Modelling the potential impact of population-wide and targeted high-risk blood pressure-lowering strategies on cardiovascular disease in China

Abstract

Background

To estimate the impact of population-wide and high-risk blood pressure-lowering strategies on cardiovascular disease (CVD) incidence in China.

Design

A modelling study based on a community cohort of 30 362 men and women aged 35-74 years in urban Shanghai, China, 3.3% of whom have existing CVD.

Methods

We modelled three blood pressure-lowering strategies: population-wide salt reduction, or antihypertensive drug treatment (following Chinese guidelines) for two subpopulations with either high blood pressure (≥ 150/95 mmHg), or high baseline-predicted CVD risk (≥ 10% in 10 years based on a multivariate risk model). Avoidable CVD events were estimated by applying a range of relative risk reductions in CVD, 5-7.5% for population-wide salt reduction and 20-25% for drug treatment derived from meta-analyses. Drug compliance was assumed to be 50%.

Results

Population-wide salt reduction would avoid 240-362 events per 100000 population over 10 years. Drug treatment for the 14.1% of people with raised blood pressure could avoid 217-273 events, whereas treating the 14.2% of people with predicted 10-year CVD risk over 10% would avoid 310-385 events. Of the prevented events, 70-80% would occur in over 60 years and almost a third of the events were predicted to occur among the 3.3% of people with prevalent CVD.

Conclusion

Population-wide and high-risk blood pressure-lowering strategies would have a similar impact on CVD incidence in urban China. The expected epidemic of CVD could be reduced by highly targeted drug treatment while more sustainable population-wide strategies are put in place. Eur J Cardiovasc Prev Rehabil 16:96-101 © 2009 The European Society of Cardiology