Hypertension Control in China: Translation from Clinical Trial to Real-World Application — Preliminary Outcomes

Guozhe Sun^1,&; Hao Peng^2,&; Songyue Liu¹; Chang Wang¹; Xiangyu Tan¹; Jia Fu³; Wenlan Dong⁴; Fang Liu⁴; Xiaofan Guo¹; Lixia Qiao¹; Nanxiang Ouyang¹; Wei Miao¹; Danxi Geng¹; Yangzhi Yin¹; Ziyi Xie¹; Pengyu Zhang¹; Caiyu Zhang¹; Chenhua He¹; Jing Wu^4,#; Yingxian Sun^1,#

1. Department of Cardiology, the First Hospital of China Medical University, Shenyang City, Liaoning Province, China;

2. Department of Epidemiology, School of Public Health Suzhou Medical College of Soochow University, Suzhou City, Jiangsu Province, China;

3. Changtu County Center for Disease Control and Prevention, Tieling City, Liaoning Province, China;

4. National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.

^& Joint first authors

^# Corresponding author: Yingxian Sun, yxsun@cmu.edu.cn; Jing Wu, wujing@chinacdc.cn.

To evaluate the adaptability of the China Rural Hypertension Control Project (CRHCP) — a multifaceted village doctor-led intervention for blood pressure control in rural China — for widespread implementation in extension projects. This project comprises two phases: a pilot project and an extension project. It builds upon our CRHCP model, implementing a multi-level comprehensive hypertension management strategy targeting the general population across rural areas and township communities in China, aligning with national policies and local initiatives. In the pilot project, 5,088 hypertensive patients were enrolled. At baseline, 1,227 subjects (25.7%) met the 140/90 mmHg target for blood pressure control. After 13 months of intervention, the blood pressure control rate (<140/90 mmHg) reached 72.5%. In the extension project, 244,046 hypertensive patients were identified through screening of 1,002,845 residents in Changtu, Wujiang, and Tongguan. Average blood pressure decreased from 146.8/88.4 mmHg to 140.4/82.6 mmHg, and the proportion of patients with controlled blood pressure increased significantly from 20.8% to 44.0%. The translation of the CRHCP model into a public health program has demonstrated potential for enhancing hypertension control in selected regions of China. While these initial results are encouraging, further research and long-term evaluation are needed to confirm its effectiveness and adaptability. If proven successful, this model may offer a replicable framework for improving public health outcomes in other low- and middle-income countries and regions.

中国高血压控制：从临床试验到真实世界的转化应用 — 初步结果

孙国哲^1,&；彭浩^2,&；刘松岳¹；王畅¹；谭湘宇¹；付佳³；董文兰⁴；刘芳⁴；郭潇繁¹；乔丽霞¹；欧阳南翔¹；苗蔚¹；耿丹溪¹；尹洋智¹；解子怡¹, 张鹏宇¹；张彩瑜¹；贺琛华¹；吴静^4,#；孙英贤^1,#

1.心内科，中国医科大学附属第一医院，沈阳市，辽宁省，中国；

2.流行病学系，公共卫生学院，中国苏州大学，苏州市，江苏省，中国；

3.中国铁岭市昌图县疾病预防控制中心，铁岭市，辽宁省，中国；

4.慢性病和非传染性疾病控制与预防中心，中国疾病预防控制中心，北京，中国。

^& 共同第一作者。

^# 通信作者：孙英贤, yxsun@cmu.edu.cn; 吴静, wujing@chinacdc.cn。

为验证中国农村高血压控制项目（CRHCP）的适用性，该项目由乡村医生主导，采用多维度干预措施，旨在为后续推广应用提供科学依据。本项目分为两个阶段：试点阶段和推广阶段。项目将基于开发的CRHCP模式，实施针对中国农村地区和乡镇社区普通人群的多层次综合高血压管理策略，并与国家政策和地方举措保持一致。在试点项目中，共纳入了5,088名高血压患者。基线时，1,227名受试者（25.7%）达到了140/90 mmHg的血压控制目标。经过13个月的干预，血压控制率（<140/90毫米汞柱）达到了72.5%。在推广阶段，本研究从昌图、吴江和潼关三地的1,002,845名居民中筛查出244,046名高血压患者。患者的平均血压从146.8/88.4 mmHg降至140.4/82.6 mmHg，血压控制率从最初的20.8%显著提高至44.0%。CRHCP模式作为公共卫生项目的实践应用，已在我国部分地区展现出显著的高血压防控效果。初步研究结果表明，该模式具有较高的推广价值和实践意义。持续深入的随访观察将进一步验证其长期效果和广泛适用性。随着研究证据的逐渐积累，该模式有望成为我国高血压防控的重要策略之一，其成功经验也可为中低收入国家和地区提供有益借鉴。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.113

