Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Sex differences in the awareness, treatment, and control of hypertension in China: a systematic review with meta-analyses

Hypertension Research volume 42, pages 273–283 (2019)Cite this article

Abstract

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.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

Buy

All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 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.

  2. World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-20. Geneva, Switzerland: World Health Organization; 2013.

    Google Scholar 

  3. NCD Risk Factor Collaboration. 2017. http://www.ncdrisc.org/index.html (accessed 10-11-2017)

  4. 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.

  5. 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.

  6. 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.

    Article  Google Scholar 

  7. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA. 2010;303:2043–50.

    CAS  Article  Google Scholar 

  8. 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.

    Article  Google Scholar 

  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.

    CAS  Article  Google Scholar 

  10. Everett B, Zajacova A. Gender differences in hypertension and hypertension awareness among young adults. Biodemography Social Biol. 2015;61:1–17.

    Article  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. 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.

  13. 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.

    Article  Google Scholar 

  14. 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)

  15. 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.

    Article  Google Scholar 

  16. 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.

    CAS  Article  Google Scholar 

  17. 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.

    Article  Google Scholar 

  18. 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.

    CAS  PubMed  Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. 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.

    Article  Google Scholar 

Download references

Funding

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).

Author information

Author notes

  1. Joint first authors: Alice Redfern, Sanne A.E. Peters

  2. Joint senior authors: Haijun Wang, Robyn Norton

Authors and Affiliations

  1. The George Institute for Global Health, University of Oxford, Oxford, UK

    Alice Redfern, Sanne A. E. Peters & Robyn Norton

  2. The George Institute for Global Health, Peking University Health Science Center, Beijing, China

    Rong Luo & Craig Anderson

  3. Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China

    Yu Cheng, Chenxiong Li & Haijun Wang

  4. Institute of Medical Humanities, Peking University Health Science Center, Beijing, China

    Jiawen Wang

  5. The George Institute for Global Health, University of New South Wales, Sydney, Australia

    Craig Anderson & Robyn Norton

Authors
  1. Alice Redfern
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sanne A. E. Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rong Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yu Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chenxiong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jiawen Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Craig Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Haijun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Robyn Norton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sanne A. E. Peters.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-018-0154-x

Keywords

  • hypertension
  • China
  • men
  • women

Further reading

Search

Advanced search

Quick links