Measuring blood pressure and taking meds to reach target levels

7. Measuring blood pressure and taking meds to reach target levels

Cost: An electronic sphygmomanometer costs 100–200 RMB. Each measurement takes 1 minute. Most antihypertensive drugs cost just a few to dozens of RMB per month. The hard part is keeping the medication regimen even when there are no symptoms.

In plain terms: For every 10 mmHg drop in blood pressure, the risk of major cardiovascular problems falls by 20%, stroke risk drops 27%, heart failure risk drops 28%, and overall mortality risk declines by 13%. Among Chinese adults aged 35–75, 44.7% have hypertension, but only 7.2% have their blood pressure under proper control.

Benefit: Data from 123 clinical trials involving over 610,000 participants shows that a 10 mmHg reduction in systolic blood pressure lowers the incidence of major cardiovascular events by roughly 20%. The relative risk is 0.80, with a 95% confidence interval of 0.77–0.83. Systolic blood pressure is the higher of the two readings taken during a measurement. Stroke risk drops by 27% (RR 0.73), heart failure risk drops by 28% (RR 0.72), and overall mortality drops by 13% (RR 0.87, 95% CI 0.84–0.91). A screening program in China involving 1.7 million adults aged 35–75 found that 44.7% had hypertension; of these, 44.7% were aware of their condition, 30.1% were receiving treatment, and only 7.2% had their blood pressure under control.

Evidence grade: A

Sources: Ettehad D et al. (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. <https://doi.org/10.1016/S0140-6736(15)01225-8>; Lu J et al. (2017). Prevalence, awareness, treatment, and control of hypertension in China (China PEACE Million Persons Project). Lancet. <https://doi.org/10.1016/S0140-6736(17)32478-9>

Notes: Start by getting your blood pressure measured at least once. Fewer than 1 in 10 Chinese adults with hypertension manage to keep their levels under control, so this single measurement is one of the most cost-effective actions you can take as outlined in this book. There is still some debate over what exact target level (130 or 140 mmHg) is ideal, but there is no dispute that knowing you have hypertension and taking steps to lower it is highly beneficial.