Supplementary Online Content Lewington S, Lacey B, Clarke R, et al; China Kadoorie Biobank Consortium. The burden of hypertension and associated risk for cardiovascular mortality in China. JAMA Intern Med. Published online March 14, 2016. doi:10.1001/jamainternmed.2016.0190. emethods. Local, ational, and International Ethics Approvals of China Kadoorie Biobank etable 1. Prevalence of Isolated Systolic Hypertension and Isolated Diastolic Hypertension by Age and Sex etable 2. Prevalence of Stage 1 Hypertension and Stage 2 Hypertension, by Age and Sex etable 3. Prevalence, Diagnosis, Treatment and Control of Hypertension, by Age and Sex etable 4. Participants With Diagnosed Hypertension, Treated and Controlled, by Age and Sex etable 5. Proportion of Participants With Treated Hypertension Taking Specific Types of Antihypertensives, by Age and Sex etable 6. Participants With Diagnosed Hypertension, Treated and Controlled, by Selected Characteristics etable 7. Baseline Characteristics by Level of Baseline Systolic Blood Pressure This supplementary material has been provided by the authors to give readers additional information about their work.
emethods. Local, ational, and International Ethics Approvals of China Kadoorie Biobank For the baseline survey and 1st resurvey, ethics approval was obtained from the Chinese Center for Disease Control and Prevention Ethical Review Committee in 2004 and the University of Oxford Tropical Research Ethics Committee in 2005. The Chinese Ministry of Health approved the study at the start in 2004 (including export of plasma samples to Oxford), and also approved the electronic linkage to health insurance records in 2011. For the 2nd resurvey in 2013-14, ethics approval was obtained from the Chinese Academy of Medical Sciences (which is now the formal collaborator of the China Kadoorie Biobank in China) Ethical Review Committee and the University of Oxford Tropical Research Ethics Committee in 2013.
etable 1. Prevalence of Isolated Systolic Hypertension and Isolated Diastolic Hypertension, by Age and Sex Hypertension (%) Isolated systolic Isolated diastolic Both Controlled Age at entry Population, SBP (mmhg): 140 <140 140 < 140 (years) DBP (mmhg): and < 90 and 90 and 90 and < 90 Male 35-39 26 172 6.5 3.1 8.1 0.2 17.9 40-49 59 240 8.2 3.7 12.7 0.7 25.2 50-59 63 725 15.2 2.8 16.5 1.4 35.9 60-69 41 339 29.6 1.2 16.0 2.4 49.2 70-74 14 691 40.1 0.5 12.7 2.8 56.2 Female 35-39 42 222 2.9 1.8 4.0 0.2 8.8 40-49 93 508 8.2 2.1 9.0 0.7 20.0 50-59 93 831 19.7 1.6 13.3 1.7 36.4 60-69 50 434 36.1 0.7 12.6 2.4 51.8 70-74 15 061 46.3 0.5 11.3 2.1 60.2 Both 35-39 68 394 4.4 2.3 5.7 0.2 12.6 40-49 152 748 8.2 2.8 10.5 0.7 22.1 50-59 157 556 17.8 2.1 14.6 1.6 36.1 60-69 91 773 33.3 0.9 14.0 2.4 50.7 70-74 29 752 43.7 0.5 11.9 2.4 58.4 All Overall 500 223 17.3 2.0 11.8 1.4 32.5 Hypertension defined as measured SBP 140 mmhg or measured DBP 90 mmhg or receiving treatment for hypertension. All analyses are standardized for region and, where appropriate, additionally standardized for age and sex.
etable 2. Prevalence of Stage 1 Hypertension and Stage 2 Hypertension, by Age and Sex Hypertension (%) Stage 1 Stage 2 Controlled Age at entry Population, SBP (mmhg): 140-159 160 < 140 (years) DBP (mmhg): or 90-99 or 100 and < 90 Male 35-39 26 172 13.8 3.9 0.2 17.9 40-49 59 240 17.5 7.1 0.7 25.2 50-59 63 725 22.9 11.6 1.4 35.9 60-69 41 339 28.7 18.1 2.4 49.2 70-74 14 691 31.2 22.2 2.8 56.2 Female 35-39 42 222 6.6 2.0 0.2 8.8 40-49 93 508 13.6 5.7 0.7 20.0 50-59 93 831 22.2 12.5 1.7 36.4 60-69 50 434 28.5 20.8 2.4 51.8 70-74 15 061 31.3 26.8 2.1 60.2 Both 35-39 68 394 9.6 2.8 0.2 12.6 40-49 152 748 15.2 6.2 0.7 22.1 50-59 157 556 22.4 12.1 1.6 36.1 60-69 91 773 28.6 19.7 2.4 50.7 70-74 29 752 31.2 24.8 2.4 58.4 All Overall 500 223 20.1 11.0 1.4 32.5 Hypertension defined as measured SBP 140 mmhg or measured DBP 90 mmhg or receiving treatment for hypertension. Stage 1 hypertension and stage 2 hypertension as defined in Seventh Report of the Joint ational Committee on Detection, Evaluation and Treatment of High Blood Pressure (participants classified by higher stage of either SBP or DBP). All analyses are standardized for region and, where appropriate, additionally standardized for age and sex.
