High Blood Pressure Is Leading Preventable Cause Of Premature Deaths In China, Causing More Than 1 Million Such Deaths Each Year

Main Category: Hypertension
Article Date: 07 Oct 2009 - 2:00 PDT

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High blood pressure (hypertension) causes more than 1 million premature deaths in China, and over 2 million total deaths, making it the leading preventable cause of death in the country. The Chinese government must make prevention and control of hypertension its top public health priority. Primary prevention, including reducing the enormous average daily salt intake and lifestyle modification, will be a vital tool in such efforts. These are the conclusions of an Article published Online First and in an upcoming edition of The Lancet, written by Prof Jiang He, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA, and colleagues.

An estimated 972 million adults, or 26•4% of the world's adult population, had hypertension in 2000. The number of adults with hypertension in 2025 is predicted to increase by 60% to 1•56 billion. This number, however, does not include prehypertension (slightly raised blood pressure that does not qualify as 'full' hypertension). In this study, the authors estimated premature deaths attributable to increased blood pressure in China. A nationally representative sample of around 170,000 Chinese adults aged 40 years and older was studied. Blood pressure and other risk factors were measured at a baseline examination in 1991 and follow-up assessment was done in 1999 - 2000. Premature death was defined as mortality before age 72 years in men and 75 years in women, which were the average life expectancies in China in 2005.

Hypertension and prehypertension were significantly associated with increased all-cause and cardiovascular mortality. In 2005, an estimated 2•3 million cardiovascular deaths were attributable to increased blood pressure in China: 2•1 million in adults with hypertension and 0•2 million in adults with prehypertension. Additionally, 1•3 million premature cardiovascular deaths were attributable to raised blood pressure in China: 1•2 million in adults with hypertension and 0•1 million in adults with prehypertension. Most blood pressure-related deaths were caused by cerebrovascular diseases: (1•9 million total deaths and 1•1 million premature deaths).

The authors say: "Our results show that raised blood pressure is the leading preventable risk factor for premature deaths in China... The enormous mortality burden related to blood pressure that we have documented is striking and unexpected compared with previous estimates."

They highlight that the prevalence of hypertension is high and increasing in the Chinese population, whereas the proportion of awareness, treatment, and control is low. A previous national survey suggested that roughly 153 million Chinese adults aged 18 years or older met criteria for diagnosis of hypertension, of whom only 24% were aware of their condition and 19% were receiving antihypertensive drugs. Worryingly, adequate control of blood pressure (<140/90 mm Hg) was achieved only in 24% of patients receiving treatment - less than 5% of all hypertensive patients.

The authors say: "Dietary sodium intake is very high in China, so lifestyle modification, especially reduction of dietary sodium, should be an effective approach for primary prevention. The enormous burden of mortality attributable to blood pressure calls for a national policy to emphasise prevention and control of hypertension as the top public health priority."

They conclude: "Traditionally, infectious disease prevention and control has been the public health priority. Our results suggest that mortality attributable to blood pressure is the major public health challenge and argue for shifting of public health priority and resources towards prevention and control of hypertension. Prompt action will save millions of lives each year."

In an accompanying Comment, Professor Stephen MacMahon, The George Institute, University of Sydney, Australia, and Professor Lijing Yan, The George Institute China, Peking University Health Science Center, Beijing, China, point out the importance of the recently established Global Alliance for Chronic Disease and the new China Rural Health Initiative in helping China's battle with chronic disease. They underline the importance of the use of cheap intervention packages that can reach all of China, such as reduced sodium cooking salt and low cost treatments including generic antihypertensive drugs.

Link to article

Source
The Lancet

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