Prevalence, awareness, treatment, and control of hypertension in China: data from 1.7 million adults in a population-based screening study (China PEACE Million Persons Project)-猫眼课题宝

DOI：

10.1016/s0140-6736(17)32478-9

发表时间：

2017-12-09

期刊：

LANCET

影响因子：

168.9

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

Lu, Jiapeng;Lu, Yuan;Jiang, Lixin

背景高血压在中国很常见，患病率呈上升趋势，但仍得不到充分控制。很少有研究能够在许多异质性亚组中对高血压的流行病学和管理进行研究。方法利用2014年9月15日至2017年6月20日中国以患者为中心的心脏事件评估（PEACE）百万人项目的数据，对中国高血压的患病率、知晓率、治疗和控制情况进行研究，并评估其在许多亚人群中的变化。这是一个基于人群的筛查项目，招募了来自中国大陆所有31个省份的约170万名35-75岁的社区成年人。在该人群中，我们将高血压定义为收缩压至少140 mm Hg，或舒张压至少90 mm Hg，或自我报告在过去2周内使用抗高血压药物。在高血压成人中，高血压的知晓、治疗和控制分别定义为自我报告的高血压诊断、当前使用抗高血压药物和血压低于140/90 mm Hg。我们评估了264475个人群亚组的知晓、治疗和控制情况，这些亚组由11个人口统计学和临床因素的所有可能组合先验定义（年龄[35-44岁、45-54岁、55-64岁和65-75岁]、性别[男性和女性]、地理区域[中国西部、中部和东部]、城市[城市vs农村]、民族[汉族和非汉族]，职业[农民和非农民]、家庭年收入[=（原文如此）50 000]、教育[小学及以下、初中、高中和大学及以上]、既往心血管事件[是或否]、当前吸烟者[是或否]和糖尿病[是或否]）及其与个人和初级卫生保健中心特征的关联，使用混合模型。结果-样本包含1 738 886名参与者，平均年龄为55.6岁（SD 9.7），其中59.5%是女性。44.7%（95%CI 44.6-44.8）的样本患有高血压，其中44.7%（446-44.8）知道自己的诊断，30.1%（30.0-30.2）正在服用处方抗高血压药物，7.2%（7.1-7.2）已获得控制。年龄标准化和性别标准化的高血压患病率、知晓率、治疗率和控制率分别为37.2%（37.1-373）、36.0%（35.8-36.2）、22.9%（22.7-23.0）和5.7%（5.6-57）。最常用的药物类别是钙通道阻滞剂（55.2%，55.0-55.4）。在高血压得到治疗但未得到控制的个体中，81.5%（81.3-816）只使用一种药物。知晓自己的高血压并正在接受治疗的参与者比例在不同亚群之间差异显著;知晓和治疗的可能性较低与男性、年龄较小、收入较低、既往无心血管事件、糖尿病、肥胖或饮酒相关（所有P

Background Hypertension is common in China and its prevalence is rising, yet it remains inadequately controlled. Few studies have the capacity to characterise the epidemiology and management of hypertension across many heterogeneous subgroups. We did a study of the prevalence, awareness, treatment, and control of hypertension in China and assessed their variations across many subpopulations.Methods We made use of data generated in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project from Sept 15, 2014, to June 20, 2017, a population-based screening project that enrolled around 1.7 million community-dwelling adults aged 35-75 years from all 31 provinces in mainland China. In this population, we defined hypertension as systolic blood pressure of at least 140 mm Hg, or diastolic blood pressure of at least 90 mm Hg, or self-reported antihypertensive medication use in the previous 2 weeks. Hypertension awareness, treatment, and control were defined, respectively, among hypertensive adults as a self-reported diagnosis of hypertension, current use of antihypertensive medication, and blood pressure of less than 140/90 mm Hg. We assessed awareness, treatment, and control in 264 475 population subgroups-defined a priori by all possible combinations of 11 demographic and clinical factors (age [35-44, 45-54, 55-64, and 65-75 years], sex [men and women], geographical region [western, central, and eastern China], urbanity [urban vs rural], ethnic origin [Han and non-Han], occupation [farmer and non-farmer], annual household income [=(sic)50 000], education [primary school and below, middle school, high school, and college and above], previous cardiovascular events [yes or no], current smoker [yes or no], and diabetes [yes or no]), and their associations with individual and primary health-care site characteristics, using mixed models.Findings The sample contained 1 738 886 participants with a mean age of 55.6 years (SD 9.7), 59.5% of whom were women. 44.7% (95% CI 44.6-44.8) of the sample had hypertension, of whom 44.7% (446-44.8) were aware of their diagnosis, 30.1% (30.0-30.2) were taking prescribed antihypertensive medications, and 7.2% (7.1-7.2) had achieved control. The age-standardised and sex-standardised rates of hypertension prevalence, awareness, treatment, and control were 37.2% (37.1-373), 36.0% (35.8-36.2), 22.9% (22.7-23.0), and 5.7% (5.6-57), respectively. The most commonly used medication class was calcium-channel blockers (55.2%, 55.0-55.4). Among individuals whose hypertension was treated but not controlled, 81.5% (81.3-816) were using only one medication. The proportion of participants who were aware of their hypertension and were receiving treatment varied significantly across subpopulations; lower likelihoods of awareness and treatment were associated with male sex, younger age, lower income, and an absence of previous cardiovascular events, diabetes, obesity, or alcohol use (all p

Prevalence, awareness, treatment, and control of hypertension in China: data from 1.7 million adults in a population-based screening study (China PEACE Million Persons Project)

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