中国筛查和控制高血压脑血管血管危险因素总体控制(2)
Screening and control of hypertension in China
Liu Lisheng
In China, Cardiovascular diseases (CVD) are emerging as the major public health problem. CVD claim about 2.6 million lives each year and cause about 28,369,000 disability adjusted life year (DALY). The data from several cross-sectional nationwide surveys show that levels of risk factors of CVD in the Chinese population has risen significantly over the past 30 years, which has been the basis for the increasing morbidity and mortality of major CVD, including stroke and coronary heart diseases. According to the Third National Survey of Blood Pressure, there were about 100 million hypertensive patients but the awareness rate was 26.3%, the treatment rate was 12.1% and the control rate was only 2.8% for hypertension. The total smoking rate was 63% in men，3.8% in women. Even in male teenagers, smoking rate was 16.7%. It was predicted that there would be 800, 000 deaths related to smoking in 2000. There were significant regional differences in the average levels of serum total cholesterol in China. The average serum cholesterol level is lower compared with most western countries, but China is among the few countries which experience a significant increasing trend for total cholesterol in the population. The challenges for CVD prevention are higher levels of incidence rate and mortality rate of stroke, the increasing incidence rate and mortality of coronary heart disease, the current already huge absolute numbers of people with CVD risk factors and still their increasing trends.(1)
, 百拇医药
In the fall of 1999, WHO and the Global Forum on Health Research jointly launched the Initiative for Cardiovascular Health in the Developing Countries.(2)
The Initiative has adopted blood pressure lowering as its immediate priority, addressing both the population-wide approach and the high-risk approaches. Its initial objectives include development of affordable screening programs, heath education and treatment programs, and evaluation of efficacy, acceptability and cost.
, 百拇医药
In China, blood pressure control is chosen as the immediate target, since it is an important determinant of the CVD and it provides a starting point for wider regional initiatives in CVD control.
In China, National blood pressure surveys were carried out in 1959, 1979 and 1991. The prevalence rate (hypertension defined as SBP 3 140mmHg and /or DBP 3 90mmHg) was 11.19% in 1991, definitely higher than 5.11% in 1959, and 7.73% in 1979.
, http://www.100md.com
Since 1999, opportunistic blood pressure screening was recommended as a more
cost/effective way for identifying hypertensive patients(3).
A total 950,356 participants aged 15 and over were examined in the Third National Survey of Blood Pressure in 1991, with a response rate of 89.49%. Survey items included measurement of blood pressure, pulse rate, height, weight and health knowledge as well as family and personal history of cardiovascular disease (CVD). Measures for quality control involved: (1) Establishment of a steering committee and a technical committee to promote and guarantee the success of the survey; (2)An Operation Manual describing design, implementation, and internationally standardized methods in detail was developed by the Scientific Screening Committee and used by all the survey teams; (3) Multistage cluster samplings were employed and well organized in order to guarantee a good representation of samples for local population. 274 samples were selected from all over the nation (461 cities and 1904 rural counties except Taiwan ). (4) Personnel training was done on two levels; national and local. All the interviewers must obtai
, http://www.100md.com
n a certificate before participating in the survey; (5) Attention was also paid to quality control during the survey. Fifteen groups of specialists and quality control personnel were sent to survey fields in different provinces to monitor the implementation; (6) Time of survey in 1991 was decided according to the local temperature to avoid extremely cold or hot seasons. (7) A program for data input was developed in the Data Management Center and used by all the local centers for data entry. All data were entered two times. With all these quality control measures, a good data set for the whole survey was obtained. Among the 950337 questionniares, only 0.31‰ and 0.74‰ had logic missing data error. Among 939138 (98.82%) blood pressure readinngs, 25.8% had 0, 19.1% had 2, 18.5% had 4, 17.3% had 6, and 19.2% had 8 as terminal digit. Only 0.13% had an odd terminal digit.
, 百拇医药
The results showed that the established hypertension is 5.29%, borderline hypertension 5.90%, and the total prevalence rate was 11.19% in 1991, which was definitely higher than 5.11% in 1959, and 7.73% in 1979. The whole process of the study was characterized by its better design, better organization, better team training and better quality control due to the unified leadership under the Ministry of Public Health, the great combined effort of the local officers, specialists and team workers and the big progress in computer assisted data analysis.
