Generalisability and potential deaths averted from intensive blood pressure treatment among the elderly population in the US and China: A nationally representative cross-sectional study.

Background: The Systolic Blood Pressure Intervention Trial (SPRINT) from the US and the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial from China have consistently demonstrated clinical benefits from intensive blood pressure (BP) treatment among elderly adults with hypertension. However, we have little data on the generalisability and potential implications of a scale-up of intensive BP treatment to all eligible elderly in the US and China. Methods: We used two nationally representative data sets from China (Health and Retirement Longitudinal Study (CHALRS), 2011-2012) and the US (National Health and Nutrition Examination Survey (NHANES), 2007-2012) and linked them with CHARLS follow-up data (2013) and the National Death Index (1999-2015), respectively. We estimated the percentage, number, and characteristics of elderly (≥60 years old) meeting the STEP and SPRINT eligibility criteria, and deaths that would be prevented or postponed with the implementation of intensive BP treatment. Results: Among the Chinese adults aged 60 years and over, 38.89% (95% confidence interval (CI) = 36.97-40.84) or 85.39 (95% CI = 81.14-89.64) million subjects met the STEP criteria, and 40.90 million (47.90%) adults were not taking antihypertensive medications. In the US, 23.77% (95% CI = 22.32%-25.28) or 12.46 (95% CI = 11.68-13.24) million elderly were eligible for the SPRINT, and 5.78 million (46.36%) were untreated. Overall, 0.07 (95% CI = 0.06-0.08) million deaths in the US and 0.31 (95% CI = 0.25-0.39) in China would be averted annually if intensive BP treatment was implemented, while 120 000 and 680 000 of hypotension cases would be identified yearly inthe US and China, respectively. Conclusions: A substantial percentage of Chinese and the US elderly meet the eligibility criteria for STEP and SPRINT. If intensive BP treatment was adopted, 70 000 and 310 000 deaths would be prevented or postponed yearly in the US and China, respectively.

Hypertension Subtypes, Mortality Risk, and Differential Effects Between Two Hypertension Guidelines.

Aim: To examine which hypertension subtypes are primarily responsible for the difference in the hypertension prevalence and treatment recommendations, and to assess their mortality risk if 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guideline were adopted among Chinese adults. Methods: We used the nationally representative data of China Health and Retirement Longitudinal Study (CHARLS) to estimate the differences in the prevalence of isolated systolic hypertension (ISH), systolic diastolic hypertension (SDH) and isolated diastolic hypertension (IDH) between the 2017 ACC/AHA and the 2018 China Hypertension League (CHL) guidelines. We further assessed their mortality risk using follow-up data from the China Health and Nutrition Survey (CHNS) by the Cox model. Results: The increase from the 2017 ACC/AHA guideline on hypertension prevalence was mostly from SDH (8.64% by CHL to 25.59% by ACC/AHA), followed by IDH (2.42 to 6.93%). However, the difference was minuscule in the proportion of people recommended for antihypertensive treatment among people with IDH (2.42 to 3.34%) or ISH (12.00 to 12.73%). Among 22,184 participants with a median follow-up of 6.14 years from CHNS, attenuated but significant associations were observed between all-cause mortality and SDH (hazard ratio 1.56; 95% CI: 1.36,1.79) and ISH (1.29; 1.03,1.61) by ACC/AHA but null association for IDH (1.15; 0.98,1.35). Conclusion: Adoption of the 2017 ACC/AHA may be applicable to improve the unacceptable hypertension control rate among Chinese adults but with cautions for the drug therapy among millions of subjects with IDH.

Prevalence and Numbers of Diabetes Patients with Elevated BMI in China: Evidence from a Nationally Representative Cross-Sectional Study.

Background: China is facing the challenges of the increasing burden of diabetes and obesity; the prevalence and numbers of diabetes patients with obesity or overweight are still unclear. Methods: Nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS) were used to estimate the prevalence of diabetes patients with elevated BMI, the recommendation rate for antidiabetic medication, the blood glucose control rate, and the corresponding population size. Results: The prevalence of diabetes patients with elevated BMI was 9.18% (95% CI: 7.88, 10.68; representing 31.54 million) in China. More than half of people with diabetes had elevated BMI (overweight or obesity). Among the participants who were not taking antidiabetic medication, 26.15% (95% CI: 18.00, 36.36; representing 3.79 million) were recommended for antidiabetic medication by the 2020 CDS guideline. There were 24.62% (95% CI: 16.88, 34.45; representing 3.64 million) patients, representing 11.13 (95% CI: 9.86, 12.41) million people, with diabetes combined with elevated BMI, taking antidiabetic medication, and still above the goal blood glucose. Conclusions: Our results indicate that diabetes combined with elevated BMI has become a major public health problem in China in people over 45 years of age. Moreover, the prevalence and population size of women are higher than those of men, and the prevalence of people over 65 years old is slightly lower than that of elderly people aged 45-65. The recommended rate of antidiabetic medication and the control rate of blood glucose were high, and prevention and treatment strategies for diabetes combined with elevated BMI are needed.