Epidemiological Characteristics of Hypertension in the Elderly in Beijing, China
Epidemiological Characteristics of Hypertension in the Elderly in Beijing, China
Lina Ma 0 1 2
Xiaoling Zhao 0 1 2
Zhe Tang 0 1 2
Yun Li 0 1 2
Fei Sun 0 1 2
Lijun Diao 0 1 2
Gaizhen Ge 0 1 2
Ming Feng 0 1 2
Jieyu Wang 0 1 2
0 Beijing , China
1 Editor: Yoshihiro Kokubo, National Cardiovascular Center Hospital , JAPAN
2 1 Department of Geriatrics, Xuan Wu Hospital, Capital Medical University , Beijing , China , 2 Department of Epidemiology and Social Medicine, Xuan Wu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders , Beijing , China , 3 Department of Emergency, Three Gorges University People's Hospital, The First People's Hospital Of Yichang , Yichang , China
The prevalence rate of hypertension increases significantly with the aging society, and
hypertension is obviously becoming a major health care concern in China. The aim of the
study was to explore the epidemiological characteristics of hypertension in the elderly and
to provide a basis for the prevention of hypertension.
3-cross sectional studies in 2000, 2004, and 2007, respectively.
A group of 2,832, 1,828, and 2,277 elderly residents aged
60 years were included this
study in 2000, 2004, and 2007, respectively.
Statistical sampling techniques included cluster, stratification, and random selection.
Trained staff used a comprehensive geriatric assessment questionnaire and a standard
survey instrument to complete the assessments. During the person-to-person interviews, the
participants’ demographic characteristics, living conditions, and health status were
collected, and their blood pressure was measured.
The prevalence rates (69.2%, 61.9%, and 56.0%) of hypertension and the control rates
(22.6%, 16.7%, and 21.5%) lowered annually, while the awareness rates (43.7%, 55.8%,
and 57.6%) of the treatment elevated annually in 2000, 2004, and 2007, respectively. There
was no increase in the control rates for males (26.2%, 16.7%, and 20.8%), younger
participants (28.0%, 18.4%, and 21.0%), and rural residents (19.5%, 9.6%, and 13.4%) in 2000,
2004, and 2007, respectively.
Our study findings indicated that the prevalence of hypertension is high in rural elderly
participants, while the rates of awareness, treatment, and control were low. This suggests that
effective public measures need to be developed to improve the prevention and control of
Hypertension is the most important risk factor for cardiovascular disease . The prevalence
rate of hypertension increases significantly with the aging society, and the danger of
cardiovascular and cerebrovascular events in elderly patients with hypertension increases more
significantly than that in younger people; thus, the prevention and treatment of hypertension in the
elderly are very important. There are >200 million hypertensive patients in China .
According to the third National Health Services Survey in 2003, the direct economic burden to China
caused by hypertension was 20,150 million yuan, and the economic burden of coronary disease
and stroke caused by hypertension is was up to 19,080 million yuan . According to the
National Nutrition and Health Survey in 2002, the awareness, treatment, and control rates
were 26.8%, 21.3%, and 3.9%, respectively .
Hypertension is a multifactorial disease, and it is related to heredity, diet, environment
pollution, and other factors. The incidence rate of hypertension is increasing annually, and it has
become a serious threat to human health . A British survey of 5,043 patients found that in
elderly people aged 65 years, the prevalence rate of hypertension was 81%, treatment rate was
56%, and control rate was 19%; the control rates were 36% and 30% in males and females,
respectively . In 1991, a national sample survey in China showed that the prevalence rate of
hypertension was 40.4% in those 60 years . In 2002, the prevalence rate of hypertension in
the Liaoning Province was 59% in those aged 65 years; in 2003, the prevalence rate of
hypertension was 80% in those aged 60 years; and in 2005, the prevalence rate of hypertension was
60.2% in those aged 60 years [8–10]. In order to observe the prevalence, awareness,
treatment, and control rates of hypertension in the elderly population in Beijing, China, we
conducted 3-cross sectional surveys in 2000, 2004, and 2007, respectively.
Data for these analyses were obtained from the Beijing Longitudinal Study of Aging [11,12].
The project baseline was based on sample data from the fourth census of Beijing, China.
Sampling was obtained from a city district (the Xuanwu District), an outskirt (the Daxing District),
and an exurb area (the Huairou District) using well-established statistical sampling techniques,
including cluster, stratification, and random selection. The sampling scheme is shown in Fig 1.
