ArticlesPremature deaths attributable to blood pressure in China: a prospective cohort study
Introduction
Hypertension is a major public-health challenge worldwide because of its high prevalence and concomitant risks of cardiovascular disease.1, 2 An estimated 972 million adults, or 26·4% of the world's adult population, had hypertension in 2000.1 The number of adults with hypertension in 2025 is predicted to increase by 60% to 1·56 billion.1 This number, however, does not include prehypertension, which is also associated with increased risk of cardiovascular disease.3, 4 Several national surveys report that more than 30% of the general adult population has prehypertension.5, 6, 7
Prospective cohort studies have established a strong, graded, and independent positive association between blood pressure and risk of cardiovascular disease and premature death.8, 9, 10 Clinical trials have documented that lowering of blood pressure reduces cardiovascular mortality in patients with hypertension.10, 11 The number of blood-pressure-attributable deaths, however, has not been rigorously estimated in the general population. We aim to estimate the population-attributable risk and number of blood-pressure-attributable deaths in China in 2005, using data from a large prospective cohort study in a nationally representative sample of Chinese adults. Accurate estimates of the contribution of major risk factors to premature mortality are essential for development of policy to improve population health. These estimates can elucidate the potential for prevention and provide an evidence base for rational planning of health services, especially in economically developing countries where health-care resources are scarce and the blood-pressure-related disease burden is substantial.2, 12
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Study population
In the 1991 China National Hypertension Survey, a multistage random cluster sampling design was used to select a nationally representative sample of the general population aged 15 years or older from all 30 provinces, autonomous regions, and municipalities of mainland China.13 The overall response rate was 89·5%. In 1999–2000, investigators from each province were invited to participate in the China National Hypertension Survey Epidemiology Follow-up Study. Of the 30 provinces, 13 were not
Results
Baseline characteristics of study participants from the 17 provinces included in the follow-up study were similar to those in the 13 excluded provinces. Mean baseline ages were 55·8 and 55·2 years; 49·2% and 48·3% were men; 24·0% and 23·2% had a high-school education; 19·8% and 18·8% were alcohol drinkers; 36·7% and 36·1% were physically inactive; 37·9% and 36·7% had ever smoked cigarettes; and 27·7% and 26·5% had hypertension in participants included and excluded from the follow-up study,
Discussion
Our results show that raised blood pressure is the leading preventable risk factor for premature deaths in China. We estimated that roughly 2·11 million cardiovascular deaths were attributable to hypertension in Chinese adults aged 40 years or older in 2005. Additionally, 0·22 million cardiovascular deaths were attributable to prehypertension. Of all cardiovascular deaths, 1·15 million related to hypertension and 0·12 million related to prehypertension were premature, of which more than 80%
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