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Impacts of undetected and inadequately treated hypertension on incident stroke in China
  1. Thang S Han1,2,
  2. Harry Hao-Xiang Wang3,4,
  3. Li Wei5,
  4. Yuesong Pan6,
  5. Ying Ma7,
  6. Yu Wang8,
  7. Jiaji Wang9,
  8. Zhi Hu7,
  9. Pankaj Sharma1,2,10,
  10. Ruoling Chen11
  1. 1Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK
  2. 2Department of Endocrinology, Ashford and St Peter’s NHS Foundation Trust, Surrey, UK
  3. 3School of Public Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
  4. 4General Practice and Primary Care, Institute of Health and Wellbeing, Glasgow University, Glasglow, UK
  5. 5Department of Practice and Policy, University College London, London, UK
  6. 6Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  7. 7School of Health Administration, Anhui Medical University, Hefei, China
  8. 8Pojen General Hospital, Taipei, China
  9. 9School of Public Health, Guangzhou Medical University, Guangzhou, China
  10. 10Department of Medicine, Imperial College London NHS Trust, London, UK
  11. 11Centre for Health and Social Care Improvement, Faculty of Education, Health and Wellbeing, Wolverhampton University, Wolverhampton, UK
  1. Correspondence to Dr. Zhi Hu; aywghz{at} and Dr Ruoling Chen; r.chen{at}


Objectives China carries the greatest burden of stroke given its largest volume of people with hypertension. This study assessed the impacts of suboptimal controls of hypertension on incident stroke and projected the number of patients with stroke saved after the control of blood pressure improved in population.

Setting Anhui, China.

Participants We examined data from the Anhui cohort of 2001–2011, consisting of 3336 participants aged ≥60 years who were randomly recruited from the urban and rural Anhui. 2852 participants had hypertensive status measured and no stroke at baseline, and were followed up until 2011 in three surveys using a standard method of interview.

Results At baseline, 1646 participants (57.7%) were identified to have hypertension, among whom 912 (55.4%) were previously undetected, 115 (7.0%) detected but not treated, 452 (27.5%) treated but not controlled and only 127 (7.7%) controlled. During the 10-year follow-up, 211 incident stroke cases (12.8/1000 person-years) occurred. Compared with normotensive individuals at baseline, multivariate adjusted HR for having stroke increased in those with undetected hypertension by 1.63 (95%CI 1.15 to 2.32), untreated by 2.21 (1.26–3.85) and uncontrolled hypertension by 3.34 (2.28–4.88), but did not differ from those with controlled hypertension (1.34; 0.60–2.99). Based on a two-fold increase in the detection and management of current levels of hypertension and algorithms on the current situation in China, approximately 250 000 incident stroke cases could be prevented annually.

Conclusions In China, hypertension is frequently undetected or inadequately treated. With appropriate management of hypertension, a substantial number of people could be saved form stroke.

  • blood pressure
  • cardiovascular risk
  • socioeconomic status
  • health care

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  • Contributors TSH and HH-XW: reviewed the topic related literature and wrote the first draft and revised the manuscript. LW, YP and YW: analysed and interpreted the data. YM: performed the study coordination and data collection. JW: performed the study concept and analysis design. ZH: performed study concept, data collection and study supervision. PS: involved in interpretation of the data and revision of the manuscript. RC: performed the study concept and design, obtained funding and carried out study supervision and revision of the manuscript; guarantor for the study. All authors: checked, interpreted results and approved the final version, contributing to the paper equally.

  • Funding The data collections at baseline and in the follow up of the cohort were funded by the Royal Society, Alzheimer’s Research and BUPA Foundation UK. RC would like to thank an undergraduate fellowship grant from King’s College London, UK to analyse the Anhui cohort data for stroke research.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Ethics Committee of University College London, and School of Health and Wellbeing at University of Wolverhampton, UK and the Research Ethics Committee of Anhui Medical University and the local governments in China.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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