Awareness, treatment and control of hypertension in patients attending hospital clinics in China

Prevalence, Awareness, and Control of Arterial Hypertension in a Russian Population. The Ural Eye and Medical Study

Background: Applying the criteria recently published by the American College of Cardiology/American Heart Association for the definition of arterial hypertension, we investigated prevalence and awareness of arterial hypertension in Russia. This new definition differentiates between normal BP [SBP (systolic blood pressure)/DBP (diastolic blood pressure) < 120/80 mmHg], elevated BP (SBP 120–129 mmHg; DBP < 80 mmHg), hypertension stage 1 (SBP 130–139 mmHg or DBP 80–89 mmHg), hypertension stage 2 (SBP ≥ 140 and ≤180 mmHg or DBP ≥ 90 and ≤120 mm Hg) and hypertensive crisis (SBP > 180 mmHg and/or DBP > 120).

Methods: The population-based Ural Eye and Medical Study, performed in an urban and rural region in the Russian republic Bashkortostan, included 5,891 (80.5%) individuals aged 40+ years out of 7,328 eligible individuals. The participants underwent a detailed interview and medical examination. Arterial hypertension was defined using the criteria defined by the American College of Cardiology/American Heart Association.

Results: The prevalence of normal blood pressure (BP), elevated BP, hypertension stage 1, stage 2, and hypertensive crisis was 750/5,891 [12.7%; 95% confidence interval (CI): 4.7, 5.9], 312/5, 891 (5.3%; 95% CI: 4.7, 5.9), 2,187/5,891 (37.1%; 95% CI: 35.9, 38.4), 2,484/5,891 (42.2%; 95% CI: 40.9, 43.4), and 158/5,891 (2.7%; 95% CI: 2.3, 3.1), respectively. The overall prevalence of elevated BP/hypertension was 5,141/5,891 (87.3%; 95% CI: 86.4, 88.1). Awareness of elevated BP/hypertension was 2,289/5,223 (45.4%; 95% CI: 44.0, 47.0). Among 1,055 (20.2%; 95% CI: 19.1, 21.3) individuals under anti-hypertensive treatment, 33 (3.1%) individuals had normal BP values. Higher risk of elevated BP/hypertension was associated with older age [odds ratio (OR): 1.04; 95% CI: 1.03,1.05], male gender (OR: 2.56; 95% CI: 2.10, 3.16), urban region (OR: 1.26; 95% CI: 1.05, 1.51), lower educational level (OR: 0.92; 95% CI: 0.87, 0.97), higher body mass index (OR: 1.15; 95% CI: 1.12, 1.18), higher waist-hip circumference ratio (OR: 6.16; 95% CI: 1.89, 20.0), higher prevalence of sitting or reclining for more than 18 h per week (OR: 1.33; 95% CI: 1.10, 1.61), higher prevalence of alcohol consumption (OR: 1.61; 95% CI: 1.27, 2.05), and higher serum concentrations of triglycerides (OR: 1.22; 95% CI: 1.05, 1.43) and glucose (OR: 1.15; 95% CI: 1.07, 1.24). Using the former definition of hypertension (systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg), the prevalence of hypertension was 3,134/5,891 (53.2%; 95% CI: 51.9, 54.5).

Conclusions: Using the new definition of arterial hypertension, the prevalence of elevated BP/hypertension in a typically mixed Russian population aged 40+ years was high (87.3%), with an awareness rate of 45.4% and treatment rate of 20.2%. The rate of therapeutic control of BP elevation in the individuals under treatment was <5%.

BASIS: The blood pressure awareness and insight scale

Impaired illness awareness or not accepting that one has hypertension (HTN) may be an important predictor of treatment adherence and optimal blood pressure control. The purpose of this study was to perform a systematic review of available instruments to evaluate HTN awareness, and subsequently present a novel scale that measures the core domains of subjective illness awareness in HTN. Based on the absence of any validated HTN specific measure identified through our review, the Blood Pressure Awareness and Insight Scale (BASIS) was developed (www.illnessawarenessscales.com). An online survey platform was used to collect data on 100 participants. BASIS showed good concurrent (r(98) = .65, P < 0.001) and discriminant validity, internal consistency (Cronbach's α = .75), and 1-month test-retest reliability (ICC = 0.77). BASIS is a comprehensive, easy-to-use instrument specifically designed to measure subjective HTN awareness. BASIS may be used in research studies and clinical practice to assess the impact of HTN awareness on treatment adherence and clinical outcomes.

