With the changes in lifestyle and increasing longevity, the prevalence of hypertension increases worldwide. However, several classes of efficacious antihypertensive drugs are readily available for the management of hypertension in most countries or regions. In the past several decades, several national or regional epidemiologic studies on hypertension and outcome trials on the management of hypertension were conducted in East Asians and native Hawaiians. In this chapter, we review the literature of epidemiology and outcome trials on hypertension in this region.
Epidemiology of Hypertension in East Asians and Native Hawaiians
Prevalence of Hypertension
After World War II, the prevalence of hypertension increased substantially in most countries and regions in East Asia and Hawaii. If the case of China would be taken as an example, the prevalence of hypertension increased from less than 10% before 1980 to approximately 25% in the latest nationwide survey in 2012 ( Fig. 3.1 ). This increase can to some extent be attributable to the increased number of elderly people over the years. However, the Westernized lifestyle characterized by high salt, high fat, high sugar and high calorie diet and physical inactivity could be a major risk factor for the increasing prevalence of hypertension in these populations.
When the most recent data from East Asians and native Hawaiians were compared across countries or regions, the prevalence of hypertension ranged from about 25% in Chinese living either in the mainland or in Taiwan and Koreans to approximately 40% in Mongolians and Native Hawaiians ( Table 3.1 ). The overall prevalence of hypertension was not reported in the most recent Japanese national blood pressure survey in 2010. The age-specific data suggested that the prevalence of hypertension in Japanese was high. The prevalence of hypertension in persons aged 60 to 69 years was more than 60% in both men and women, much higher than the 49.1% of prevalence in Chinese aged 60 years or older in 2002.
| Country or Region and Year | Age Range, Years | Number of Subjects | Prevalence, % | Awareness, % | Treatment, % | Aware and Treated, % | Control, % | Treated and Controlled, % |
|---|---|---|---|---|---|---|---|---|
| China | ||||||||
| ≥15 | 950,356 | 11.3 | 26.6 | 12.1 | 45.5 | 2.8 | 23.1 |
| ≥18 | 141,892 | 18.8 | 30.2 | 24.7 | 81.8 | 6.1 | 25.0 |
| ≥60 | NR | 49.1 | 37.6 | 36.2 | 96.3 | 7.6 | 24.1 |
| Japan | ||||||||
| 30-39 | NR | Men 20; Women 5.6 | — | — | — | — | — |
| 40-49 | NR | Men 29.9; Women 12.6 | — | — | — | — | — |
| 50-59 | NR | Men 63.2; Women 38.4 | — | Men 43.4; Women 31.2 | — | Men 32.1; Women 44.1 | — |
| 60-69 | NR | Men 65.6; Women 62.3 | — | Men 50.6; Women 68.8 | — | Men 29.9; Women 40.9 | — |
| 70-79 | NR | Men 80.8; Women 71.2 | — | Men 29.9; Women 12.6 | — | Men 33.3; Women 40.5 | — |
| Korea | ||||||||
| ≥30 | 9146 | 24.9 | 60.6 | 52.2 | 86.2 | 36.7 | 70.3 |
| Mongolia | ||||||||
| 15-64 | 4502 | 36.5 | 65.8 | 35.9 | 54.6% | 24.1 | 67.1 |
| Native Hawaiians | ||||||||
| 20-59 | 257 | 25 | — | — | — | — | — |
| Taiwan | ||||||||
| ≥19 | 6,479 | 23.5 | — | — | — | — | — |
Awareness, Treatment, and Control of Hypertension
There is not much high quality data on the management of hypertension except for the national blood pressure surveys in China and Korea. According to the currently available data, Koreans and Japanese seemed to have higher awareness, treatment, and control rates of hypertension than other East Asian populations and native Hawaiians ( Table 3.1 ). The control rate of hypertension was about 35% in Koreans and Japanese, 24% in Mongolians, and less than 10% in Chinese.
Outcome Trials in Hypertension in East Asians and Native Hawaiians
Placebo-Controlled Trials
Since the late 1980s, several placebo-controlled outcome trials were conducted in China to investigate whether antihypertensive therapy would prevent cardiovascular complications in hypertensive patients ( Table 3.2 ).
| AGE, YEARS | SBP/DBP, MM HG | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Trial | Masking | Number of Patients | Antihypertensive Treatment (MG) | Entry Criteria | Mean (SD) | Entry Criteria | Mean (SD) at Baseline | Difference During FU | FU Time | Favorable Results |
| Active treatment vs. placebo or no treatment | ||||||||||
| Double | 9800 | HCTZ (12.5)+felodipine (5-10) vs. HCTZ (12.5)+placebo | 50-79 | 61.5 (7.2) | 140-180/90-100 on HCTZ (12.5 mg) | 154.3/91.2 (17.5/9.6) | 4.2/2.1 | 40 m | Felodipine |
| Double | 5665 | Indapamide (2.5) vs. placebo | None | 60 (8) | None | 154/93 (23/13) | 5/2 | 2 y | Indapamide |
| Single | 1632 | Nifedipine vs. placebo | 60-79 | 168.5/97.7 (—/—) | 9.4/5.5 | 30 m | Nifedipine | ||
| Double | 2394 | Nitrendipine (10-40)+captopril (12.5-50)+HCTZ (12.5-50) vs. placebo | ≥60 | 66.5 (5.5) | 160-219/<95 | 170.5/86.0 (11.1/6.8) | 9.1/3.2 | 3.0 y | Active treatment |
| Actively controlled trials | ||||||||||
| Open | 4728 | Amlodipine (2.5-10) vs. Candesartan (4-8) | None | 63.8 (10.5) | 140-179/90-109 (<70 y) or 160-179/90-109 (≥70 y) | 162.8/91.7 (14.2/11.2) | 1.7/0.6 | 3.2 y | Neutral |
| Open | 3293 (3501) a | Benidipine (4)+ARB vs. Benidipine (4)+α-blocker vs. Benidipine (4)+diuretic | 40-85 | 63.1 (10.7) | 140-199/90-119 on/off treatment | 153.9/88.8 (11.6/9.7) | 0.8/0.6 | 3.61 y | Neutral |
| Open | 1650 | Nifedipine Retard (20-40) vs. ACE inhibitors | <75 | 64.5 (8.5) | ≥150/90-120 or treated | 146/82 (19.5/11.5) | 4/1 | 36 m | Neutral |
| Double | 414 | Nicardipine SR (40-80) vs. Trichlormethiazide (2-4) | ≥60 | 69.8 (6.5) | 160-220/<115 | 172.3/93.8 (11.9/10.2) | −1/−1 | 3 y | Neutral |
| Intensive vs. less intensive | ||||||||||
| Open | 4418 (4508) a | <140 vs. 140-159 mm Hg | 65-85 | 73.6 (5.3) | ≥160/ | 171.6/89.1 (9.8/9.5) | 9.7/3.3 | 2 y | Neutral |
| Open | 3260 | <140 vs. 140-149 mm Hg | 70-84 | 76.1 (4.1) | 160-199/− | 169.5/81.5 | 5.4/1.7 | 3.07 | Neutral |
| Subgroup of multinational trials | ||||||||||
| Double | 3845 (1526) b | Indapamide (1.5)+perindopril (2-4) vs. placebo | ≥80 | 83.6 (3.2) | 160-199/<110 | 173.0/90.8 (8.5/8.5) | 15.0/6.1 | 1.8 y | Active treatment |
| Double | 6105 (2352) b | Perindopril (4)+indapamide (2.5) vs. placebo | None | 64 (10) | <180/<110 | 147/86 (19/11) | 9/4 | 3.9 y | Active treatment |
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