The findings indicated high rates in the prevalence of pre-hypertension and hypertension, relatively low levels in hypertension awareness, treatment, and control, and a total increase in the hypertension prevalence, awareness, and control in rural Southwestern China. However, the trend in the treatment of hypertension did not differ over the 7 years studied. The findings also indicated that ethnicity and individual SES have significant relationships with actual hypertension prevalence, awareness, and control, as well as the temporal trends in the hypertension prevalence, awareness, and control.
In the study, the prevalence of pre-hypertension (50.0%) in Yunnan Province was greater than that observed in central China (27.4%)  or Iran (31.6%) . The hypertension prevalence (39.5%) in Yunnan Province was also higher than in other parts of China (24.7%)  and other Asian countries, including Myanmar (34.2%) , Vietnam (18.4%) , and other low- and middle-income countries (32.3%) . The prevalence of pre-hypertension and hypertension was relatively high in rural Yunnan Province across the study period. The study did not show a growth in the prevalence of pre-hypertension over the 7 years studied. However, it revealed a substantially increasing trend in hypertension prevalence and indicated that hypertension is a chief and increasing public health issue in the regions under study. The findings suggested that more effective interventions are needed to avoid and control hypertension. Encouragingly, the hypertension awareness, treatment, and control rates (53.1%, 75.7%, and 30.6%, respectively) in 2016 were higher than those found in a national study of China (36.0%, 22.9%, and 5.7%) , indicating that hypertension health education programs and improving access to healthcare have helped achieve progress in rural Southwestern China.
The study also revealed gender variances in the prevalence of pre-hypertension, in hypertension awareness and control, as well as in trends in the hypertension prevalence. The hypertension prevalence, awareness, and control increased markedly both men and women in rural Southwestern China over the seven years studied, similar to the results of rural areas conducted in Myanmar . One possible reason for the variance in the prevalence of pre-hypertension between men and women is that men meet metabolic hazard opportunities for pre-hypertension more commonly than women. Although previous Chinese studies demonstrated that males had a higher hypertension prevalence than females [15, 17], our study showed no relationship between gender and the hypertension prevalence. Greater awareness and control rates in females were found in the study, which can be explained by previous research indicating that females report more use of health services than males . Thus, more screening and treatment projects and opportunities for males are desired.
The study also showed ethnic differences in temporal trends in hypertension prevalence, and hypertension awareness, treatment, and control in rural Southwestern China. Consistent with another study conducted in Europe , ethnic variation concerning hypertension was found in the study. In 2009, the Han people’s hypertension prevalence was found to be equivalent with that in ethnic minority groups. However, the Han people had higher prevalence of hypertension than ethnic minority populations over the seven years studied. One of the reasons might be that ethnic minorities have healthier lifestyles, such as plain food and more activities . In both 2009 and 2016, the treatment rate of hypertension in ethnic minority populations was significantly lower than which in the Han people, which may be attributed to the economically disadvantaged status of the ethnic minority population . Furthermore, only the Han majority population improved the rates in hypertension awareness and control. Thus, specific efforts must be taken in the ethnic minority groups to advance the awareness, treatment, and control of hypertension as well as to improve their economic status and their access to medical services.
In the study, we discovered that the level of education impacted the hypertension prevalence, awareness, and control. In 2016, the hypertension prevalence rate was higher in illiterate group than in their counterparts. This result was inconsistent with that from a prior study , which reported that people who have higher education position had a higher hypertension prevalence. Over the seven years we studied, the hypertension prevalence markedly increased in less educated people. However, there was no remarkable change in the increase of awareness, treatment, and control between different education levels groups. In particular, the study showed stable treatment rates of hypertension between the two survey years, suggesting that the treatment of hypertension had entered a bottleneck stage in the study region, and novel effective measures should be taken to continue to improve the treatment rate. In both 2009 and 2016, higher rates in awareness and control were found in more educated people than less educated participants. Although the treatment of hypertension did not differ in groups with diverse education level, the control of hypertension was significantly lower in illiterate groups than in educated groups. The specific reasons need further study.
In this study, the hypertension prevalence in the low-income population significantly increased over the 7 years studied. Low-income individuals were more possible to experience hypertension than their higher-income ones. This finding aligned with those in previous studies [12, 26], but it was inconsistent with other studies [25, 27]. Although there was a significant increase in awareness between different income groups over the 7 years studied, it only appeared in the high-income group for control. Encouragingly, the study revealed a similar treatment rate of hypertension between low-income participants and their higher-income counterparts both in 2009 and in 2016. Although the low-income participants had equivalent awareness and treatment of hypertension as their higher-income counterparts, the rate of control was dramatically lower in the low-income participants than their counterparts over the 7 years studied. The reasons might be low-income people use incorrect treatment methods or do not adhere to their treatment for a long time . The findings underline an urgent need to improve the control of hypertension for the low-income population.
There were some limitations in the study. First, as the data were collected using a cross-sectional design, we were unable to determine causal relationships. Second, the trends in prevalence, awareness, treatment, and control of hypertension were analyzed based on a seven years study period, which is a relatively short-range time period; to determine whether the trends will persist over a longer time frame, more data will be needed.