Prevalence, awareness, treatment and control of hypertension in Macau: results from a cross-sectional epidemiological study in Macau, China

BACKGROUND

Awareness of hypertension, as well as its prevalence, treatment, and control status, has not been comprehensively investigated in Macau Special Administrative Region (SAR), China.

METHODS

A survey was conducted on a randomly sampled population of 1,410 participants (n = 638 men) aged 18-93 years in 2012. Blood pressure was individually measured twice. Awareness, treatment, and control of hypertension were assessed by interview-administered questionnaire.

RESULTS

Prevalence of hypertension was 34% in Macau, similar to the United States (30%) and United Kingdom (31%). Among hypertensives, 69% were aware of their condition, 59% were treated, and 30% were adequately controlled. Older age (≥50 years; odds ratio (OR) = 5.3; 95% confidence interval (CI) = 4.6-6.1), being of the male sex (OR = 2.2; 95% CI = 1.9-2.5), having retired (OR = 2.0; 95% CI = 1.8-2.3), being married (OR = 1.5; 95% CI = 1.3-1.9), having a low level of education in women (OR = 1.5; 95% CI = 1.1-2.1), Pinteraction = 0.01), and lack of salt awareness (OR = 1.1; 95% CI = 1.0-1.3) were associated with hypertension. Older age, having retired, and being married were also associated with higher awareness and treatment rates. Those who were older and married were better controlled. These demographic factors differed by sex. Those who had some knowledge of salt intake were more likely to have higher hypertension awareness, treatment, and control rates.

CONCLUSIONS

The prevalence of hypertension in Macau in 2012 has increased compared with 2006 (28%) and is comparable with prevalence rates in developed countries. Specific health promotion campaigns related to knowledge of risk factors such as salt intake and smoking may be useful for hypertension prevention and to improve hypertension awareness, treatment, and control rates.

Frequency, Awareness, Treatment and Control of Hypertension in the over 40 Population of Erzincan

To determine distribution of blood pressure (BP) and prevalence, awareness, treatment and control of hypertension in 5 primary health care centers of Erzincan. A population-based cross-sectional survey was carried out in January - May 2009. A two-stage sampling method was used to select a sample of adult population 40 and over years of age. The total number of participants was 1570. Data were collected by face-to-face interview technique in the primary health care setting. Main outcome measures; mean systolic and diastolic blood pressures, distribution of blood pressure, prevalence of hypertension (mean systolic BP≥140 mmHg or mean diastolic BP ≥90 mmHg, or previously diagnosed and/or taking antihypertensive drugs) awareness, treatment and control of hypertension were assessed. The overall hypertension prevalence was 67.0% in the study sample and 77.4% of them were aware of their hypertension and received a pharmacologic treatment. Of the patients who were aware of the disease, 51.8% use drug treatment. Of the patients who had a drug treatment, 33.9 % were under control in terms of blood pressure. Our data indicate that hypertension is a highly prevalent but inadequately managed health problem in Erzincan. There is an urgent need for population-based strategies to improve prevention, early detection, and control of hypertension.

A systematic review of adherence to cardiovascular medications in resource-limited settings

BACKGROUND

Medications are a cornerstone of the prevention and management of cardiovascular disease. Long-term medication adherence has been the subject of increasing attention in the developed world but has received little attention in resource-limited settings, where the burden of disease is particularly high and growing rapidly. To evaluate prevalence and predictors of non-adherence to cardiovascular medications in this context, we systematically reviewed the peer-reviewed literature.

METHODS

We performed an electronic search of Ovid Medline, Embase and International Pharmaceutical Abstracts from 1966 to August 2010 for studies that measured adherence to cardiovascular medications in the developing world. A DerSimonian-Laird random effects method was used to pool the adherence estimates across studies. Between-study heterogeneity was estimated with an I(2) statistic and studies were stratified by disease group and the method by which adherence was assessed. Predictors of non-adherence were also examined.

