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The comparison of the prevalence, awareness, treatment and control of hypertension among adults along the three provinces of the Lancang–Mekong River countries—China, Laos and Cambodia

Archives of Public Health volume 82, Article number: 224 (2024) Cite this article

Abstract

Background

Under the background of similar geography and culture in Lancang-Mekong countries and rapid changes in the regional economy and lifestyle, this study aimed to describe and compare the prevalence, awareness, treatment, and control of hypertension and assess the hypertension care cascade in three provinces of China, Laos, and Cambodia.

Methods

A cross-sectional study was conducted between 2021 and 2023 in the three provinces of Lancang–Mekong River countries using consistent investigative procedures. We included 11,005 participants aged ≥ 18 years from three provinces, and data were collected through questionnaires, physical examinations, and biochemical tests. We analyzed the cascade of hypertension care and compared the prevalence, awareness, treatment, and control of hypertension.

Results

The hypertension care cascade indicated that 46.3%, 51.6%, and 63.1% of patients in Yunnan Province (China), Oudomxay Province (Laos), and Ratanakiri Province (Cambodia), respectively, were not diagnosed, and 10.7%, 12.8% and 21.1% of patients, respectively, did not receive treatment. After sex-age standardization, the prevalence rates of hypertension in the three provinces were 33.4%, 34.5%, and 23.6%, respectively. Higher awareness rate in Yunnan Province (53.4%) and Oudomxay Province (46.5%) than in Ratanakiri Province of Cambodia (39.7%). The treatment rate of hypertension in Yunnan Province (42.4%) was higher than that in Oudomxay Province (34.5%), and Ratanakiri Province (16.9%). In addition, less than 20% of the patients in the three provinces had their blood pressure under control. The factors associated with hypertension differed across the three provinces.

Conclusions

In the three provinces of the Lancang-Mekong River Basin countries, there is a high burden of hypertension and a significant unmet need for hypertension care. Targeted and precise intervention strategies are urgently needed to improve the awareness, treatment, and control of hypertension in low- and middle-income regions.

Graphic Abstract

Peer Review reports

Text box 1. Contributions to the literature

• This study indicated a high prevalence of hypertension and low rates of awareness, treatment, and control in the three provinces of the Lancang-Mekong countries, especially in Oudomxay province (Laos) and Ratanakiri province (Cambodia).

• A significant loss of patients at each step of the hypertension care cascade, especially in Laos and Cambodia, where only 8.1% and 5.0% of patients were screened, diagnosed, treated, and controlled.

• Undiagnosed hypertension is the most significant obstacle to control blood pressure in the three Lancang-Mekong River provinces, developing and implementing targeted intervention strategies and precision management of hypertension.

Introduction

Hypertension is a significant risk factor and a leading cause of mortality and premature death among non-communicable diseases (NCDs) [1, 2], reportedly affecting more than 1 billion individuals globally, with the majority (two-thirds) living in low- and middle-income countries (LMICs).

The Lancang-Mekong River is a major transboundary river that originates in the Qinghai‒Tibet Plateau in China and flows through six LMICs- China, Myanmar, Laos, Thailand, Cambodia and Vietnam [3]. The inhabitants of this region share similar living environments, lifestyles, dietary patterns, and cultural connections. In addition, Lancang–Mekong River countries are experiencing rapid economic booms and quick hypertension epidemiological transitions [4].

Hypertension emerged as the most critical NCD in Lancang–Mekong River countries (37.4%) [5, 6]. The prevalence of hypertension among adults aged 18–64 years was 20% in Laos in 2013 [7], 23.5% among those aged 40–69 years in Cambodia in 2016 [8], and 27.5% among adults aged ≥ 18 years in China in 2018 [9]. The varying inclusion criteria and diagnostic definitions across different years render a direct comparison of prevalence among these countries nearly impossible. There is a lack of up-to-date data on the prevalence, awareness, treatment, and control of hypertension in this region, which may hinder the implementation of health policies and public health interventions to reduce the burden of NCDs in these areas. Therefore, this study aimed to describe and compare the prevalence, awareness, treatment, and control of hypertension by sex and age in three provinces of Lancang–Mekong River countries and assess the hypertension care cascade.

Methods

Study design and participants

This cross-sectional study was conducted in three low-income provinces [10] along the Lancang–Mekong River- Yunnan Province of China, Oudomxay Province of Laos, and Ratanakiri Province of Cambodia (Details of the survey sites are provided in Additional file 1). As a less developed province in Southwest China, Yunnan Province borders northern Laos, with a total population of approximately 47.2 million [11]. The selection procedure for the Yunnan samples has been described in detail in previous studies [12]. In brief, a total of 8860 residents aged 18 and older were selected via a multistage stratified random sampling method from January to December 2021. Oudomxay province is situated in northern Laos adjacent to China, with an estimated population of approximately 322,000 thousand and a per capita GDP of approximately USD 1368 [13, 14]. Ratanakiri Province is located in northeastern Cambodia and ranks among the lowest per capita income provinces in the country. The province borders Laos and has an approximate population of about 150,000 [15]. During the survey conducted from September to December 2022, samples were selected from Oudomxay Province (Laos) and Ratanakiri Province (Cambodia). First, all towns and villages within these provinces were categorized into urban or rural areas for primary sampling. Two areas were subsequently selected for the urban and rural areas, and all eligible residents in these villages were included in the survey. The inclusion criteria for participation across the three provinces were as follows:

The selection criteria were as follows: ① age ≥ 18 years; ② residency at the survey site for more than six months within the past year; ③and signed informed consent. The exclusion criteria were as follows: ① inability to cooperate due to severe physical disorders or psychological conditions; ② pregnancy; ③ and missing blood pressure measurement information, previous hypertension diagnosis, and medication history. In total, 8,860 participants from Yunnan Province (China), 1,039 from Oudomxay Province (Laos), and 1,107 from Ratanakiri Province (Cambodia) were included (see Additional file 2 for sample size calculation details).