2972, 2104 and 2567 individuals were surveyed in the year 2000, 2004 and 2007, and the
participation rate was 95.3%, 86.9% and 88.7%, respectively. The reasons of rejection of participation
were not cooperate with the investigation, go out not at home and so on. This study included
2,832, 1,828, and 2,277 people aged
60 years in communities of Beijing, China in 2000, 2004,
and 2007, respectively. The study was approved by the Xuan Wu Hospital’s Committee on
Ethics of Human Experiments. All study participants provided written informed consent prior to
enrollment. The participant consent was recorded in a file and the ethics committee approved
this consent procedure.
Trained staff completed the questionnaires by using standard survey instruments. During the
person-to-person interviews, data were collected on the participants’ demographic
characteristics, living conditions, and health status, and their blood pressure was measured.
Measurement of blood pressure
The blood pressure of each participant was measured in a quiet environment by trained
doctors. Investigators were trained by the professional staff. The blood pressure was obtained from
the nondominant arm with a mercury sphygmomanometer, which was calibrated regularly
every three months. Two sitting blood pressure readings were taken on the right arm after 5
min of rest. Systolic and diastolic blood pressures were Korotkoff I and V, respectively, and an
average was taken of the two values. The same machines were used in different sites and
different years. The device was calibrated at the beginning of the recording by inducing stepwise
Fig 1. The sampling of research project. Specific approach is divided into three steps. The first step, according to the natural and living environment and
economic level, 18 administrative districts were divided into two categories: City (8 districts) and suburds districts (10 districts, including 5 Outskirts plain
districts and 5 exurds mountain districts). Then from the above two areas, 3 districts (Xuanwu District, Daxing District, Huairou District) were selected in three
districts as representative of middle economic level. The above three districts were composed of 9 streets, 27 towns and 21 towns seperately. The second
step, according to the population aging degree and culture degree, a random sample of 2 streets in Xuanwu District, 2 towns in Daxing District, 1 village in
Huairou District was selected. Several neighborhood committees and villages were randomly selected from the above districts. The third step, in the selected
neighborhood committees and villages, all aged 60 years and older were registered and arranged to several age groups according to age, 60~64 years
group, 65~69 years group, 70~74 years group, 75~79 years old group and 80 ~ group. The number of each age group in identified each town, neighborhood
committee and village was determined according to the distribution proportion of the existing population of Beijing.
changes in pressure from 0 to 200 mm Hg through the device pump, which was connected to a
mercury column . Hypertension was defined as systolic blood pressure (SBP) 140 mm
Hg, diastolic blood pressure (DBP) 90 mm Hg, current treatment with antihypertensive
medication, or a self-reported diagnosis of hypertension. The individuals were screened for a
definitive diagnosis of hypertension depending on whether they were receiving antihypertensive
Evaluation of demographic characteristics of hypertension
Participants who reported that a doctor or another health worker ever told them they had
hypertension were considered aware of their disease, and the awareness rate of hypertensive
was defined as the percentage of patients who knew they had hypertension before the
investigation. The treatment rate was defined as the percentage of those among the hypertensive
patients who were taking antihypertensive drugs in the last two weeks. Participants who were
using antihypertensive medication and who had both SBP and DBP pressure lower than 140/
90 mm Hg were classified as having controlled hypertension,and the control rate was defined
as the percentage of those among the hypertensive patients whose who had controlled
Data quality control
Investigators received unified training. Two reviewers independently evaluated and
crosschecked the questionnaire. The file management method was used to ensure the authenticity
and homogeneity of data. Quality control points in the process of implementation was set up,
and manual check was conducted to ensure the authenticity and integrity of data.
All the statistical analyses, including the χ2 tests, were performed using SPSS, version 11.5
(SPSS, Inc., Chicago, IL, USA). A P value <0.05 was considered statistically significant.
There was a decreasing tendency in the prevalence rate of hypertension in the elderly in Beijing,
and the prevalence rates were 69.2%, 61.9%, and 56% in 2000, 2004, and 2007, respectively.
The awareness and treatment rates of hypertension increased, while the control rate of
hypertension did not improve. In 2007, the prevalence rate of hypertension was 56%, and the
awareness, treatment, and control rates were 57.6%, 56.2%, and 21.5%, respectively, in the elderly
population in Beijing (Table 1).
Prevalence rate [Number (%)]
Awareness rate [Number (%)]
Treatment rate [Number (%)]
Control rate [Number (%)]
The epidemiological characteristics of hypertension in the elderly
according to sex, age, and living condition
The prevalence rate of hypertension in men and women were decreased, and the awareness
and treatment rates were improved; however, the control rate of hypertension did not increase
The patients were divided into two groups according to age: younger (aged <75 years) and
older (>75 years). Our study found that the prevalence rate of hypertension was decreased in
both groups, while the awareness and treatment rates were improved in both groups. The
control rate in the elderly group was increased, while the control rate in the younger group did not
improve (Table 2).