, http://www.100md.com
In 1999 an opportunistic blood pressure screening(4) among 10,000 out-patient clinic subjects was designed to gather data on patients already utilizing the health care system. The objective of this project was to determine the awareness of hypertension, the rate of success of current treatment, and the source of medical information in this patient population. It was found that by focusing on this group of patients, who already had medical access, a preventive medical program could be developed to focus on interventions that would have the largest impact with the least resources required.
, http://www.100md.com
Community-based comprehensive prevention of CVD was implemented in 400,000
people in three urban and one rural communities. From 1992 to 1995 KAB showed a significant improve in the intervention community. There was a lowering in
morbidity and mortality of CVD, by taking measures of hypertension control, health
promotion, dietary cholesterol an sodium restriction (5).
, http://www.100md.com
The community-based comprehensive prevention of CVD study aimed to explore the comprehensive intervention effect on lowering incidence and mortality of CVD in 400, 000 population. Measures included intervention of nutrition, health promotion, management of Hypertensive patients; monitoring the trend of incidence and mortality of CVD, especially in the population aged above 35. Community-based comprehensive prevention was implemented in 400,000 people in three urban communities in Beijing, Shanghai and Changsha respectively, and in one rural community in Fangshan, a Beijing suburb, during the period of "The Eighth Five-Year Plan". Each community population was divided into two parts, an intervention community and a control community demographically and economically comparable. Results: Incidence and mortality of stroke decreased by 21.4% and 33.2%, respectively, in the intervention communities after four years, as compared with those of 6.2% and 24.7%, respectively, in the control communities. Stroke Incid ence and mortality averaged 180.34 and 116.09 per 100,000 respectively in the intervention communities; 203.57 and 135.75 per 100,000 respectively in the control communities during 1992 - 1995. Incidence and mortality of acute myocardial infarction and coronary heart disease was 46.3%, 32.81, respectively, during 1992-1995 in the intervention communities; 59.6%, 44.8% respectively in the control communities. In the intervention community, systolic blood pressure decreased by 2.39 mmHg, the rate of taking medicine among hypertensive patients increased from 15.4 to 26.3%. The total serum Cholesterol decreased by 0.11-0.30 mmol/L. The smoking rate decreased by 0.9 % in urban communities, and 6.6% in rural communities and the dietary sodium intake decreased by 367mg in female population. Knowledge, Attitude and Behavior showed a significant improvement in the intervention community.
, 百拇医药
Only few industries can afford health screen for employees biannually, and
monitoring of CVD, DM as well as cancer events.
Some industries can afford Health Screen for employees biannually. The Qingdao Port Health Study(6) is an example. 1500 employees aged 18-64 have been surveyed every two years for a detailed medical history, physical examinations, lifestyle interviews and laboratory tests. Some new diagnostic technologies are also involved in the survey, such as echocardiography (an ultrasound exam of the heart), carotid artery ultrasound. All patients with hypertension or diabetes discovered by the survey will be managed, all events of CVD, stroke and cancer (fatal and non-fatal) are monitored.
, http://www.100md.com
We have been rightly encouraged by the positive results we have achieved in combating CVD in the past 3 decades and more recently in implementing the 1999 Initiative for Cardiovascular Health in Developing Countries. However, we are fully aware that the challenges we face at present and will continue to face in the foreseeable future are tremendous. In China, the world's most populous developing country, all projects to prevent and control CVD are inevitably subject to serious limitations in terms of material, financial and human resources. At present, the whole nation is going all out to achieve sustainable economic development. It will take the concerted efforts of several generations before our country will build up a strong, modernized economy. We must be prepared to work, and to work hard, with limited resources and yet strive for the best possible results.
, http://www.100md.com
References
1.Dong Zhao, Cardiovascular Risk Factors and Their control in China;
2.Prof. K. Srinath Reddy on behalf of CVD Research Initiative. Introducing CVD Research Initiative in the Developing Countries.
3.PRC National Blood Pressure Survey Cooperative Group, A summary on the 1991 national sampled study on Hypertension in China et al. Chinese Journal of Hypertension; 1995 Apr 3(Suppl).
