title: The Burden of Hypertension and Associated Risk for Cardiovascular Mortality in China.
abstract: OBJECTIVE
  Hypertension is a leading cause of premature death in China, but limited evidence is available on the prevalence and management of hypertension and its effect on mortality from cardiovascular disease (CVD).
  
  
  OBJECTIVE
  To examine the prevalence, diagnosis, treatment, and control of hypertension and to assess the CVD mortality attributable to hypertension in China.
  
  
  METHODS
  This prospective cohort study (China Kadoorie Biobank Study) recruited 500 223 adults, aged 35 to 74 years, from the general population in China. Blood pressure (BP) measurements were recorded as part of the baseline survey from June 25, 2004, to August 5, 2009, and 7028 deaths due to CVD were recorded before January 1, 2014 (mean duration of follow-up: 7.2 years). Data were analyzed from June 9, 2014, to July 17, 2015.
  
  
  METHODS
  Prevalence and diagnosis of hypertension (systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg, or receiving treatment for hypertension) and treatment and control rates overall and in various population subgroups.
  
  
  METHODS
  Cox regression analysis yielded age- and sex-specific rate ratios for deaths due to CVD comparing participants with and without uncontrolled hypertension, which were used to estimate the number of CVD deaths attributable to hypertension.
  
  
  RESULTS
  The cohort included 205 167 men (41.0%) and 295 056 women (59.0%) with a mean (SD) age of 52 (10) years for both sexes. Overall, 32.5% of participants had hypertension; the prevalence increased with age (from 12.6% at 35-39 years of age to 58.4% at 70-74 years of age) and varied substantially by region (range, 22.7%-40.7%). Of those with hypertension, 30.5% had received a diagnosis from a physician; of those with a diagnosis of hypertension, 46.4% were being treated; and of those treated, 29.6% had their hypertension controlled (ie, systolic BP <140 mm Hg; diastolic BP <90 mm Hg), resulting in an overall control rate of 4.2%. Even among patients with hypertension and prior CVD, only 13.0% had their hypertension controlled. Uncontrolled hypertension was associated with relative risks for CVD mortality of 4.1 (95% CI, 3.7-4.6), 2.6 (95% CI, 2.4-2.9) and 1.9 (95% CI, 1.8-2.0) at ages 35 to 59, 60 to 69, and 70 to 79 years, respectively, and accounted for about one-third of deaths due to CVD (approximately 750 000) at 35 to 79 years of age in 2010.
  
  
  CONCLUSIONS
  About one-third of Chinese adults in this national cohort population had hypertension. The levels of diagnosis, treatment, and control were much lower than in Western populations, and were associated with significant excess mortality.
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lewington
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Ben
authors.initials: B
authors.lastname: Lacey
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Robert
authors.initials: R
authors.lastname: Clarke
authors.affiliation: Department of Epidemiology, School of Public Health, Peking University Health Science Centre, Beijing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Xiang Ling
authors.initials: XL
authors.lastname: Kong
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Ling
authors.initials: L
authors.lastname: Yang
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Yiping
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Epidemiology, School of Public Health, Peking University Health Science Centre, Beijing, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Bian
authors.affiliation: China National Centre for Food Safety Risk Assessment, Chaoyang District, Beijing, China.
authors.forename: Junshi
authors.initials: J
authors.lastname: Chen
authors.affiliation: Liuzhou Centre for Disease Control, Liuzhou, China.
authors.forename: Jinhuai
authors.initials: J
authors.lastname: Meng
authors.affiliation: Liuyang Centre for Disease Control, Baiyikengdao, Liuyang, China.
authors.forename: Youping
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: Huixian Centre for Disease Control, Huixian, China.
authors.forename: Tianyou
authors.initials: T
authors.lastname: He
authors.affiliation: Qingdao Centre for Disease Control, Qingdao, China.
authors.forename: Zengchang
authors.initials: Z
authors.lastname: Pang
authors.affiliation: Suzhou Centre for Disease Control, Jiangsu, China.
authors.forename: Shuo
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Rory
authors.initials: R
authors.lastname: Collins
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Richard
authors.initials: R
authors.lastname: Peto
authors.affiliation: Department of Epidemiology, School of Public Health, Peking University Health Science Centre, Beijing, China9Head Office, Chinese Academy of Medical Science, Beijing, China.
authors.forename: Liming
authors.initials: L
authors.lastname: Li
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Zhengming
authors.initials: Z
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000401:mortality*; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents