Hypertension is a prevalent risk factor associated with negative outcomes, responsible for over 10 million deaths worldwide per year. Evidence indicates that control of hypertension leads to reductions in cardiovascular events and death. The prevalence of hypertension has declined in recent years owing to its improved treatment and control in several high-income countries. Within China specifically, large nationwide initiatives have started for further control of hypertension, but unfortunately, there is a paucity of high-quality evidence regarding the burden of hypertension in China. This retrospective study examined trends in the prevalence and number of adults with hypertension as well as awareness, treatment, and control of hypertension. Outcomes studied included presence, awareness, treatment, and control of hypertension. Data was collected from six rounds of the China Chronic Disease and Risk Factor Surveillance (CCDRFS) survey. Overall, 642 523 community-dwelling adults were included in the study from 2004 – 2018. The prevalence of hypertension increased from 24.9% (95% CI 24.4% – 25.3%) to 38.1% (37.8% – 38.3%) during the 2004 – 2018 study period. Trends in prevalence were similar in urban and rural areas for both sexes. From 2004 – 2018, hypertension awareness increased from 30.8% (28.0% – 33.6%) to 38.3% (36.3% – 40.4%), treatment rose from 25.9% (23.5% – 28.4%) to 34.6% (32.6% – 36.7%), and control rose from 7.1% (6.0% – 8.2%) to 12% (10.6% –13.4%), all of which were statistically significant (P<.001). Annual changes in awareness and treatment were higher in rural areas than in urban areas yet control in urban areas increased at a higher pace than in rural areas, though without statistical significance. Both sexes had higher awareness, treatment, and control of hypertension in urban areas than in rural areas. Overall, this study found that the prevalence of hypertension decreased overall from 2004 – 2018, and awareness, treatment, and control remained low throughout the study period. In addition, inequalities between rural and urban areas persisted with respect to the prevalence, awareness, treatment, and control of hypertension. A limitation of this study is the survey format, and non-response may lead to non-response bias affecting the results of this study. This study is an important first step to evaluate the current steps being taken to decrease the prevalence of hypertension and for future steps to identify and address the causes of this low hypertension awareness, treatment, and control.
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