Trends and Disparities by Age, Sex, Region, and Socioeconomic Status in Hypertension Prevalence, Awareness, Treatment, and Control in China, 2012-2020

Objective: Hypertension has consistently maintained a high prevalence rate in China, however, comprehensive evidence for recent hypertension trends across specific population subgroups was limited. Our study aimed to examine trends in prevalence, awareness, treatment, and control of hypertension in China. Design and method: Data was derived from two cross-sectional nationally representative surveys, which enrolled 455770 participants aged 18 years or older in the 2012-2015 and 297065 participants in the 2020-2022. Hypertension was defined as a systolic blood pressure >= 140 mmHg, and/or a diastolic blood pressure >= 90 mmHg, and/or taking antihypertensive medication. The main outcome were prevalence of hypertension and awareness, treatment, and control rates for hypertension. We classified regions by socioeconomic status using the human development index (HDI). We also decomposed changes in hypertension prevalence into population growth, shift in population age structure, and changes in age-specific rate. Results: The mean age[SD] were 45.5 (17.6) years in 2012-2015, and 47.9 (18.1) in 2020-2022 in China. The weighted prevalence of hypertension increased from 23.2% (95% confidential interval [95%CI] 22.2%-24.3%) in 2012-2015 to 31.9% (95%CI 30.3%-33.4%) in 2020-2022, with the prevalence among 25-34 years old more than doubling. The gap in hypertension prevalence between urban and rural areas has widened, and the prevalence in rural areas exceeded that in urban areas in 2020-2022. In both surveys, the highest age-standardised prevalence was observed in very-high HDI region, north and northeast China, with the largest increase areas with upper-middle HDI level. In 2020-2022, the awareness, treatment, and control of hypertension were 43.8% (95%CI 41.4%-46.1%), 38.3% (95%CI 36.0%-40.6%), and 13.6% (95%CI 11.9%-15.5%), respectively. Higher age-standardised awareness, treatment, and control rates was observed in high and very-high HDI region in 2020-2022, and improvements were noted in very-low HDI and high HDI region. Nationally, changes in age-specific hypertension prevalence were the primary driver of increased prevalence of hypertension. Conclusions: Hypertension prevalence was still high in China, with an upward trend from 2012 to 2022. Awareness, treatment, and control of hypertension remained low. Findings in this study highlight the necessity for a more targeted strategy in addressing hypertension management.