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Metabolic syndrome (MetS) is associated with cardiovascular risk, and there are various definitions, but which is most predictive of future cardiovascular disease (CVD) in the Chinese population is still unclear. MetS was defined with the revised ATP III (Third Adult Treatment Panel Report), International Diabetes Federation (IDF), and the Joint Committee for Developing Chinese Guidelines (JCDCG) definitions. Cox regression was used to estimate the hazard risk of cardiovascular disease among 20,888 participants using the Chinese Hypertension Survey (CHS) data. Sensitivity, specificity, and receiver operating characteristic (ROC) curve distance were used to test the ability of three MetS criteria to identify CVD. During an average follow-up of 4.89 years of 20,888 participants, 925 CVD events occurred (stroke, 560; coronary heart disease, 275; and other cardiovascular events, 119). The revised ATP III criteria identified the most individuals with MetS and had the highest prevalence of MetS. In addition, MetS was associated with a high risk of CVD in both men and women, according to three criteria. The highest diagnostic specificity was for IDF in men and JCDCG in women. The revised ATP III criteria had the highest sensitivity and shortest ROC curve distance in both men and women. Although the MetS definitions, including the revised ATP III, IDF, and JCDCG, are all related to the increased risks of CVD, overall, the revised ATP III performs best and is the most recommended for the Chinese population. [ABSTRACT FROM AUTHOR]

This study intended to compare the prevalence of hypertension in adolescents aged 15–17 years in China according to different criteria defined by various guidelines. We included 28 715 adolescents aged 15–17 years from the China Hypertension Survey study (CHS) 2012–2015, and the 2017 American Association of Pediatrics (AAP) Clinical Practice Guideline and 2018 Chinese guidelines for children and adults were used to define hypertension. The prevalence of hypertension among Chinese adolescents aged 15–17 years was 24.4% according to the 2018 Chinese guidelines for children; the corresponding values were 18.6% according to the 2017 AAP Guidelines, and 3.5% according to 2018 Chinese guidelines for adults. The age‐specific prevalence of hypertension in the age of 15, 16, and 17 years in the same population was 26.2%, 24.4%, and 23.3% according to 2018 Chinese guidelines for children; 18.8%, 17.9%, and 19.2% as per the 2017 AAP Guidelines; 3.4%, 3.4%, and 3.6% as per the 2018 Chinese guidelines for adults. A highest prevalence of hypertension was observed according to 2018 Chinese guidelines for children than the other two guidelines. Compared with the 2018 Chinese guidelines for children, a higher 95th percentile BP (systolic and diastolic) was also observed in the present study in each gender‐age‐height‐specific group. And the height, which was key factor to influence blood pressure, was similar between adolescents aged 15–17 and adults, and a paralleled result was seen in the present study. Therefore, the 2018 Chinese guidelines for adults may also be appropriate for adolescents aged 15–17 years. [ABSTRACT FROM AUTHOR]

