Hypertension awareness, treatment, control, and prognosis: insights from the sub-cohort of China PEACE million persons project

It is unclear whether and to what extent hypertension (HTN) awareness, treatment, and control affect prognosis in real-world settings. This study utilized data from the sub-cohort of the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project. A total of 102,358 adults aged 35-75 years were enrolled from Guangdong Province between January 2016 and December 2020. The primary outcomes were hospitalizations for major adverse cardiovascular events (MACEs) (a composite of myocardial infarction, coronary heart disease, stroke, heart failure, and cardiovascular mortality) and all-cause mortality. The secondary outcomes were the individual components of MACEs. Among the HTN patients, the proportions of HTN awareness and treatment were 58.6% and 48.7%, respectively. Only 22.0% and 7.9% of the population had their blood pressure (BP) controlled at <140/90 and <130/80 mmHg. Older age, female sex, higher socioeconomic status, elevated body mass index and waist circumference, as well as a history of DM, dyslipidemia, and cardiovascular disease, were associated with increased HTN awareness, treatment, and control. Current smokers and drinkers experienced lower chances of HTN care cascade. Hypertensive individuals with BP controlled at <130/80 mmHg faced similar risks of MACEs and mortality compared to normotensive individuals, while hypertensive subjects with uncontrolled BP or unawareness of HTN exhibited nearly double the risk of adverse cardiovascular outcomes. In conclusion, several factors were significantly associated with the performance of HTN awareness, treatment, and control. Hypertensive individuals with BP controlled at an optimal level shared a similar risk for MACEs and mortality compared to their normotensive counterparts.