Key result
A two-visit diagnostic strategy yielded a 62.1% lower estimated incidence of hypertension (1.82%) compared to a one-visit strategy (4.80%) among Chinese adults.
Why the study?
Hypertension diagnosis should clinically rely on two visits, but surveys mostly use a one-visit strategy, leaving the impact on estimated burden unknown.
Does a two-visit strategy for diagnosing hypertension reduce the estimated incidence and prevalence of hypertension compared to a one-visit strategy in Chinese adults?
Cohort (n=14,057)
Yes
Does a two-visit strategy for diagnosing hypertension reduce the estimated incidence and prevalence of hypertension compared to a one-visit strategy in Chinese adults?
Applying a two-visit strategy for diagnosing hypertension significantly reduces the estimated incidence and prevalence compared to a one-visit strategy, preventing substantial overestimation of the national hypertension burden.
Answers are grounded in this paper and cite their sources.
May curb overestimation of hypertension burden in Chinese adults; leaves open whether two-visit confirmation improves outcomes before practice change.
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.
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Liu et al. (2020) conducted a cohort in Hypertension (n=14,057). Two-visit strategy for hypertension diagnosis vs. One-visit strategy was evaluated on Age-adjusted incidence of hypertension (62.1% lower). A two-visit diagnostic strategy yielded a 62.1% lower estimated incidence of hypertension (1.82%) compared to a one-visit strategy (4.80%) among Chinese adults.
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