Obesity has become a global health public problem. The study aims to examine the latest prevalence of overweight and obesity in China. Data came from the China Hypertension Survey (CHS), a nationally representative cross-sectional study among residents aged ≥18 years from October 2012 to December 2015. Overweight and obesity were defined as 25 ≤ BMI < 30 kg/m2 and BMI ≥ 30 kg/m2 according to the WHO classifications, respectively. The data of 441 306 participants were analyzed. The prevalence of overweight and obesity was 28.1% and 5.2% respectively. The prevalence of overweight and obesity varied considerably across provinces. The prevalence of overweight was the highest in Beijing, which was 2.8 fold of the lowest in Guangxi (40.9% vs. 14.6%). The prevalence of obesity was the highest in Tianjin, which was 9.4 fold of the lowest in Hainan (12.2% vs. 1.3%). There was a striking north-south gradient with the prevalence higher in Northeast and Northwest China and lower in Southeast China. Multivariate logistic regression analysis indicated that sex, age, education, smoking, marital status and family history of cardiovascular disease were significantly associated with overweight and obesity. Overweight and obesity are highly prevalent among Chinese adults, and their prevalence varies greatly among different population subgroups and provinces. National and provincial obesity control and prevention strategies should be public health priorities in China. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a major health burden worldwide. However, there is no nationwide epidemiological data on HF in China after 2000. The aims of this study are (i) to determine the prevalence of left ventricular (LV) dysfunction and HF (with reduced, mid-range, and preserved ejection fraction) in a nationally representative Chinese population, and (ii) to investigate the treatment and control of hypertension in HF patients.Methods and Results: Data from the China Hypertension Survey (CHS) and 22 158 participants were eligible for analysis in this study. For each participant, a self-reported history of HF and any other cardiovascular diseases was acquired. Two-dimensional and Doppler echocardiography was used to assess LV dysfunction. Overall, 1.3% (estimated 13.7 million) of the Chinese adult population aged ≥35 years had HF, 1.4% of participants had LV systolic dysfunction (ejection fraction <50%), and 2.7% were graded as having 'moderate' or 'severe' LV diastolic dysfunction. The weighted prevalence of HF was similar between urban and rural residents (1.6% vs. 1.1%, P = 0.266), and between men and women (1.4% vs. 1.2%, P = 0.632). In addition, among HF patients with hypertension, 57.7% received antihypertensive medication, and 14.5% had their blood pressure controlled <140/90 mmHg.Conclusions: In summary, there was an increase in the prevalence of HF, and LV dysfunction was very common in China. However, treatment and control of hypertension in participants with HF were low.Clinical Trial Registration Number: ChiCTR-ECS-14004641. [ABSTRACT FROM AUTHOR]

The 2017 guidelines on the diagnosis and treatment of high blood pressure in adults were published by the American College of Cardiology and the American Heart Association. The impact on clinical outcomes and costs needs to be estimated prior to adopting these guidelines in China. Data from a nationally representative sample in China were analyzed. The prevalence and treatment were calculated based on the criteria of the 2017 guidelines and 2018 Chinese guidelines among participants aged ≥35 years old. Direct medical costs, as well as the averted disability adjusted of life years and cost saving from cardiovascular disease events prevented by controlling hypertension, were also estimated. The prevalence and treatment rate of hypertension were 32.0% and 43.4% according to the 2018 Chinese guidelines. Based on the 2017 guidelines, another 24.5% of the adult population (estimated 168.1 million) would be classified as having hypertension; of whom, about 32.1 million would need to be pharmaceutically treated to reach the current treatment rate of 43.4%. As a result, an estimated additional 42.7 billion US dollars  of the direct medical cost would be required for lifetime therapy. By preventing cardiovascular events, the new guidelines would reduce lifetime costs by 3.77 billion US dollars, while preventing 1.41 million disability adjusted of life years lost. Application of the 2017 guidelines in China will substantially increase the prevalence of hypertension and produce a large increase in therapy costs, although it would prevent cardiovascular disease events and save disability adjusted of life years. [ABSTRACT FROM AUTHOR]

Background: Although the prevalence of hypertension (HTN) continues to increase in developing countries, including China, recent data are lacking. A nationwide survey was conducted from October 2012 to December 2015 to assess the prevalence of HTN in China.Methods: A stratified multistage random sampling method was used to obtain a nationally representative sample of 451 755 residents ≥18 years of age from 31 provinces in mainland China from October 2012 to December 2015. Blood pressure (BP) was measured after resting for 5 minutes by trained staff using a validated oscillometric BP monitor. HTN was defined as systolic BP (SBP) ≥140 mm Hg/or diastolic BP (DBP) ≥90 mm Hg or use of antihypertensive medication within 2 weeks. Pre-HTN was defined as SBP 120 to 139 mm Hg and DBP 80 to 89 mm Hg without antihypertensive medication. HTN control was defined as SBP <140 mm Hg and DBP<90 mm Hg. In addition, the prevalence of HTN (SBP ≥130 or DBP ≥80 mm Hg) and control rate (SBP <130 and DBP <80 mm Hg) of HTN were also estimated according to the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline.Results: Overall, 23.2% (≈244.5 million) of the Chinese adult population ≥18 years of age had HTN, and another 41.3% (≈435.3 million) had pre-HTN according to the Chinese guideline. There were no significant differences of HTN prevalence between urban and rural residents (23.4% versus 23.1%, P=0.819). Among individuals with HTN, 46.9% were aware of their condition, 40.7% were taking prescribed antihypertensive medications, and 15.3% had controlled HTN. Calcium channel blockers were the most commonly used antihypertensive medication (46.5%) as monotherapy, and 31.7% of treated hypertensive patients used ≥2 medications. The prevalence of HTN based on the 2017 American College of Cardiology/American Heart Association guideline was twice as high as that based on 2010 Chinese guideline (46.4%), whereas the control rate fell to 3.0%.Conclusions: In China, there is a high prevalence of HTN and pre-HTN, and awareness, treatment, and control of HTN were low. Management of medical therapy for HTN needs to improve. [ABSTRACT FROM AUTHOR]

