressure was measured three times consecutively with a 1-min interval in the sitting position, using automated BP monitors in 288 342 participants and transmitted to a central database by a smartphone app. Questionnaire data were collected with the same app. After imputation, the overall proportion of hypertension was 29.8%. Of those with hypertension, the rates of awareness, treatment, and control were 62.3%, 57.3%, and 35.9%, respectively. In analysis based on linear regression models, both systolic and diastolic BP were higher with cigarette smoking, alcohol intake, and overweight and obesity. Our study results suggest that hypertension management is improving in comparison with the data in MMM 2017 and the nationwide survey in 2012-15, and several known lifestyle factors are key to hypertension management.

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.

An overview of hypertension and cardiac involvement in Asia: Focus on heart failure

Cardiovascular Disease (CVD) is the leading cause of deaths worldwide, contributing to about 30% of all deaths. Half of the cases of CVD are estimated in Asia, the world's most populous continent. Hypertension, a major modifiable risk factor for CVD, results in more deaths than any other CV risk factors in the Asian regions. The total number of patients with hypertension is likely to grow as the population ages. The proportion of the elderly population aged 65 years or more in Asia is expected to increase from 7.4% in 2015 to 10.9% in 2030. It is important to note that more than half (54%) of the world's population live in Asia. Aside of being the biggest single risk factor for global deaths, hypertension is also an important precursor and most common risk factor of heart failure (HF). An increase in HF prevalence is clearly related to the rapid epidemiological transition caused by changes in lifestyle in Asian countries. However, the availability of data on HF burden and health care delivery is limited in Asia compared with Europe and North America. This reality has driven the working group of Asian experts for example the HOPE Asia Network to concentrate on hypertension as risk factors for CVD, with the mission to improve the management of hypertension resulting in organ protection toward a goal of achieving "ZERO" CV event in Asia. This paper aims to give an overview regarding the heart problems caused by hypertension in Asia, focus on HF.