Hypertension is the major cause of preventable disease burden in China. However, limited evidence is available on sex differences in the awareness, treatment, and control of hypertension. We assessed sex differences in the awareness, treatment, and control of hypertension in China. A systematic search of four English language and four Chinese-language databases was conducted to identify studies conducted from 2005 that reported sex-specific data on the awareness, treatment, and control of hypertension in China. Random-effects meta-analysis weighted by the inverse of the variances were used to obtain pooled sex-specific rates and women-minus-men differences, and their 95% confidence intervals (CI). Overall, 57 studies comprising 2,155,829 individuals (55% women) were included. Awareness (53% in women vs. 47% in men), treatment among all (44% vs. 38%), treatment among aware (65% vs. 60%), control among all (17% vs. 14%), and control among treated (27% vs. 27%) were low for both sexes, but more favourable in women than men. The corresponding women-minus men difference was 7% (95% CI: 6; 8%) for awareness, 6% (5; 8%) for treatment among all, 6% (2; 9%) for treatment among aware, 3% (2; 3%) for control among all, and 0% (−2; 1%) for control among treated. Awareness, treatment, and control of hypertension in China is low in both sexes, but greater in women than men. Sex-specific interventions may be needed to efficiently combat the burden of hypertension.
Subscribe to Journal
Get full journal access for 1 year
only $21.58 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet. 2017;389:37–55.
World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-20. Geneva, Switzerland: World Health Organization; 2013.
NCD Risk Factor Collaboration. 2017. http://www.ncdrisc.org/index.html (accessed 10-11-2017)
Lu J, Lu Y, Wang X, Li X, Linderman G and Wu C. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet. 2017;390:2549–58.
Su M, Zhang Q, Bai X, Wu C, Li Y and Mossialos E. Availability, cost, and prescription patterns of antihypertensive medications in primary health care in China: a nationwide cross-sectional survey. Lancet. 2017;390:2559–68.
Li Y, Yang L, Wang L, Zhang M, Huang Z, Deng Q, et al. Burden of hypertension in China: a nationally representative survey of 174,621 adults. Int J Cardiol. 2017;227:516–23.
Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA. 2010;303:2043–50.
Gee ME, Campbell NR, Gwadry-Sridhar F, Nolan RP, Kaczorowski J, Bienek A, et al. Antihypertensive medication use, adherence, stops, and starts in Canadians with hypertension. Can J Cardiol. 2012;28:383–9.
Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013;310:959–68.
Everett B, Zajacova A. Gender differences in hypertension and hypertension awareness among young adults. Biodemography Social Biol. 2015;61:1–17.
Sarganas G, Neuhauser HK. The persisting gender gap in hypertension management and control in Germany: 1998 and 2008-11. Hypertens Res: Off J Jpn Soc Hypertens. 2016;39:457–66.
Zhang Y and Moran AE. Trends in the prevalence, awareness, treatment, and control of hypertension among young adults in the United States, 1999 to 2014. Hypertension. 2017;70:736-42.
Choi HM, Kim HC, Kang DR. Sex differences in hypertension prevalence and control: Analysis of the 2010-4 Korea National Health and Nutrition Examination Survey. PLoS ONE. 2017;12:e0178334.
Redfern A, Luo R, Cheng Y, Li Q, Wang H. A systematic review of access to care and quality of care for women with non-communicable diseases in China. PROSPERO 2016:CRD42016050415 2016. https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016050415 (accessed 10-11-2017)
Gu Q, Burt VL, Paulose-Ram R, Dillon CF. Gender differences in hypertension treatment, drug utilization patterns, and blood pressure control among US adults with hypertension: data from the National Health and Nutrition Examination Survey 1999-2004. Am J Hypertens. 2008;21:789–98.
Daugherty SL, Masoudi FA, Ellis JL, Ho PM, Schmittdiel JA, Tavel HM, et al. Age-dependent gender differences in hypertension management. J Hypertens. 2011;29:1005–11.
Lewington S, Lacey B, Clarke R, Guo Y, Kong XL, Yang L, et al. The burden of hypertension and associated risk for cardiovascular mortality in China. JAMA Intern Med. 2016;176:524–32.
Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender differences in the utilization of health care services. J Fam Pract. 2000;49:147–52.
Turnbull F, Woodward M, Neal B, Barzi F, Ninomiya T, Chalmers J, et al. Do men and women respond differently to blood pressure-lowering treatment? Results of prospectively designed overviews of randomized trials. Eur Heart J. 2008;29:2669–80.
Song Y, Bian Y, Petzold M, Li L, Yin A. The impact of China’s national essential medicine system on improving rational drug use in primary health care facilities: an empirical study in four provinces. BMC Health Serv Res. 2014;14:507.
This work was supported by a policy grant from the Oxford Martin School at the University of Oxford. SP is supported by a UK Medical Research Council Skills Development Fellowship (MR/P014550/1).
Conflict of interest
The authors declare that they have no conflict of interest.
Electronic supplementary material
About this article
Cite this article
Redfern, A., Peters, S.A.E., Luo, R. et al. Sex differences in the awareness, treatment, and control of hypertension in China: a systematic review with meta-analyses. Hypertens Res 42, 273–283 (2019). https://doi.org/10.1038/s41440-018-0154-x
Association of age and blood pressure among 3.3 million adults: insights from China PEACE million persons project
Journal of Hypertension (2021)
Association of hemoglobin glycation index and its interaction with obesity/family history of hypertension on hypertension risk: a community-based cross-sectional survey
BMC Cardiovascular Disorders (2020)
Gender differences and determinants of prevalence, awareness, treatment and control of hypertension among adults in China and Sweden
BMC Public Health (2020)
Transcutaneous electrical acupoint stimulation for stage 1 hypertension: protocol for a randomized controlled pilot trial
Sex differences in the association between major risk factors and the risk of stroke in the UK Biobank cohort study