We assessed the relationship between alcohol consumption and serum lipids in a middle-aged Chinese population. The overall prevalence of drinking among 10 154 participants was 34.07% in males and 3.61% in females. Heavy alcohol drinkers (≥ 30 g/d) tended to be older, smokers, hypertensive, do heavy physical activity, and have a lower body mass index. Levels of high-density lipoprotein cholesterol (HDL-C), apolipoprotein (apo) A1, low-density lipoprotein cholesterol–HDL-C ratio, and apo B–apo A1 ratio rose with increase in alcohol intake in males. An increase of 0.27 mmol/L in triglycerides and a decrease of 2.10 mg/dL in lipoprotein(a), Lp(a), were observed in male alcohol drinkers who consumed ≥30 g alcohol/d compared with abstainers after controlling for all confounders. Levels of total cholesterol, HDL-C, and apo A1 increased with increase in alcohol intake in both genders and Lp(a) decreased with the increase in alcohol intake in males. [ABSTRACT FROM AUTHOR]

BACKGROUND Blood pressure (BP) control in China is generally poor. It is assumed that an important cause of this unsatisfactory situation is the present standard of care provided by primary care physicians. METHODS One thousand community health centers (CHCs) were selected across China based on geographical location, previous cooperative experience, and acceptance of an invitation to implement a standardized protocol of community-based BP management. Baseline information for each hypertensive patient under the care of these CHCs was collected, and the present pattern of hypertensive drug treatment was analyzed. RESULTS Of all identified hypertensive patients (n = 249,830), 37% were treated with drugs. Characteristics linked with hypertension treatment included systolic BP, age, sex, region, smoking and alcohol consumption status, body mass index, comorbidities, and family history. The most frequently prescribed classes of antihypertensive drugs were diuretics (56.0%), followed by centrally active drugs (CADs) (38.3%), calcium channel blockers (CCBs) (36.8%), vasodilators (26.5%), and angiotensin-converting enzyme inhibitors (ACEIs) (23.3%). In regards to drug combination patterns, diuretics plus CADs was the most frequently used 2-drug combination (61.4%) and vasodilators plus CADs plus diuretics was the most frequently used 3-drug therapy (69.2%). Seventy-seven percent of patients on combination therapy were prescribed single pill combinations, 87.2% of which were composed of CADs and vasodilators and 12.8% of which were composed of ACEIs and diuretics. The control rates of patients on monotherapy and combination therapy were 27.7% and 24.1% (P < 0.05), respectively. CONCLUSIONS Our study identified major shortcomings in the present status of antihypertensive pharmacotherapy in routine medical practice in China. It is essential to implement a program of professional education regarding the appropriate use of antihypertensive drugs. [ABSTRACT FROM PUBLISHER]

We investigated the prevalence, awareness, treatment, and control of hypertension and the related risk factors among Chinese working population. From 2012 to 2013, a total of 37,856 employees aged 18–60 years from 61 workplaces were sampled. Standard questionnaire surveys and physical examinations were undertaken. Multilevel logistic regression models were performed to identify the risk factors. Overall, the age-standardized prevalence of hypertension was 23.3% (95% confidence interval [CI]: 22.9%–23.7%). Among the hypertensives, 47.8% (95% CI: 46.8%–48.8%) were aware of their condition, 20.6% (95% CI: 19.8%–21.4%) were in treatment, but only 8.5% (95% CI: 7.9%–9.1%) had controlled hypertension. White-collar employees had a lower odds of hypertension compared with the blue-collar (odds ratio: 0.77, 95% CI: 0.71–0.84), whereas the state-owned enterprise employees had a higher odds compared with their private enterprise counterparts (odds ratio: 1.69, 95% CI: 1.07–2.65). Lower awareness and treatment were associated with being younger, higher education, and those from workplace without affiliated hospital. Higher occupation status individuals were more likely to be treated but no sign of better control. There is substantial room for improvement in hypertension diagnosis and treatment among the employees. Effective intervention programs are urgently needed at the workplaces. [ABSTRACT FROM AUTHOR]

To evaluate the accuracy of the Omron HBP-1300, an automatic device for blood pressure (BP) measurement, compared with the standard auscultatory method with a mercury sphygmomanometer, we conducted a large population-based survey. From 2012 to 2015, a total of 500,000 participants were randomly selected from the 262 urban cities and rural counties in China, of them BP was measured three times simultaneously with mercury sphygmomanometer and Omron HBP-1300 in 37,816 participants. Bias was estimated as the average of the auscultatory measurements minus the average of the oscillometric measurements, with its corresponding 95% limits of agreement. The Association for the Advancement of Medical Instrumentation standards and British Hypertension Society protocols were used to evaluate the accuracy of the oscillometric device. The results showed that the Omron underestimated systolic BP by 1.0 mm Hg (95% limits of agreement: −9.2, 11.2) and underestimated diastolic BP by 0.2 mm Hg (95% limits of agreement: −8.5, 8.1). The bias in systolic BP values was related to heart rate, systolic BP, and pulse pressure level, while the bias in diastolic BP was related to the heart rate and pulse pressure level. Omron HBP-1300 passed the Association for the Advancement of Medical Instrumentation standards and British Hypertension Society protocol requirements. The sensitivity and specificity of the Omron HBP-1300 to detect hypertension were 86.2% and 98.0%, respectively. Our results showed that the Omron HBP-1300 could be used for measuring BP in large epidemiology studies. The bias of BP measurement was related to the age, systolic BP, and pulse pressure level. [ABSTRACT FROM AUTHOR]

Abstract Background Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic vascular morbidity after coronary heart disease and stroke. Epidemiology data of PAD is very limited in low-income and middle-income countries. A national wide survey was conducted from October 2012 to December 2015 to assess the prevalence of PAD in China. Methods Data from the China Hypertension Survey (CHS). In total, 56,000 people aged 35 years or older were enrolled in this sub-survey for PAD, and 30,025 participants were eligible for analysis. Ankle-brachial index was measured using an automated ABI device (WatchBP Office device Microlife, China). PAD was defined by ABI and Edinburgh Claudication Questionnaire. Results and conclusions Overall, 6.6% (estimated 45.3 million) of the Chinese adult population age 35 years or older had PAD. The weighted prevalence of PAD increased significantly after aged ≥75 years. There were no significant differences in PAD prevalence between urban and rural residents, as well as between males and females. Among individuals with PAD, only 4.9% (95% CI: 0%–10.1%) were aware of their condition, 1.9% (95% CI: 0%–4.0%) received revascularization, and 0.2% (95% CI: 0%–0.4%) achieved ABI >0.9. Older age, Han population, current smokers, education level, hypertension, CAD, diabetes, dyslipidemia, and rural residences all were significantly associated with an increased risk of PAD. In China, there is an increasing prevalence of PAD, but the awareness, treatment, and control were very low. Special attention should be paid to prevent and control PAD in China. Clinical trial registration number: ChiCTR-ECS-14004641. Highlights • Overall, 6.6% (estimated 45.3 million) of the Chinese adult population age 35 years or older had PAD. • The weighted prevalence of PAD increased significantly after aged ≥75 years. • Among individuals with PAD, 4.9% were aware of their condition, 1.9% received revascularization, and 0.2% achieved ABI >0.9. • Older age, Han population, current smokers, education level, and rural residences can increase the risk of PAD. [ABSTRACT FROM AUTHOR]