etable 3. Prevalence, Diagnosis, Treatment and Control of Hypertension, by Age and Sex Age at entry (years) Male Population, Prevalence of hypertension, % Diagnosed among hypertensives, % Treated among diagnosed, % Among treated, % Controlled Among all hypertensives, % 35-39 26 172 17.9 10.8 39.0 35.4 1.4 40-49 59 240 25.2 18.5 44.6 30.5 2.6 50-59 63 725 35.9 26.8 48.0 30.6 4.0 60-69 41 339 49.2 35.5 49.4 27.9 4.8 70-74 14 691 56.2 36.1 48.7 28.1 4.8 All 205 167 33.7 27.8 48.3 29.5 4.0 Female 35-39 42 222 8.8 15.2 43.8 37.9 2.5 40-49 93 508 20.0 24.4 45.2 33.1 3.7 50-59 93 831 36.4 33.5 47.0 31.9 5.0 60-69 50 434 51.8 38.3 44.8 27.6 4.7 70-74 15 061 60.2 37.9 39.7 23.2 3.5 All 295 056 31.9 32.5 45.1 29.4 4.4 Both 35-39 68 394 12.6 13.3 41.9 37.1 2.0 40-49 152 748 22.1 21.7 45.0 32.3 3.2 50-59 157 556 36.1 30.5 47.4 31.6 4.5 60-69 91 773 50.7 37.0 46.7 27.9 4.7 70-74 29 752 58.4 37.0 43.3 25.4 4.1 Overall 500 223 32.5 30.5 46.4 29.6 4.2
Hypertension defined as measured SBP 140 mmhg or measured DBP 90 mmhg or receiving treatment for hypertension. All analyses are standardized for region and, where appropriate, additionally standardized for age and sex. See etable 4 for numbers of participants in each group.
etable 4. Participants With Diagnosed Hypertension, Treated and Controlled, by Age and Sex Age at entry (years) Male Population, Hypertensives, Diagnosed, Treated, Controlled, 35-39 26 172 4 660 504 201 60 40-49 59 240 15 433 2 840 1 238 386 50-59 63 725 22 916 6 134 2 932 909 60-69 41 339 20 257 7 288 3 645 1 019 70-74 14 691 8 209 3 067 1 525 432 All 205 167 71 475 19 833 9 541 2806 Female 35-39 42 222 3 804 525 234 72 40-49 93 508 18 740 4 396 1 965 621 50-59 93 831 33 982 11 238 5 242 1 647 60-69 50 434 25 640 10 051 4 563 1 303 70-74 15 061 8 853 3 546 1 482 375 All 295 056 91 019 29 756 13 486 4018 Both 35-39 68 394 8 464 1 029 435 132 40-49 152 748 34 173 7 236 3 203 1 007 50-59 157 556 56 898 17 372 8 174 2 556 60-69 91 773 45 897 17 339 8 208 2 322 70-74 29 752 17 062 6 613 3 007 807 Overall 500 223 162 494 49 589 23 027 6 824 Hypertension defined as measured SBP 140 mmhg or measured DBP 90 mmhg or receiving treatment for hypertension.
etable 5. Proportion of Participants With Treated Hypertension Taking Specific Types of Antihypertensives, by Age and Sex % of treated hypertensives % of treated hypertensives (single antihypertensive medication only) Age at entry Treated Calcium Calcium hypertensives, ACE Beta- channel ACE Beta- channel (years) inhibitors blockers blockers Diuretics inhibitors blockers blockers Diuretics Any Male 35-59 4371 37.1 23.8 54.8 5.2 22.7 15.9 38.5 3.5 80.6 60-69 3645 29.8 25.1 60.0 5.0 17.5 15.7 45.1 3.2 81.5 70-74 1525 26.9 26.4 58.0 7.1 16.1 17.9 44.1 5.0 83.1 Female 35-59 7441 31.8 25.1 56.4 5.8 19.6 17.2 42.3 3.7 82.9 60-69 4563 22.5 27.7 59.3 6.5 14.3 19.5 47.3 4.4 85.4 70-74 1482 20.9 28.9 56.2 7.2 14.2 21.7 45.6 5.9 87.5 Both 35-59 11812 33.8 24.6 55.8 5.6 20.7 16.7 40.9 3.6 82.0 60-69 8208 25.7 26.5 59.6 5.8 15.7 17.8 46.3 3.8 83.7 70-74 3007 23.9 27.6 57.1 7.1 15.2 19.8 44.9 5.5 85.3 Overall 23027 29.6 25.7 57.3 5.9 18.2 17.5 43.4 4.0 83.0 Treated hypertensives were defined as those who reported being diagnosed with hypertension by a physician and taking antihypertensive medication at baseline.