Association Between Pulse Pressure and the Risk of Death Events — Beijing Municipality, China, 2010–2021

Yingqi Wei¹, Kai Fang¹, Rui Hou¹, Chen Xie¹, Aijuan Ma¹, Zhong Dong^1,#

1. Beijing Center for Disease Prevention and Control, Beijing, China.

^# Corresponding author: Zhong Dong, bjcdcdongz@wjw.beijing.gov.cn.

Pulse pressure (PP), an indicator of aortic stiffening, may be associated with adverse cardiovascular outcomes. However, the relationship between PP levels and mortality risk in the Chinese population remains unclear. Total 102,311 participants aged 40 and above were recruited in this prospective study in Beijing during 2010–2012, and followed up until 2021. Blood pressure measurements and related factors were collected at baseline. All-cause and cardiovascular or cerebrovascular disease (CCVD) related deaths were identified as endpoints. Compared with the lowest quartile of PP (<40 mmHg), mortality risk increased by 9.8%–23.9% among individuals with PP in the second through fourth quartiles, with particularly elevated risk among females, adults aged 60–74 years, and overweight or obese individuals. The association between PP and CCVD-specific mortality risk was attenuated but remained statistically significant among people with PP ≥60 mmHg. Death risk increased with rising PP levels in middle-aged and elderly populations in Beijing. These findings emphasize the need to develop comprehensive and effective PP management strategies to reduce mortality.

脉压差与死亡风险的关联 — 北京直辖市，中国，2010–2021年

隗瑛琦¹；方凯¹；侯锐¹；谢晨¹；马爱娟¹；董忠^1,#

1. 北京市疾病预防控制中心，北京，中国。

^# 通讯作者: 董忠，bjcdcdongz@wjw.beijing.gov.cn。

脉压差是主动脉硬化的指标，可能与心血管不良结局有关。然而中国人群脉压差水平与死亡风险之间的关联尚不清楚。这项位于北京的前瞻性研究，在2010年至2012年间共纳入102,311名40岁及以上调查对象，并追踪到2021年。在基线时收集血压值和相关因素，全因死亡及心脑血管疾病相关死亡均被确定为本研究的终点事件。与脉压差的最低四分位数（<40 mmHg）相比，脉压差处于第二至第四分位数的受试者的死亡风险增加了9.8%-23.9%，女性、60-74岁以及超重或肥胖者的风险更高。脉压差与心脑血管疾病特异性死亡风险之间的关联虽有所减弱，但在脉压差≥60 mmHg的人群中仍具有统计学意义。北京中老年人群的死亡风险随着脉压差水平的升高而增加。这些发现强调了制定全面有效的脉压差管理策略，以降低死亡率的必要性。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.114

Associations of Mediterranean-DASH Intervention for Neurodegenerative Delay Diet with Blood Pressure and Hypertension Among Older Adults — China, 2019–2022

Bowen Wang¹; Jixiang Ma²; Virginia Byers Kraus³; Xin Gao¹; Bo Jiang⁴; Wei Guo⁵; Wei Yan⁶; Xiaolei Guo²; Kui Qin⁷; Yi Yang⁸; Yunfan Li¹; Zhaoxue Yin^1,#

1. Chinese Center for Disease Control and Prevention, Beijing, China;

2. Shandong Provincial Center for Diseases Control and Prevention, Jinan City, Shandong Province, China;

3. Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, NC, USA;

4. Beijing Center for Disease Control and Prevention, Beijing, China;

5. Jilin Provincial Center for Diseases Control and Prevention, Changchun City, Jilin Province, China;

6. Jiangxi Provincial Center for Diseases Control and Prevention, Nanchang City, Jiangxi Province, China;

7. Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning City, Guangxi Zhuang Autonomous Region, China;

8. Ningxia Hui Autonomous Region Center for Disease Control and Prevention, Yinchuan City, Ningxia Hui Autonomous Region, China;

^# Corresponding author: Zhaoxue Yin, yinzx@chinacdc.cn.