FINDINGS

Our search identified 2,353 abstracts, of which 76 studies met our inclusion criteria. Overall adherence was 57.5% (95% confidence interval [CI] 52.3% to 62.7%; I(2) 0.98) and was consistent across study subgroups. Studies that assessed adherence with pill counts reported higher levels of adherence (62.1%, 95% CI 49.7% to 73.8%; I(2) 0.83) than those using self-report (54.6%, 95% CI 47.7% to 61.5%; I(2) 0.93). Adherence did not vary by geographic region, urban vs. rural settings, or the complexity of a patient's medication regimen. The most common predictors of poor adherence included poor knowledge, negative perceptions about medication, side effects and high medication costs.

INTERPRETATION

Our study indicates that adherence to cardiovascular medication in resource-limited countries is sub-optimal and appears very similar to that observed in resource-rich countries. Efforts to improve adherence in resource-limited settings should be a priority given the burden of heart disease in this context, the central role of medications in their management, and the clinical and economic consequences of non-adherence.

Survey of prevalence, awareness, treatment, and control of hypertension among Chinese governmental and institutional employees in Beijing

BACKGROUND

Few studies have been done on the effects that awareness, treatment, and control have on hypertension among governmental and institutional employees.

HYPOTHESIS

The aim of this study was to explore prevalence, awareness, treatment and control of hypertension among governmental and institutional employees.

METHODS

A total of 80 governmental organizations and institutions were selected with a 2-stage clustering sampling method in Beijing and all employees in the selected institutions were considered our study subjects. The survey questionnaires included demographic characteristics; medical, personal, and family health history; lifestyle information; and sources of blood pressure knowledge.

RESULTS

The ages of 30 682 subjects ranged from 18 to 65 years and averaged 40.3 +/- 11.4 years. The proportion of males was 54.4% (16 702 subjects). A total of 9216 subjects were diagnosed hypertensive and the prevalence rate was 30.0%. Among hypertensive patients, 5399 subjects were aware of being hypertensive and the awareness rate was 58.6%. Although 51.7% of hypertensive subjects were taking antihypertensive medications, only 2371 subjects had their blood pressure under control (<140/90 mm Hg) and the control rate was 25.7%. Only 4915 subjects (16.0%) monitored their own blood pressure regularly. Health publications (50.6%) and families/friends (49.1%) were the main sources of hypertension knowledge. Female hypertensive subjects have more effectively controlled blood pressure than their male counterparts. Subjects with a bachelor's degree or higher had a lower awareness rate and treatment rate, but a higher control rate.

CONCLUSIONS

The percentage of hypertensive subjects who are aware, treated, and controlled are unacceptably low among Chinese governmental and institutional employees. Regular medical check-ups and measuring of blood pressure are necessary to improve awareness, treatment, and control of hypertension.

Treatment of hypertension in rural Cambodia: results from a 6-year programme

This study was aimed to describe the outcomes of a hypertension treatment programme in two outpatient clinics in Cambodia. We determined proportions of patients who met the optimal targets for blood pressure (BP) control and assessed the evolution of mean systolic and diastolic BP (SBP/DBP) over time. Multivariate analyses were used to identify predictors of BP decrease and risk factors for LTFU. A total of 2858 patients were enrolled between March 2002 and June 2008 of whom 69.2% were female, 30.5% were aged ≥64 years and 32.6% were diabetic. The median follow-up time was 600 days. By the end of 2008, 1642 (57.4%) were alive-in-care, 8 (0.3%) had died and 1208 (42.3%) were lost to follow-up. On admission, mean SBP and DBP were 162 and 94 mm Hg, respectively. Among the patients treated, a significant SBP reduction of 26.8 mm Hg (95% CI: 28.4-25.3) was observed at 6 months. Overall, 36.5% of patients reached the BP targets at 24 months. The number of young adults, non-overweight patients and non-diabetics reaching the BP targets was more. Older age (>64 years), uncontrolled DBP (≥90 mm Hg) on last consultation and coming late for the last consultation were associated with LTFU, whereas non-diabetic patients were 1.5 times more likely to default than diabetics (95% CI: 1.3-1.7). Although the definite magnitude of the BP decrease due to antihypertension medication over time cannot be assessed definitely without a control group, our results suggest that BP reduction can be obtained with essential hypertension treatment in a large-scale programme in a resource-limited setting.

Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries

Objective To systematically review quantitative differences in the prevalence, awareness, treatment and control of hypertension between developed and developing countries over the past 6 years. Methods We searched Medline [prevalence AND awareness AND treatment AND control AND (hypertension OR high blood pressure)] for population-based surveys. Prevalence, awareness, treatment and control of hypertension were compared between men and women, and between developing and developed countries, adjusting for age. The proportions of awareness, treatment and control were defined relative to the total number of hypertensive patients. Results We identified 248 articles, of which 204 did not fulfill inclusion criteria. The remaining articles reported data from 35 countries. Among men, the mean prevalence, awareness, treatment and control of hypertension were 32.2, 40.6, 29.2 and 9.8%, respectively, in developing countries and 40.8, 49.2, 29.1 and 10.8%, respectively, in developed countries. Among women, the mean prevalence, awareness, treatment and control of hypertension were 30.5, 52.7, 40.5, and 16.2%, respectively, in developing countries and 33.0, 61.7, 40.6 and 17.3%, respectively, in developed countries. After adjusting for age, the prevalence of hypertension among men was lower in developing than in developed countries (difference, S6.5%; 95% confidence interval, S11.3 to S1.8%). Conclusion There were no significant differences in mean prevalence, awareness, treatment and control of hypertension between developed and developing countries, except for a higher prevalence among men in developed countries. The prevalence, awareness, treatment and control of hypertension in developing countries are coming closer to those in developed countries.

Comparison of hypertension and its risk factors between the Guangxi Bai Ku Yao and Han populations

OBJECTIVE

Little is known about the prevalence of hypertension in Bai Ku Yao, an isolated subgroup of the Yao minority in China. The aim of this study was to compare the difference in the prevalence of hypertension and its risk factors between the Guangxi Bai Ku Yao and Han populations.

METHODS

A cross-sectional study of hypertension in 1170 subjects of Bai Ku Yao and 1173 participants of Han Chinese aged 15-89 was conducted by a stratified randomized cluster sampling. Information on diet and lifestyle was collected with standardized questionnaires. Blood pressure, serum lipids and several anthropometric parameters were obtained in all subjects.

RESULTS

Systolic, diastolic and pulse pressure levels and hypertension prevalence (10.85% vs 16.45%, p<0.001) were lower in Bai Ku Yao than in Han. Hypertension was positively correlated with male, age, physical activity, body mass index, waist circumference, total energy, total fat and sodium intakes, and negatively associated with education level and total dietary fibre intake in both ethnic groups (p<0.05-0.001). Hypertension was also positively associated with alcohol consumption in Han. The rates of awareness, treatment and control were lower in Bai Ku Yao than in Han (p<0.05 for all).

CONCLUSIONS

The difference in the hypertension prevalence between the two ethnic groups might result from different diet, lifestyle, physical activity level, sodium intake and genetic factors.

Prevalence of arterial hypertension in the adult population in rural and urban China: the Beijing eye study

BACKGROUND

This study aimed to investigate the prevalence of arterial hypertension in China.

METHODS

The Beijing Eye Study 2006 is a population-based investigation including 3,251 subjects aged 45+ years. Blood pressure measurements were performed for 3,222 (99.1%) subjects. Hypertension was defined as a systolic blood pressure > or =140 mm Hg and/or a diastolic blood pressure > or =90 mm Hg, and/or self-reported current treatment for hypertension.

RESULTS

A diastolic blood pressure of >or =90 mm Hg was detected in 106 (3.3%) subjects, and a systolic blood pressure > or =140 mm Hg was measured in 866 (26.9%) subjects. Arterial hypertension was present in 1,500 (46.6%) subjects. Prevalence of arterial hypertension was significantly associated with age (P < 0.001), body mass index (P < 0.001), serum concentration of cholesterol (P = 0.02), diabetes mellitus (P < 0.001; odds ratio: 1.48), family history of hypertension (P < 0.001; odds ratio: 2.96), and rural region (P < 0.001; odds ratio: 2.27). Among the arterial hypertensive subjects, 82.7% were aware of the diagnosis. Awareness of hypertension was significantly associated with urban area, higher age, higher body mass index, and family history of hypertension. Out of the 1,500 hypertensive subjects, 1,106 (73.7%) were treated for arterial hypertension. Out of the treated subjects, 487 (44%) had abnormally high arterial blood pressure measurements.