etable 6. Participants With Diagnosed Hypertension, Treated and Controlled, by Selected Characteristics Characteristics Participants, Hypertensives, Diagnosed, Treated, Controlled, Region (type) Haikou (U) 28 394 6 871 2 704 1 411 494 Sichuan (R) 54 268 13 286 2 874 1 058 269 Liuzhou (U) 49 379 14 723 6 880 4 462 1 724 Harbin (U) 55 118 17 125 6 110 2 948 919 Hunan (R) 59 651 19 198 6 871 4 150 914 Suzhou (U) 52 591 18 294 5 519 2 040 722 Gansu (R) 46 845 15 112 3 132 1 561 207 Qingdao (U) 35 194 12 043 3 929 1 402 355 Henan (R) 61 655 22 227 5 124 2 803 909 Zhejiang (R) 57 128 23 615 6 446 1 192 311 Annual Household income, <5000 48 551 19 226 4 900 1 918 365 5000-19 999 236 682 74 244 21 854 10 641 2 981 20 000 214 990 69 024 22 835 10 468 3 478 Educational level o formal school 92 657 40 731 11 507 3 352 698 Primary school 162 141 57 447 17 571 8 407 2 147 Middle or high school 217 041 57 195 17 691 9 604 3 301 Technical school or university Prior CVD 28 384 7 121 2 820 1 664 678 o 477 594 149 398 40 154 17 366 5 032 Yes 22 629 13 096 9 435 5 661 1 792 Season b Winter 100 664 39 883 10 399 4 611 921 Spring or Autumn 276 906 92 266 28 499 13 124 3 813 Summer 122 653 30 345 10 691 5 292 2 090 Overall 500 223 162 494 49 589 23 027 6 824 Abbreviations: CVD, cardiovascular disease; R, rural; U, urban. a Defined as measured systolic blood pressure of at least 140 mm Hg, measured diastolic blood pressure of at least 90 mm Hg, or treatment for hypertension. b Season of baseline survey. Winter indicates December to February; spring, March to May; autumn, September to ovember; and summer, June to August.
etable 7. Baseline Characteristics by Level of Baseline Systolic Blood Pressure Systolic blood pressure (mmhg) <120 120-139 140 Mean (SD) SBP, mmhg 110 ( 7) 129 ( 6) 158 (16) Mean (SD) DBP, mmhg 69 ( 7) 78 ( 8) 88 (11) Mean (SD) age, years 48 ( 9) 51 (10) 57 (10) Proportion female, (%) 104 172 (66) 108 523 (55) 82 361 (57) Proportion urban, (%) 78 434 (50) 82 523 (42) 59 719 (41) Household income 20 000 Yuan, (%) 69 175 (44) 85 344 (43) 60 471 (42) Educated to middle school or higher, (%) 92 659 (59) 98 565 (50) 54 201 (37) Current smokers, (%) (males only) 1 35 036 (66) 54 541 (62) 36 215 (57) Alcohol at least weekly, (%) (males only) 1 15 478 (29) 30 257 (34) 22 767 (36) Mean (SD) BMI, kg/m 2 23 ( 3) 24 ( 3) 25 ( 4) Fresh fruit consumed daily, (%) 35 526 (23) 35 488 (18) 22 880 (16) Fresh vegetable consumed daily, (%) 149 080 (95) 187 585 (95) 137 953 (95) Prior CVD, (%) 3 885 ( 2) 7 892 ( 4) 10 852 ( 7) Proportion diabetic, (%) 2 484 ( 2) 5 522 ( 3) 7 879 ( 5) Proportion taking statins, (%) 2 88 (0.1) 279 (0.1) 760 (0.5) Month of baseline survey: April to Sept, (%) 98 156 (62) 97 767 (50) 62 144 (43) 1 In females, overall prevalence of current smokers was 2% (n=7003) and overall prevalence of drinking alcohol at least weekly was 2% (n=6124). 2 In those with prior CVD at baseline, overall prevalence of statin use was 1.4%.