The Impact of Hypertension Definition Based on Two-visit Strategy on Estimate of Hypertension Burden: Results From the China Health and Nutrition Survey 1989–2011

BACKGROUND: The diagnosis of hypertension should be based on the mean of two or more properly measured BP readings on each of two visits for clinical practice, but a one-visit strategy was applied in most epidemiological surveys. The impact of hypertension definition based on two visits on estimates of hypertension burden is unknown. This study aims to assess the impact of hypertension diagnosis based on a two-visit strategy for estimating hypertension burden in China. METHODS: The one-visit and two-visit strategies were applied to investigate the incidence of hypertension in a cohort study based on the China Health and Nutrition Survey (CHNS) 1989–2011. Additionally the prevalence of hypertension was investigated in a cross-sectional study based on the CHNS 2006–2009/2011 and the hypertension burden in China was estimated with data from the 2012–2015 China hypertension survey. RESULTS: Overall, the age-adjusted incidence of hypertension based on the two-visit strategy (1.82%; 95% confidence interval [CI], 1.74–1.90%) was 62.1% lower than estimation based on the one-visit strategy (4.80%; 95% CI, 4.68–4.93%). Similar results were found in the prevalence of hypertension (one-visit: 18.13% [95% CI, 17.34–18.92%]; two-visit: 9.47% [95% CI, 8.87–10.07%]). When the two-visit strategy was applied to the 2012–2015 China hypertension survey, the hypertension burden was predicted to be overestimated by 25.5–47.8% (based on JNC 7) and 23.5–48.2% (based on the 2017 ACC/AHA). CONCLUSION: The hypertension burden would decrease from 244.5 million persons to 127.5–182.3 million persons in China if the two-visit strategy was applied.