One-size-fits-all management of hypertension: a key to poor control of hypertension in low income settings in sub-Saharan Africa?

Blood pressure and noncommunicable diseases in middle-aged and older adults in China

Background

There are few studies examining the association between blood pressure (BP) and noncommunicable diseases (NCDs) in consideration of the new hypertension guidelines in China.

Methods

Data were drawn from the China Health and Retirement Longitudinal Study. 14 390 eligible participants (aged 45 years and older) were selected through four-stage, stratified, and cluster sampling. Hypertension was considered as a mean systolic blood pressure (SBP) of 130 mm Hg (old definition: 140 mm Hg) or higher, a mean diastolic blood pressure (DBP) of 80 mm Hg (old definition: 90 mm Hg) or higher or taking anti-hypertensive medication. Cochran-Armitage trend test and logistic regression analyses were conducted to test the association between BP level and NCDs.

Results

The prevalence of hypertension based on the latest definition was 56.35% (while by old definition: 42.75%). The awareness, treatment, and control among hypertensive participants were 38.62% (51.18%), 43.10% (56.81%), and 9.91% (13.06%), respectively. An increasing rate of NCDs (diabetes, heart disease, stroke, and memory-related disease) among participants were found with the ascending of BP level. After adjusted for demographics and behavioral risks, the following 3 NCDs had been shown to correlate with hypertension: diabetes (adjusted OR 1.15, 0.91–1.45 for elevated BP; 1.20, 0.97–1.49 for hypertension stage 1; 1.55, 1.28–1.86 hypertension stage 2), heart disease (0.94, 0.79–1.12; 1.05, 0.90–1.22; 1.28, 1.12–1.47), and stroke (1.77, 1.25–2.51; 1.32, 0.93–1.87; 1.85, 1.37–2.49).

Conclusions

The association between hypertension and the risk of NCDs is of concern in China. The combined efforts on NCDs prevention and lowered blood pressure should be made by nationally integrated strategies, especially in middle-aged and older adults.