Three-quarters of stroke patients in China have hypertension

"Stroke is the leading cause of death in China and a significant source of disability," said Dr Tang. "Our study investigated the levels of risk factors patients had before being hospitalised for stroke, whether patients knew about their risk factors, and whether the risk factors were under control."

The researchers collected information on 20 570 patients hospitalised for acute stroke at 41 hospitals in 25 provinces in China during January to May 2011. The average age of patients was 63 years and nearly two-thirds (64%) were male.

The investigators found that 75.5% of patients had hypertension, 53.5% had high low density lipoprotein (LDL) cholesterol, 33.2% were smokers, 37.3% had diabetes and 6.5% had atrial fibrillation (irregular heartbeat).

When they looked at how many risk factors patients had, the researchers found that 75.2% of stroke patients had two or more risk factors and 43.0% had three or more risk factors.

"Most stroke patients had multiple risk factors for stroke before they were admitted to hospital with a stroke," said Dr Tang. "This shows that there are warning signs that people can address to avoid having a stroke."

For 15 329 patients this was their first stroke. Of those who had hypertension, 70% were aware of it but only 20% receiving treatment had reached their target blood pressure. Just over half of the diabetics knew about it (54.4%) but only 9.1% of those with elevated LDL were aware of the fact. Awareness of risk factors was higher in patients with recurrent stroke (83.0% for hypertension, 70.2% for diabetes and 16.1% for elevated LDL) but control rates were low.

Dr Tang said: "The pre-hospital treatment rates and control rates of risk factors were very low for both first ever and recurrent stroke patients. Both primary and secondary prevention of stroke need to be drastically improved in China to prevent deaths and disability."

"Chinese people often eat high salt diets and this is likely to be a big contributor to the high prevalence of hypertension in stroke patients," continued Dr Tang. "Lack of exercise and low prescription of medications to control blood pressure, serum LDL cholesterol and blood glucose and may also contribute to the elevated levels of risk factors."

Professor Dayi Hu, president of the China Heart Federation and president of the Chinese Association of Tobacco Control (CATC), said: "Smoking and salt consumption are out of control in China. We desperately need a ban on smoking in public plans and reduced salt levels in processed food. Prevention of cardiovascular disease has not been given enough priority and the Chinese population is paying the price through death and disability."

Professor Michel Komajda, a past president of the ESC and course director of the ESC programme in China, said: "This important study suggests that risk factor control of stroke patients in China is suboptimal since three-quarters had hypertension, half had increased LDL cholesterol and more than one-third had diabetes mellitus. It is therefore important to promote better control of risk factors and adopting a healthy lifestyle early in life in order to prevent acute disabling events such as stroke more efficiently."

Dr Tang concluded: "To reduce the devastating effects of stroke in China, people urgently need to lower the amount of salt in their diets, stop smoking, be physically active and keep alcohol within recommended levels. Doctors can help by making sure that blood pressure, glucose and lipids are at the optimal levels."