, http://www.100md.com
4.Liu Lisheng, MD, Blood Pressure Status in Patients attending Hospital Clinics in the People's Republic of China; Preliminary Results of the 1999 Blood Pressure Survey Project; CVD Prevention volume 2, Number 4, December 1999; 305
5.Li Shichuo, Wang Wenzhi, Wu Shengping, et al. Effects of Community-based Comprehensive Prevention on Incidence and Mortality of Stroke et al. Chinese Journal of Preventive Medicine; Volume 32, February 28, 1998
6.Hongye Zhang. Brief Introduction of Qingdao Port Health Study., 百拇医药(刘力生)
Liu Lisheng
In China, Cardiovascular diseases (CVD) are emerging as the major public health problem. CVD claim about 2.6 million lives each year and cause about 28,369,000 disability adjusted life year (DALY). The data from several cross-sectional nationwide surveys show that levels of risk factors of CVD in the Chinese population has risen significantly over the past 30 years, which has been the basis for the increasing morbidity and mortality of major CVD, including stroke and coronary heart diseases. According to the Third National Survey of Blood Pressure, there were about 100 million hypertensive patients but the awareness rate was 26.3%, the treatment rate was 12.1% and the control rate was only 2.8% for hypertension. The total smoking rate was 63% in men，3.8% in women. Even in male teenagers, smoking rate was 16.7%. It was predicted that there would be 800, 000 deaths related to smoking in 2000. There were significant regional differences in the average levels of serum total cholesterol in China. The average serum cholesterol level is lower compared with most western countries, but China is among the few countries which experience a significant increasing trend for total cholesterol in the population. The challenges for CVD prevention are higher levels of incidence rate and mortality rate of stroke, the increasing incidence rate and mortality of coronary heart disease, the current already huge absolute numbers of people with CVD risk factors and still their increasing trends.(1)
, 百拇医药
In the fall of 1999, WHO and the Global Forum on Health Research jointly launched the Initiative for Cardiovascular Health in the Developing Countries.(2)
The Initiative has adopted blood pressure lowering as its immediate priority, addressing both the population-wide approach and the high-risk approaches. Its initial objectives include development of affordable screening programs, heath education and treatment programs, and evaluation of efficacy, acceptability and cost.
, 百拇医药
In China, blood pressure control is chosen as the immediate target, since it is an important determinant of the CVD and it provides a starting point for wider regional initiatives in CVD control.
In China, National blood pressure surveys were carried out in 1959, 1979 and 1991. The prevalence rate (hypertension defined as SBP 3 140mmHg and /or DBP 3 90mmHg) was 11.19% in 1991, definitely higher than 5.11% in 1959, and 7.73% in 1979.
, http://www.100md.com
Since 1999, opportunistic blood pressure screening was recommended as a more
cost/effective way for identifying hypertensive patients(3).
A total 950,356 participants aged 15 and over were examined in the Third National Survey of Blood Pressure in 1991, with a response rate of 89.49%. Survey items included measurement of blood pressure, pulse rate, height, weight and health knowledge as well as family and personal history of cardiovascular disease (CVD). Measures for quality control involved: (1) Establishment of a steering committee and a technical committee to promote and guarantee the success of the survey; (2)An Operation Manual describing design, implementation, and internationally standardized methods in detail was developed by the Scientific Screening Committee and used by all the survey teams; (3) Multistage cluster samplings were employed and well organized in order to guarantee a good representation of samples for local population. 274 samples were selected from all over the nation (461 cities and 1904 rural counties except Taiwan ). (4) Personnel training was done on two levels; national and local. All the interviewers must obtai
, http://www.100md.com
n a certificate before participating in the survey; (5) Attention was also paid to quality control during the survey. Fifteen groups of specialists and quality control personnel were sent to survey fields in different provinces to monitor the implementation; (6) Time of survey in 1991 was decided according to the local temperature to avoid extremely cold or hot seasons. (7) A program for data input was developed in the Data Management Center and used by all the local centers for data entry. All data were entered two times. With all these quality control measures, a good data set for the whole survey was obtained. Among the 950337 questionniares, only 0.31‰ and 0.74‰ had logic missing data error. Among 939138 (98.82%) blood pressure readinngs, 25.8% had 0, 19.1% had 2, 18.5% had 4, 17.3% had 6, and 19.2% had 8 as terminal digit. Only 0.13% had an odd terminal digit.
, 百拇医药
The results showed that the established hypertension is 5.29%, borderline hypertension 5.90%, and the total prevalence rate was 11.19% in 1991, which was definitely higher than 5.11% in 1959, and 7.73% in 1979. The whole process of the study was characterized by its better design, better organization, better team training and better quality control due to the unified leadership under the Ministry of Public Health, the great combined effort of the local officers, specialists and team workers and the big progress in computer assisted data analysis.
, http://www.100md.com
In 1999 an opportunistic blood pressure screening(4) among 10,000 out-patient clinic subjects was designed to gather data on patients already utilizing the health care system. The objective of this project was to determine the awareness of hypertension, the rate of success of current treatment, and the source of medical information in this patient population. It was found that by focusing on this group of patients, who already had medical access, a preventive medical program could be developed to focus on interventions that would have the largest impact with the least resources required.