The Mediterranean-dietary approaches to stop hypertension (DASH) intervention for neurodegenerative delay (MIND) diet has demonstrated benefits for brain health, yet evidence regarding its antihypertensive effects among older adults remains limited and inconsistent. This study investigated associations between the MIND diet and blood pressure outcomes among Chinese older adults. Logistic regression analysis was used to examine associations between MIND diet scores and both baseline hypertension prevalence and incident hypertension. Repeated measures analysis of variance assessed adjusted mean differences in blood pressure between MIND diet score groups. Sensitivity analysis was conducted after imputing missing blood pressure values at follow-up using multiple imputation techniques. Logistic regression analyses revealed that high MIND diet scores were negatively associated with baseline hypertension prevalence (P<0.05); however, no significant relationship was observed between MIND diet adherence and incident hypertension (P>0.05). Among participants who completed follow-up, those with high MIND diet scores had significantly lower blood pressure (P<0.05) compared to those with low scores and  the adjusted mean differences for systolic blood pressure (SBP) and diastolic blood pressure (DBP) were -1.46 [95% confidence interval (CI): -2.59, -0.31] mmHg and -1.09 (95% CI: -1.76, -0.41) mmHg, respectively. Similar results were observed among both participants with hypertension taking medication at baseline and those without hypertension at baseline. Sensitivity analyses following multiple imputation confirmed these findings. The study revealed the potential of the MIND diet to reduce blood pressure levels, providing new approaches for hypertension prevention among older adults.

老年人延缓神经退变膳食模式与血压水平及高血压的关系 — 中国，2019–2022年

王博文¹；马吉祥²；Virginia Byers Kraus ³；高欣¹；姜博⁴；郭伟⁵；颜伟⁶；郭晓雷²；秦奎⁷；杨艺⁸；李云帆¹；殷召雪^1,9,#

1. 中国疾病预防控制中心，北京，中国；

2. 山东省疾病预防控制中心，济南市，山东省，中国；

3. 杜克大学医学院，杜克分子生理研究所，达勒姆市，北卡罗来纳州，美国；

4. 北京市疾病预防控制中心，北京，中国；

5. 吉林省疾病预防控制中心，长春市，吉林省，中国；

6.江西省疾病预防控制中心，南昌市，江西省，中国；

7. 广西壮族自治区疾病预防控制中心，南宁市，广西壮族自治区，中国；

8.  宁夏回族自治区疾病预防控制中心，银川市，宁夏回族自治区，中国；

9.  辐射防护与核安全医学所，中国疾病预防控制中心, 北京，中国。

^# 通信作者: 殷召雪，yinzx@chinacdc.cn。

延缓神经退变 [Mediterranean-dietary approaches to stop hypertension (DASH)intervention for neurodegenerative delay (MIND)]膳食模式对血压的影响尚缺乏一致的证据。本研究探讨中国老年人MIND膳食与血压水平及高血压发病的关联。采用Logistic回归分析探索MIND膳食评分与基线高血压患病率的关联及其与新发高血压的关系；采用重复测量方差分析比较不同MIND膳食评分组间血压调整均值的差异。对随访血压缺失值进行多重填补后开展敏感性分析。Logistic回归分析显示，高MIND膳食评分与基线高血压患病率呈负相关（P<0.05），但未发现其与新发高血压存在显著关联（P>0.05)。在完成随访的个体中，与低MIND膳食评分组相比，高MIND膳食评分组收缩压（systolic blood pressure, SBP）和舒张压（diastolic blood pressure, DBP）均显著较低（P<0.05），调整后的两组SBP与DBP均值差分别为-1.46（95% CI: -2.59, -0.31）mmHg和-1.09（95% CI: -1.76, -0.41）mmHg。在基线规律服药的高血压人群及基线无高血压人群中均发现相似结果。经多重填补后的敏感性分析结果与上述结论一致。本研究揭示了MIND膳食降低血压水平的潜力，为老年人群高血压防控提供了新思路。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.116

Development of 3-Year Risk Prediction Model for Type 2 Diabetes in Older Adults with Prediabetes — China, 2019–2022

Xiujuan Zhang^1,&; Yunfan Li^2,&; Virginia Byers Kraus³; Yonghui Wang¹; Xin Gao²; Bowen Wang²; Zhaoxue Yin^2,4,#

1. Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China;

2. Chinese Center for Disease Control and Prevention, Beijing, China;

3. Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, NC, USA;

4. National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, China.

^& Joint first authors.

