Use of medications and lifestyles of hypertensive patients with high risk of cardiovascular disease in rural China.
BACKGROUND
Hypertension, with a global prevalence of 40%, is a risk factor for cardiovascular diseases (CVD). We conducted an exploratory study in Zhejiang China to understand the prevention of CVD among hypertensive patients with a 10 year CVD risk of 20% or higher. We assessed current practices in a rural 'township hospital' (a primary care facility), and compared them with international evidence-based practice.


METHODS
A questionnaire survey was conducted to examine the use of modern drugs (antihypertensive drugs, statins and aspirin) and traditional drugs, compliance to medications and lifestyle among 274 hypertensive patients aged 40-74, with a CVD risk of 20% or higher (using the Asian Equation).


RESULTS
The majority (72%) were diagnosed with hypertension at township hospitals. Only 15% of study participants used two anti-hypertensive drugs, 0.7% took statin and 2.9% aspirin. Only 2.9% combined two types of modern drugs, while 0.4% combined three types (antihypertensives, statins and aspirin). Herbal compounds, sometimes with internationally rarely recommended drugs such as Reserpine were taken by 44%. Analysis of drug adherence showed that 9.8% had discontinued their drug therapy by themselves. 16% had missed doses and these were on less anti-hypertensive drugs than those who did not (t=-5.217, P=0.003). Of all participants, 28% currently smoked, 39% drank regularly and only 21% exercised frequently. The average salt intake per day was 7.1 (±3.8) g, while the national recommended level is 6g.


CONCLUSIONS
The study revealed outdated and inadequate treatment and health education for hypertensive patients, especially for those who have high risk scores for CVD. There is a need to review the community-based guidelines for hypertension management. Health providers and patients should make a transition from solely treating hypertension, towards prevention of CVD. Health system issues need addressing including improving rural health insurance cover and primary care doctors' capacity to manage chronic disease patients.
COMDIS Health Services Delivery Research Program, China Program, University of Leeds, Shenzhen, China.
Guanyang
G
Zou
COMDIS Health Services Delivery Research Program, China Program, University of Leeds, Shenzhen, China.
Zhitong
Z
Zhang
Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom.
John
J
Walley
Zhejiang Centre for Disease Control and Prevention, Hangzhou, China.
Weiwei
W
Gong
Schoo of Public Health, Zhejiang University, Hangzhou, China.
Yunxian
Y
Yu
Zhejiang Centre for Disease Control and Prevention, Hangzhou, China.
Ruying
R
Hu
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.
Jia
J
Yin
Zhejiang Centre for Disease Control and Prevention, Hangzhou, China.
Min
M
Yu
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.
Xiaolin
X
Wei
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002681:China / Q000453:epidemiology; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012307:Risk Factors
D000959:Antihypertensive Agents