CONCLUSIONS

These survey results underscore the fact that hypertension is highly prevalent, relatively poorly treated, and an escalating health challenge in China. As in other studies, people in metropolitan areas had the highest rates of awareness, treatment, and control. It implies that effective public health measures are needed to enhance the treatment, and control rates in the Chinese population, particularly in the rural regions.

Diet, lifestyle, and blood pressure of the middle-aged and elderly in the Guangxi Bai Ku Yao and Han populations

BACKGROUND

Bai Ku Yao is an isolated subgroup of the Yao minority in China. Little is known about the association of diet and lifestyle with the prevalence of hypertension in this population.

METHODS

A total of 485 subjects of Bai Ku Yao and 501 participants of Han Chinese aged 40-89 were surveyed using stratified randomized cluster sampling. Information on diet and lifestyle was collected by using standard questionnaires. Blood pressure (BP) and serum lipid levels were measured.

RESULTS

Physical activity levels, carbohydrate, vegetal protein, and dietary fiber intake were higher in Bai Ku Yao than in Han, whereas educational level, height, weight, body mass index (BMI), waist circumference, and total energy, fat, protein, dietary cholesterol, and salt intake were higher in Han than in Bai Ku Yao. Systolic, diastolic, and pulse pressure (PP) levels and the prevalence of hypertension (21.9% vs. 28.9%, P < 0.05)were lower in Bai Ku Yao than in Han. Hypertension was positively correlated with age, physical activity,BMI, and waist circumference, as well as with total energy, fat, and salt intake, and negatively associated with educational levels and dietary fiber intake in both ethnic groups (P < 0.05 for all). Hypertension was also positively correlated with triglycerides (TGs) in Bai Ku Yao and alcohol consumption in Han (P < 0.05 for each).

CONCLUSIONS

The differences in BP levels and the prevalence of hypertension among the middle-aged and elderly between Bai Ku Yao and Han might result from different dietary patterns, lifestyle choices, physical activity levels, sodium intake, and even genetic factors.

Effects of alcohol consumption and other lifestyle behaviors on blood pressure for the middle-aged and elderly in the Guangxi Hei Yi Zhuang and Han populations

Han is the largest group and Zhuang is the largest minority among the 56 ethnic groups in China. Geographically and linguistically, Zhuang can be classified into 43 ethnic subgroups, in which Hei Yi Zhuang is proved to be the most conservative subgroup. Little is known about the relationship between alcohol consumption and blood pressure levels in this population. Therefore, the present study was undertaken to compare the effects of alcohol consumption and other lifestyle behaviors on blood pressure levels for the middle-aged and elderly in the Guangxi Hei Yi Zhuang and Han populations. A total of 657 subjects of Hei Yi Zhuang aged 40 and older were surveyed by a stratified randomized cluster sampling. Information on demography, diet, and other lifestyle factors was collected by standard questionnaires. Anthropometric parameters and serum lipid levels were also obtained in all subjects. The results were compared with those in 520 participants of Han Chinese from the same region. The levels of systolic blood pressure and pulse pressure in Hei Yi Zhuang were higher than those in Han (P < .01-.001). Hypertension was positively correlated with sex (male), age, physical activity, alcohol consumption, serum triglyceride levels, and total energy, total fat, and salt intakes, and negatively associated with educational level in Hei Yi Zhuang (P < .05-.001), whereas positively correlated with sex (male), age, physical activity, alcohol consumption, body mass index, waist circumference, serum total cholesterol levels, and total energy, total fat, and salt intakes, and negatively associated with educational level in Han (P < .05-.001). The difference in blood pressure levels between the two ethnic groups might result from different dietary habit, lifestyle, sodium intake, educational level, physical activity, and even genetic factors.

