More than one in three Chinese adults has high blood pressure, according to two studies published Thursday in British medical journal The Lancet.
The first paper, published by scientists at Fuwai Hospital in Beijing and Yale-New Haven Hospital in Connecticut, draws on data from a survey of 1.7 million Chinese people between 35 and 75 years of age — the largest national blood pressure survey ever conducted, covering all of the country’s provinces, municipalities, and autonomous regions.
The researchers found that 37 percent of this group had hypertension — a condition the World Health Organization (WHO) describes as “a silent, invisible killer.”
Every year, 9.4 million deaths worldwide can be attributed to hypertension, and almost half of all deaths from heart disease are blood pressure-related. Not monitoring one’s blood pressure brings a greater risk of stroke, which in China accounts for one out of every five deaths, according to Jiang Lixin, a cardiologist at Fuwai Hospital and one of the authors of the study.
“Blood pressure levels in China are increasing,” Jiang said in The Lancet’s press release, citing urbanization and an aging population as key contributors to this trend. Lifestyle factors such as salt consumption, general diet, and obesity also have a considerable impact on blood pressure, she said. On any given day, the average Chinese person consumes double the amount of salt deemed healthy by the WHO.
More worrying than the prevalence of hypertension, however, is the general lack of control: One in 20 Chinese people diagnosed with high blood pressure ends up keeping it at a safe and healthy level, according to the study. Awareness, too, is a concern, as only around 36 percent of people with high blood pressure know it, and fewer still of those who do — just 23 percent — seek treatment.
Demographics to whom these statistics most readily apply include the poor and the poorly educated, while people in rural and western areas of the country — where medical facilities are fewer and farther between — are also less likely to receive treatment, the authors found. Moreover, men tend to be more susceptible to hypertension than women, especially in China, where they are far more likely to smoke cigarettes and drink alcohol.
“The alarmingly low control rate, even among the minority of people who receive treatment, highlights the need for a national strategy on the prevention and treatment of hypertension,” Jiang was quoted as saying.
The second Lancet study, meanwhile, concluded that the lack of “high-value” blood pressure medication — that which is both cheap and effective — in China is yet another factor that could explain the country’s high incidence of hypertension. Only around one-third of the 3,362 health care facilities surveyed for this study carried all four varieties of antihypertensive medication, including beta blockers and diuretics, and one in 12 primary care centers stocked no blood pressure medication at all. In addition, the researchers encountered medical workers who prescribed expensive treatments without any evidence that they were more effective.
The authors of the first study assert that major policy and lifestyle changes are needed, particularly with respect to diet and exercise. Specifically, they call for awareness campaigns, free blood pressure screenings, and a wider distribution of cheap medication.
For its part, the Chinese government has been exploring measures to curb hypertension. In February, for example, the State Council, China’s cabinet, issued a plan for the prevention and treatment of chronic diseases and condition that mentions high blood pressure by name.
And earlier this month, the George Institute for Global Health, a medical research organization affiliated with Peking University in Beijing, launched Action on Salt China, a four-year campaign to reduce the country’s sodium intake, with support from the central government, whose stated goal is to ensure that all people with high blood pressure are registered with clinics or hospitals and receiving proper care by 2030.
“It’s encouraging that the government has already introduced corresponding policies — the serious situation could still be gradually reversed,” said Jiang.
However, not all experts are as optimistic as Jiang. Therese Hesketh and Zhou Xudong of University College London and Zhejiang University, respectively, believe China has not done enough to address what has by now become a deep-seated problem. In a follow-up article published on the same day as the two studies, Hesketh and Zhou describe the situation as especially worrying given that China has prioritized awareness and treatment of high blood pressure for over two decades, albeit with very little to show for its efforts.
The two Lancet studies point to a considerable gap between policy and practice, write Hesketh and Zhou: “It is simple deficiencies in the country’s health system that make a large contribution to the disease burden.”
Editor: David Paulk.
(Header image: A man has his blood pressure taken at the Oriental Sports Center in Shanghai, July 4, 2013. Yang Shenlai for Sixth Tone)