The Impact of Hypertension Definition Based on Two-visit Strategy on Estimate of Hypertension Burden: Results From the China Health and Nutrition Survey 1989–2011

Abstract

Background: The diagnosis of hypertension should be based on the mean of two or more properly measured BP readings on each of two visits for clinical practice, but a one-visit strategy was applied in most epidemiological surveys. The impact of hypertension definition based on two visits on estimates of hypertension burden is unknown. This study aims to assess the impact of hypertension diagnosis based on a two-visit strategy for estimating hypertension burden in China. Methods: The one-visit and two-visit strategies were applied to investigate the incidence of hypertension in a cohort study based on the China Health and Nutrition Survey (CHNS) 1989-2011. Additionally the prevalence of hypertension was investigated in a cross-sectional study based on the CHNS 2006-2009=2011 and the hypertension burden in China was estimated with data from the 2012-2015 China hypertension survey. Results: Overall, the age-adjusted incidence of hypertension based on the two-visit strategy (1.82%; 95% confidence interval [CI], 1.74-1.90%) was 62.1% lower than estimation based on the one-visit strategy (4.80%; 95% CI, 4.68-4.93%). Similar results were found in the prevalence of hypertension (one-visit: 18.13% [95% CI, 17.34-18.92%]; two-visit: 9.47% [95% CI, 8.87-10.07%]). When the two-visit strategy was applied to the 2012-2015 China hypertension survey, the hypertension burden was predicted to be overestimated by 25.5-47.8% (based on JNC 7) and 23.5-48.2% (based on the 2017 ACC=AHA). Conclusion: The hypertension burden would decrease from 244.5 million persons to 127.5-182.3 million persons in China if the two-visit strategy was applied.

Trends in Prevalence of Hypertension and Hypertension Phenotypes Among Chinese Children and Adolescents Over Two Decades (1991–2015)

“…Details about the study design of CHNS are available elsewhere ( 18 , 19 ). In brief, CHNS is a longitudinal health and nutrition survey in China, beginning in 1989 and having been continuously conducted every 2 or 4 years.…”

Hypertension Prevalence Based on Blood Pressure Measurements on Two vs. One Visits: A Community-Based Screening Programme and a Narrative Review

“…When a study did not report explicitly the relative difference in the prevalence of hypertension when estimates were based on reading on ≥2 vs. 1 visits, the relative difference was estimated based on the prevalence values indicated in the study (in the tables or figures). Studies that provided only data on systolic BP [ 21 , 22 ], diastolic BP [ 23 , 24 , 25 , 26 ], using a single BP measurement on a particular visit, giving the estimation of hypertension prevalence based on the sole reading on the final visit [ 27 ], having an interval between visits exceeding 2 months [ 12 ] or were not community-based surveys [ 28 , 29 ] were excluded. We also excluded the papers for which only the abstracts were available in the 3 searched library databases [ 30 , 31 , 32 , 33 ].…”

“…In one instance, the results of a potentially suitable study were published in both French [ 34 ] and English [ 35 ] in different journals and we only included the publication in English in our review. We identified 51 studies that seemed to have assessed hypertension prevalence in community survey based on ≥2 vs. 1 visits [ 6 , 10 , 11 , 12 , 15 , 16 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ], and 10 met our inclusion criteria (Table 6).…”

“…A Canadian cross-sectional community survey showed that, while the number of BP readings made at a single visit can influence prevalence estimates (e.g., when the prevalence is based on the average of three readings or the last two of three readings), the prevalence decreased most (by 12% and 17%) when based on BP readings measured again at two or three subsequent visits [ 11 ]. Similarly, the prevalence of hypertension decreased by as much as 48% when BP was measured on a second visit taking place at least 2 years after the first visit in a recent Chinese study, independently of hypertension treatment [ 12 ].…”

Effect of comprehensive psychosomatic promotion in hypertension patients with anxiety and depression based on community

“…The prevalence of hypertension is doomed to increase in the next few decades, due to increase longevity and lifestyle changes. [ 2 ] In addition to the body itself or genetic factors, the psychological factors contribute to occurrence of hypertension. Hypertension caused by long-term depression and anxiety, compromises the quality of life and poor prognosis.…”