The prevalence rate of hypertension decreased in the rural and city groups, and the
awareness and treatment rates were increased in both groups. The control rate was improved in the
city group; however, it was not improved in the rural group (Table 2).
Our study showed there was a great deal of variability in some of the prevalences between
years, although we used the same way to collect data, the same sampling techniques, the same
trained investigators and the same questionnaires between years, and the standard survey
instruments were used to avoid the variablity. This study showed that the prevalence rate of
hypertension in the elderly decreased annually, which indicates that the prevention of
hypertension was greatly improved. There is a great progress in hypertension health education thses
years in China, and those people who were in the high normal blood pressure can take active
measures to prevent the progress of prehypertensive into hypertension. The popularity of
hypertension prevention knowledge in this community makes it easier to diagnose and treat
the elderly with hypertension in Beijing’s urban and rural areas; thus, the awareness and
treatment rates were significantly improved. In 1991, the ratio of the controlled to treated
individuals was 1:4, and this remained mostly unaltered in 2002 at 1:4.2 ; in our study, the ratio
remained at 1:4.4, 1:5.9, and 1:4.6 in 2000, 2004, and 2007, respectively. Compared with many
other countries, the ratio of the controlled to treated individuals was almost the same (about
1:3); however, it was obviously much lower than that in the United States(about 2:3) [15–18].
The control rate over the 7 years in our study did not significantly increase or even decline, and
the reason may lie in the unstandardized treatment of hypertension and the decreased drug
compliance, which led to the unsatisfactory degree of blood pressure control.
Many factor such as aging in China, genetic, environment, behaviour and ecology of the
medicare on aging and hypertension caused the above phenomenon. China will experience an
enormous increase in the prevalence of cardiovascular-related morbidity and mortality that is
attributable to blood pressure over the next few years . Another study performed in the
Henan Province of China reported that the levels of hypertension awareness, treatment, and
control are low, which indicates that necessary actions such as prevention, detection, and
treatment are necessary to prevent the situation from worsening . Some studies had found
polymorphism of the specific gene was associated with cardiovascular risk factors and may
contribute to susceptibility to cardiovascular disease , while some other studies found there
was no significant association identified between GNB3-C825T polymorphism and EH in Han
Chinese population . Chinese Government has initiated widespread reform , reinforce
health promotion in older adults and improve health services in rural communities . Shao
S attempted to map the medical care ecology of Beijing urban population and provides timely
baseline information for health care reform in China .
Our study indicated that the state of prevention and control of hypertension in the elderly
in Beijing, China is not good, especially in the younger, rural hypertensive population.
Individuals with hypertension have lower quality of life than normotensives in China, even after
controlling for gender and age . This study showed that the control rate did not improve in the
younger group, there are several reasons, some younger patients are young is still at full time or
part time work, and increased mental stress, which lead to poor blood pressure control;
therefore, we should strengthen the health care education for this population, encourage them to
change their life style, monitor their blood pressure, and support regular attendance at
followups. The control rate did not increase in the rural population, which may be due to the
difference between the urban and rural living standards, which include the dietary habits, physical
labor intensity, and mental pressure [26,27]. People in the rural areas may have a lower
education level, lack of health care knowledge, and absence of self-health care consciousness, which
can lead to a low control rate of blood pressure; therefore, we should pay attention to the
prevention and control of hypertension in the rural population.
A limitation of our study was that the sample was restricted to community residents in
Beijing, China. Therefore, our findings are not representative of the overall Chinese population.
The numbers of participant is moderate, not very large, and the study was respective not
continuous. Therefore, a large scale analysis comprising continuous study would be desirable.
Hypertension is a lifelong disease, and long-term treatment is needed; therefore, we should
strengthen the prevention and control of hypertension and health care knowledge in the
Beijing community. It is important to establish health files in the community; make full use of the
health education and health promotion interventions; encourage people to change their
attitude on hypertension; and constantly improve the awareness, treatment, and control rates of
hypertension in order to effectively control hypertension and to reduce the incidence and
mortality of cardiovascular diseases, which will improve the overall health level of this population
S1 File. The data underlying our findings. The file shows all the data included 2,832, 1,828,
60 years in communities of Beijing, China in 2000, 2004, and 2007,
Conceived and designed the experiments: ZT. Performed the experiments: LM XZ FS LD GG.
Analyzed the data: XZ ZT. Contributed reagents/materials/analysis tools: MF YL JW. Wrote
and 2,277 people aged
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