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Table 3 Key findings of the eleven most important studies

From: Health system strengthening and hypertension management in China

  Author Published year No. and title Source Study population Objective Key findings
Health System Governance Wong et al 2012 Performance Comparison among the Major Healthcare Financing Systems in Six Cities of the Pearl River Delta Region, Mainland China. PLOS ONE 1830 patients of the Pearl River Delta Compare the effect pf hospital-funded, government-funded and private-funded CHCs The hypertension treatment rate in hospital-funded community health care centers (CHCs) ranged from 83.1 to 92.1 %, which was lower in government-funded CHCs (70.3 %, adjusted OR 0.46 95 % CI 0.33–0.66) and private-funded CHCs (29.9 %, adjusted OR 0.03 95 % CI 0.02–0.05 ); the control rate in hospital-funded CHCs 22.7 %, ranged from 20.1 to 28.9 %, which was higher in the Government-funded (25.8 %, adjusted OR 1.63, 95 % CI 1.16–2.29), lower in the private-funded CHC (8.9 %, adjusted OR 0.15 95 % CI 0.069–0.31).
Health Financing Guo et al 2015 The dynamics of hypertension prevalence, awareness, treatment, control and associated factors in Chinese adults. Journal of Hypertension 75,526 records of 24, 410 adults in 1991–2011 CHNS Compare effect of insurance with non-insurance Compared with those without medical insurance, hypertensive patients who had medical insurance were more likely to be aware of their hypertensive condition (aOR 1.5, 95 % CI 1.4–1.7), more likely to be medicated for hypertension (aOR 1.7, 95 % CI 1.5–1.8) and more likely to control their blood pressure within normal range (aOR 1.3, 95 % CI 1.2–1.4).
Basu et al 2013 Social epidemiology of hypertension in middle-income countries determinants of prevalence, diagnosis, treatment, and control in the WHO SAGE study. Hypertension 15050 subject in China of SAGA data Compare effect of voluntary insurance with mandatory insurance Compared with people covered by mandatory insurance, the risk of being undiagnosed was higher (aOR 4.286, 95 % CI 1.159–15.84, ten times, 95 % CI 2.1–47.4 in Chinese cohort), the risk of being untreated was near four times higher (aOR 4.64, 95 % CI 1.05–20.46), as well as the risk of being uncontrolled (aOR 4.51, 95 % CI 0.98–20.82) .
Feng et al 2014 Health system strengthening and hypertension awareness, treatment and control:data from the China Health and Retirement Longitudinal Study Bulletin of the World Health Organization 13,707 individuals of CHARLs Compare the effect of insurance providing costs of outpatient care with those that contributed nothing to this part Those with insurance that covered the costs of outpatient care were less likely to be unaware of their hypertension (30.1 % VS 44.4 %, aRR: 0.74; 95 % CI: 0.62–0.88) , to be untreated for it (38.2 % VS 57.8 %, aRR: 0.80; 95 % CI: 0.68–0.93) and to be not controlling it effectively (71.0 % VS 81.0 %, aRR: 0.90; 95 % CI: 0.83–1.00), when compared with those in the insurance contributed nothing to outpatient care.
Health Information Wang et al 2010 Hypertension Control in Communities (HCC): evaluation result of blood pressure management among hypertensive. Chinese Journal of Epidemiology 29,411 subjects in six provinces Evaluate the effect of guideline-based hypertension management After 1-year intervention, hypertension control rate raised from 21.6 to 74.7 %(P < 0.05), with an estimated effect of 53.1 % (95 % CI 52.4–53.8 %).
Li et al 2015 Effects of guideline-based hypertension management in rural areas of Guangdong Province. Chinese Medical Journal 3113 patients with essential hypertension in rural Guangdong Compare effect of traditional therapy and the guideline-based HTN management (the novel therapy) After 2 years following up, hypertension treatment and control increased in both groups and the control rate increased more significantly in the guideline-based group (from 31.1 to 37.9 % in the traditional group, and from 26.9 to 64.3 % in the guideline-based group, P < 0.001).
Mendis et al 2010 Cardiovascular risk management and its impact on hypertension control in primary care in low-resource settings a cluster-randomized trial Bulletin of the World Health Organization 2397 patients in China and Nigeria Evaluate the effect of WHO CVD risk management package After 12-month following up, the reductions of systolic blood pressure and diastolic blood pressure were significantly greater in the intervention group, with the marginal effects size of 3.86 and 1.53 mmHg in China (−13.28 vs −9.42 mmHg, −6.07 vs −4.54 mmHg, P < 0.001).
Health Service delivery Lu et al 2015 Community-based interventions in hypertensive patients a comparison of three health education strategies BMC Public Health 360 participants in Guangdong Compare three health education strategies including self-learning, monthly lecture and interactive education workshop. Compared with self-learning, after the 2-y intervention, the likelihood of normalized BP was greater in lecture group (from41.2 to 63.2 %, p < 0.001, aOR 2.37, 95 % CI 1.26–4.47) and interactive workshop group (from 40.2 to 86.3 %, p < 0.001, aOR 14.66, 95 % CI 6.59–32.62 and 2.37).
Yun et al 2014 Effectiveness of a Community-Based Individualized Lifestyle Intervention Among Older Adults With Diabetes and Hypertension, Tianjin, China, 2008–2009 Prev Chronic Dis 213 participants of five local community health clinics in Tianjin Evaluate the effect of Zhiji management Systolic blood pressure and diastolic blood pressure decreased significantly by 10.9 and 4.0 mmHg in the treatment group (P < 0.001).
Niu et al 2014 Differences and determinants in access to essential public health services in China a case study with hypertension people and under-sixes as target population. Chin Med J (Engl) 1505 hypertensive patients Evaluate the effect of accessibility The control rate in those who lived less than 5 min away from the nearest health institution was 39.3 %, slightly higher than the rate for those who lived more than 20 min away, which was 35.8 % (aOR 1.03, 95 % CI 0.60–1.79).
  Gu et al 2015 The Cost-Effectiveness of Low-Cost Essential
Antihypertensive Medicines for Hypertension
Control in China: A Modelling Study
PLOS Medicine   Evaluate the cost-effectiveness of different treating strategy Treating all hypertensives for primary and secondary prevention to goal of <140/90 if age 35–64 years, goal of <150/90 if age65 could prevent about 800,000 cardiovascular disease events annually (95 % CI 0.6–1.0 million) and was borderline cost-effective incremental to treating only cardiovascular disease and stage two patients (2015 Int$13,000 per QALY gained [95 % CI, Int$10,000 to Int$18,000])