Effects of Demographic Characteristics, Health-Related Behaviors and Lifestyle Factors on the Prevalence of Hypertension for the Middle-Aged and Elderly in the Guangxi Hei Yi Zhuang and Han Populations

BACKGROUND/AIMS

Hei Yi (meaning black worship and black dress) Zhuang is the most conservative group among the 43 ethnic subgroups of Zhuang in China due to its unique culture and customs. The prevalence of hypertension in this population has not been well defined. Therefore, the present study was undertaken to compare the effects of the demographic characteristics, health-related behaviors and lifestyle factors on the prevalence of hypertension in the middle-aged and elderly of the Guangxi Hei Yi Zhuang and Han populations.

METHODS

A total of 657 people of Hei Yi Zhuang aged 40 and over were randomly selected from 7 villages in Napo County of China. Information on the demographic characteristics, health-related behaviors and lifestyle factors was collected by questionnaire. Blood pressure, height, weight, waist circumference, serum lipid and apolipoprotein levels were measured, and body mass index (BMI) was calculated as a measure of weight relative to height. The results were compared with those of 520 Han who live in the same district.

RESULTS

The prevalence of hypertension and isolated systolic hypertension in Hei Yi Zhuang was significantly higher than in Han (32.9 vs. 24.6%, p < 0.01, and 16.7 vs. 5.2%, p < 0.001, respectively). The systolic blood pressure levels and pulse pressure in Hei Yi Zhuang were also significantly higher than in Han (129 +/- 20.1 vs. 125.8 +/- 17.4 mm Hg, p < 0.01, and 51.5 +/- 16.1 vs. 47.1 +/- 12.0 mm Hg, p < 0.01, respectively). The prevalence of hypertension was positively correlated with triglycerides, male, age, and alcohol consumption in Hei Yi Zhuang, whereas it was positively correlated with total cholesterol, male, age, alcohol consumption and BMI in Han. The rates of awareness, treatment and control in Hei Yi Zhuang and Han are 7.9 vs. 19.5%, 4.2 vs. 13.3% and 1.4 vs. 9.4% (p < 0.01 for all), respectively.

CONCLUSION

The current study reveals a significant difference in the prevalence of hypertension, blood pressure levels, and the relative factors between the Hei Yi Zhuang and Han ethnic groups, which may have been due to differences in geographical characteristics, lifestyle, sodium intake, education levels, and even genetic factors.

Physicians, patients, and public knowledge and perception regarding hypertension and stroke: a review of survey studies

BACKGROUND

Hypertension is the most common treatable risk factor for stroke. Efforts have been made to raise the awareness of both hypertension and stroke. There is a lack of clear understanding of the current state of knowledge, attitudes, and perceptions about hypertension and stroke among patients, the public, and physicians.

OBJECTIVES

To understand the level of knowledge, attitudes, and perceptions regarding hypertension and stroke among patients, the public, and physicians and to highlight the practices of physicians in managing hypertension given current hypertension guideline recommendations.

METHODS

Current Contents, Embase, and Medline databases were searched to identify manuscripts published between January 1994 and December 2004 reporting surveys concerning the knowledge and perceptions of patients, the public, and physicians regarding hypertension and stroke. Studies were summarized and collated into a spreadsheet.

RESULTS

Of a total of 85 manuscripts identified, only 43 contained information meeting the study objectives. Based on the reported results, it was observed that patients and public alike are generally aware that hypertension is one of the risk factors of stroke, and that stroke could be a consequence of hypertension, but do not consider hypertension to be a serious health concern. Physicians appreciate the importance of managing hypertension to avoid future complications such as stroke. However, they do not conform to the recommendations made in various hypertension guidelines. They have higher thresholds than guideline recommendations for defining and categorizing hypertension, for starting antihypertensive therapy, and for target blood pressure goals. They do not aggressively manage hypertension in older people, considering that the elderly are at greater risk for developing stroke.

CONCLUSIONS

Patients and public are aware of the link between hypertension and stroke but do not appreciate the consequences of uncontrolled hypertension. Physicians worldwide need to engage in patient communication regarding hypertension, stroke, and the dangers of uncontrolled hypertension, and need to implement guideline recommendations for hypertension diagnosis and management.