^# Corresponding authors: Zhaoxue Yin, yinzx@chinacdc.cn.

Prediabetes is a well-established risk factor for type 2 diabetes development. While existing risk prediction models primarily focus on the general adult population, those specifically designed for older adults remain scarce. This study aimed to develop and validate a 3-year risk prediction model for type 2 diabetes specifically for older adults with prediabetes. Data were derived from the Health Aging Evaluation Longitudinal Survey (HAELS), which included 1,127 older adults with prediabetes defined by fasting plasma glucose (FPG) between 5.6–7.0 mmol/L at baseline (2019). Incident diabetes was defined as FPG ≥7.0 mmol/L at 3-year follow-up (2022). A multivariable Cox proportional hazards regression model with stepwise variable selection was used to identify predictors and construct the prediction model. Bootstrapping was employed for internal validation. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA). A nomogram was constructed to visualize individualized risk. Seven predictors were included in the final model: age, physical activity, waist circumference, baseline FPG, triglycerides, systolic blood pressure, and dessert intake. The model demonstrated good discrimination (AUC=0.752 in the training dataset, 0.793 in the validation dataset) and satisfactory calibration. DCA indicated a net clinical benefit within a threshold probability range of 0.02–0.5. This model, demonstrating good predictive performance and clinical utility, provides a simple and practical tool to estimate the 3-year diabetes risk in older adults with prediabetes.

老年糖尿病前期人群2型糖尿病3年风险预测模型的构建 — 中国，2019–2022年

张秀娟^1,&；李云帆^2,& ； Virginia Byers Kraus³；王永慧¹；高欣²；王博文²；殷召雪^2,4,#

1. 内分泌科，首都医科大学附属北京朝阳医院，北京，中国；

2. 中国疾病预防控制中心，北京，中国；

3. 杜克大学医学院杜克分子生理研究所，达勒姆市，北卡罗来纳州，美国;

4.辐射防护与核安全医学所，中国疾病预防控制中心, 北京，中国。

^& 共同第一作者。

^# 通信作者：殷召雪，yinzx@chinacdc.cn。

糖尿病前期发展为2型糖尿病的风险较高，已有的风险预测模型多针对一般成人，但适用老年人的预测模型非常缺乏。本研究旨在构建并验证一个老年糖尿病前期人群3年糖尿病发病风险预测模型。本研究基于中国"健康老龄化评估纵向调查 (HAELS)"。纳入2019年基线空腹血糖 (FPG)水平为5.6–7.0 mmol/L的1,127名65岁及以上老年人，随访至2022年。2022年新发糖尿病定义为FPG ≥7.0 mmol/L。采用多变量Cox比例风险回归模型，利用逐步筛选法识别关键预测因子建立预测模型，并通过自助法 (bootstrapping)构建验证集进行内部验证。通过ROC曲线下面积 (AUC)、校准曲线及决策曲线 (DCA)评估模型性能，并构建诺模图用于个体风险评估。最终模型纳入7个独立预测因子：年龄、锻炼、腰围、基线空腹血糖、甘油三酯、收缩压和甜食摄入频率。模型在训练集和验证集中的AUC分别为0.752和0.793，校准曲线拟合良好。决策曲线显示，在0.02–0.5阈值概率范围内表现出较好的临床净效益。本研究构建的风险预测模型可有效识别老年糖尿病前期人群中高风险个体，具备良好的预测性能和临床实用价值。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.117

Association Between Triglyceride-glucose Index, Its Trajectories and the Risk of Large for Gestational Age — Beijing Municipality, China, 2018–2022

Lirui Zhang^1,&; Xin Yan^2,&; Wei Zheng¹; Xianxian Yuan¹; Ruihua Yang¹; Junhua Huang¹; Huiyuan Pang¹; Yixuan Lu¹; Yujie Zhang¹; Tengda Chen¹; Ziyu Wang¹; Guanghui Li^1,#

1. Department of Nutrition and Endocrine Metabolism, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China.

2. Department of Nutrition and Endocrine Metabolism, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.

^& Joint first authors.