, http://www.100md.com
Community-based comprehensive prevention of CVD was implemented in 400,000
people in three urban and one rural communities. From 1992 to 1995 KAB showed a significant improve in the intervention community. There was a lowering in
morbidity and mortality of CVD, by taking measures of hypertension control, health
promotion, dietary cholesterol an sodium restriction (5).
, http://www.100md.com
The community-based comprehensive prevention of CVD study aimed to explore the comprehensive intervention effect on lowering incidence and mortality of CVD in 400, 000 population. Measures included intervention of nutrition, health promotion, management of Hypertensive patients; monitoring the trend of incidence and mortality of CVD, especially in the population aged above 35. Community-based comprehensive prevention was implemented in 400,000 people in three urban communities in Beijing, Shanghai and Changsha respectively, and in one rural community in Fangshan, a Beijing suburb, during the period of "The Eighth Five-Year Plan". Each community population was divided into two parts, an intervention community and a control community demographically and economically comparable. Results: Incidence and mortality of stroke decreased by 21.4% and 33.2%, respectively, in the intervention communities after four years, as compared with those of 6.2% and 24.7%, respectively, in the control communities. Stroke Incid ence and mortality averaged 180.34 and 116.09 per 100,000 respectively in the intervention communities; 203.57 and 135.75 per 100,000 respectively in the control communities during 1992 - 1995. Incidence and mortality of acute myocardial infarction and coronary heart disease was 46.3%, 32.81, respectively, during 1992-1995 in the intervention communities; 59.6%, 44.8% respectively in the control communities. In the intervention community, systolic blood pressure decreased by 2.39 mmHg, the rate of taking medicine among hypertensive patients increased from 15.4 to 26.3%. The total serum Cholesterol decreased by 0.11-0.30 mmol/L. The smoking rate decreased by 0.9 % in urban communities, and 6.6% in rural communities and the dietary sodium intake decreased by 367mg in female population. Knowledge, Attitude and Behavior showed a significant improvement in the intervention community.
, 百拇医药
Only few industries can afford health screen for employees biannually, and
monitoring of CVD, DM as well as cancer events.
Some industries can afford Health Screen for employees biannually. The Qingdao Port Health Study(6) is an example. 1500 employees aged 18-64 have been surveyed every two years for a detailed medical history, physical examinations, lifestyle interviews and laboratory tests. Some new diagnostic technologies are also involved in the survey, such as echocardiography (an ultrasound exam of the heart), carotid artery ultrasound. All patients with hypertension or diabetes discovered by the survey will be managed, all events of CVD, stroke and cancer (fatal and non-fatal) are monitored.
, http://www.100md.com
We have been rightly encouraged by the positive results we have achieved in combating CVD in the past 3 decades and more recently in implementing the 1999 Initiative for Cardiovascular Health in Developing Countries. However, we are fully aware that the challenges we face at present and will continue to face in the foreseeable future are tremendous. In China, the world's most populous developing country, all projects to prevent and control CVD are inevitably subject to serious limitations in terms of material, financial and human resources. At present, the whole nation is going all out to achieve sustainable economic development. It will take the concerted efforts of several generations before our country will build up a strong, modernized economy. We must be prepared to work, and to work hard, with limited resources and yet strive for the best possible results.
, http://www.100md.com
References
1.Dong Zhao, Cardiovascular Risk Factors and Their control in China;
2.Prof. K. Srinath Reddy on behalf of CVD Research Initiative. Introducing CVD Research Initiative in the Developing Countries.
3.PRC National Blood Pressure Survey Cooperative Group, A summary on the 1991 national sampled study on Hypertension in China et al. Chinese Journal of Hypertension; 1995 Apr 3(Suppl).
, http://www.100md.com
4.Liu Lisheng, MD, Blood Pressure Status in Patients attending Hospital Clinics in the People's Republic of China; Preliminary Results of the 1999 Blood Pressure Survey Project; CVD Prevention volume 2, Number 4, December 1999; 305
5.Li Shichuo, Wang Wenzhi, Wu Shengping, et al. Effects of Community-based Comprehensive Prevention on Incidence and Mortality of Stroke et al. Chinese Journal of Preventive Medicine; Volume 32, February 28, 1998
6.Hongye Zhang. Brief Introduction of Qingdao Port Health Study., 百拇医药(刘力生)