^# Corresponding authors: Guanghui Li, liguanghui@ccmu.edu.cn.

To investigate the associations of the triglyceride-glucose (TyG) index in different trimesters and its trajectories with the risk of large for gestational age (LGA). A prospective cohort study was conducted including 46,236 singleton pregnant women who received regular antenatal care and delivered at Beijing Obstetrics and Gynecology Hospital, Capital Medical University between 2018 and 2022. Neonates were categorized into the LGA group (n=9,138) and the non-LGA group (n=37,098) based on birthweight. Pregnant women were stratified into high TyG (≥75th percentile) and low TyG (<75th percentile) groups based on their TyG index in each trimester. TyG trajectories across pregnancy were identified using group-based trajectory modeling with a quadratic polynomial function. Binary logistic regression was used to evaluate the associations between TyG levels, TyG trajectories, and LGA. In all three trimesters, the TyG index was significantly higher in the LGA group than in the non-LGA group. High TyG levels were associated with increased risks of LGA by 15%, 34%, and 80% in the first, second, and third trimesters, respectively. Four TyG trajectories were identified: consistently low, low-to-high, high-to-low, and consistently high. Compared with the consistently low group, the low-to-high [adjusted odds ratio (aOR)=1.37, 95% confidence interval (CI): 1.20, 1.56] and consistently high (aOR=1.29, 95% CI: 1.22, 1.37) groups showed significantly increased risks of LGA, whereas no significant association was observed in the high-to-low group (aOR=0.98, 95% CI: 0.91, 1.05). Elevated TyG levels throughout pregnancy were associated with an increased risk of LGA. Maternal TyG levels may serve as a potential biomarker for excessive fetal growth. Monitoring and optimizing TyG levels during pregnancy, particularly from the first trimester onward, may contribute to lowering the risk of LGA, although interventional studies are needed to further verify this association.

甘油三酯-葡萄糖指数及其变化轨迹与大于胎龄儿的关系 — 北京直辖市，中国，2018–2022年

张黎锐^1,&；严欣^2,&；郑薇¹；袁仙仙¹；杨蕊华¹；黄俊花¹；庞慧源¹；卢怡璇¹；张雨洁¹；陈腾达¹；王紫玉¹；李光辉^1,#

1. 营养与内分泌代谢科, 首都医科大学附属北京妇产医院，北京妇幼保健院，北京，中国；

2. 营养与内分泌代谢科，首都医科大学附属北京妇产医院，北京，中国。

^& 共同第一作者。

^# 通信作者：李光辉, liguanghui@ccmu.edu.cn。

探讨妊娠各阶段甘油三酯-葡萄糖（triglyceride-glucose, TyG）指数及其动态变化轨迹与大于胎龄儿（large for gestational age, LGA）的关系。采用前瞻性队列研究设计，纳入2018-2022年于首都医科大学附属北京妇产医院规律产检并分娩的46,236例单胎孕妇及其新生儿。根据出生体重将新生儿分为LGA组（n=9,138）和非LGA组（n=37,098）。基于妊娠早、中、晚期TyG指数水平，将孕妇分为高TyG组（≥第75百分位数）和低TyG组（<第75百分位数）。基于组轨迹模型识别孕期TyG指数变化轨迹，通过二元Logistic回归分析评估各孕期TyG水平及变化轨迹与LGA的关联。在各孕期，LGA组的TyG指数均显著高于非LGA组。妊娠早、中、晚期高TyG水平的孕妇分娩LGA的风险分别增加15%、34%和80%。轨迹分析共识别出4种TyG轨迹：持续低水平、低-高递增型、高-低递减型及持续高水平。与TyG指数持续低水平组孕妇相比，低-高递增型（aOR=1.37, 95% CI: 1.20, 1.56）和持续高水平组（aOR=1.29, 95% CI: 1.22, 1.37）LGA风险显著增加，而高-低递减型组的风险差异无统计学意义（aOR=0.98, 95% CI: 0.91, 1.05）。妊娠各阶段TyG指数升高增加LGA风险。母体TyG水平可能作为胎儿过度生长的潜在生物标志物，孕期监测并调控TyG指数可能有助于降低LGA发生风险。未来需通过干预性研究进一步验证调控妊娠期TyG水平与降低LGA风险的关联。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.115