The study was reviewed and approved by the Central Ethics Committee of Fuwai Hospital (China), the Ethics Committee of Saimangkorn International Hospital (Laos), and the Referal Hospital (Cambodia). The survey was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. All participants provided written informed consent and their signatures.

Data collection and measurements

This survey followed the WHO STEPS (STEPwise approach to surveillance) methodology [16], which includes face‒to‒face questionnaire interviews (STEP 1), physical examinations, and blood pressure measurements (STEP 2), followed by biochemical index testing (STEP 3).

In Yunnan Province, the field survey utilized a structured questionnaire developed by the National Center for Cardiovascular Disease (Beijing, China) and used an iPad for data collection and management. A trained investigation team comprising 20 experienced clinicians, nurses, pharmacists, and medical students executed this task. The investigators performed face‒to‒face interviews with the subjects to collect demographic information such as sex, age, residence, ethnicity, education level, behavior and lifestyle, disease history, etc. Subsequently, the height, weight, and blood pressure of each participant were measured using calibrated standardized instruments. Finally, fasting plasma glucose levels, total cholesterol, and uric acid concentrations were measured after 8 h of fasting.

The field questionnaires for Oudomxay Province (Laos) and Ratanakiri Province (Cambodia) were compiled from the Chinese questionnaire, with professionals translating them into Lao and Khmer (the official languages of Cambodia) questionnaires, respectively. The investigation video in English from China was shared with investigators from Laos and Cambodia. Subsequently, teams comprising 10–15 experienced doctors and nurses received training to comprehend the objectives, content, field investigation skills, and relevant knowledge of NCDs. The team conducted a face‒to‒face questionnaire survey with respondents, and the procedures and contents of all the questionnaires, physical examinations, and biochemical index examinations were consistent with China.

Blood pressure measurement and outcome variables

Blood pressure (BP) was measured on the right upper arm of the subjects using the OMRON HBP-1300 sphygmomanometer (OMRON Healthcare Co., Ltd., Kyoto, Japan) in Yunnan Province (China), whereas OMRON HEM-9200 L (OMRON Healthcare Co., Ltd., Kyoto, Japan) devices were utilized in Laos and Cambodia. Systolic and diastolic blood pressure (SBP, DBP) measurements were taken at least 5 min apart, participants in Yunnan Province (China) took three measurements, and participants in Oudomxay and Ratanakiri Province took two measurements and recorded their measurement readings. The mean values of blood pressure were calculated separately for statistical analysis.

We used the International Society of Hypertension and the WHO guidelines definition, hypertension was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg, or self-reported use of antihypertensive drugs in the past two weeks [17, 18]. Among hypertensive patients, self-reported previous diagnosis of hypertension by a physician was considered as “awareness”; taking antihypertensive medication in the past 2 weeks was considered as “treatment”; SBP < 140 mmHg and DBP < 90 mmHg was considered as “control” [19]. Outcome variables included the prevalence, awareness, treatment, and control of hypertension.

Explanatory variables

Drawing upon previous studies [15, 20], we selected potential variables for the prevalence, awareness, treatment, and control of hypertension. Age was divided into four groups (18–34, 35–49, 55–64, and ≥ 65) [21], and educational attainment was classified as (no education/illiterate; primary school; junior high school and above). The main nationality in China was Han, that in Laos was Lao-Tai, and that in Cambodia was Khmer. Current smokers were defined as those who smoked every day and at least 7 cigarettes per week for at least 6 months [22]. Current drinkers were defined as those who consumed alcohol in the past month [23]. Insufficient physical activity was defined by the WHO as less than 75 min of strenuous activity or less than 150 min of moderate activity per week [24]. A frequency of less than 1–3 days per month for fruit and vegetable consumption was classified as inadequate [25]. Body weight was divided by the square of height to obtain the body mass index (BMI). A BMI of 25 to 29.9 kg/m2 was considered overweight, and a BMI of ≥ 30 kg/m2 as obese [26]. Hypercholesterolemia was defined as total cholesterol ≥ 5.17 mmol/l (200 mg/dL) or the use of lipid-lowering drugs [27]. Hyperuricemia was defined as uric acid ≥ 420.0 µmol/L (7.06 mg/dL) in males and ≥ 360 µmol/L (6.05 mg/dL) in females [28].

Statistical analysis

The procedure for calculating the hypertension care cascade involved entry into each subsequent stage of the cascade, which was contingent on an individual having achieved the previous stage. The number of people with hypertension formed the denominators for all other stages of the respective care cascade. Additionally, the loss from each step in the care cascade was calculated using the people who had achieved the previous step as the denominator [29].

Descriptive statistics were used to present the demographic characteristics and measurement data. Categorical variables were reported as frequency number (n) and percentage (%), and the group differences were compared using the chi-square test. Continuous variables were described with means and standards, and t-tests were employed to compare sex differences. We used direct standardization to calculate the prevalence, awareness, treatment, and control of hypertension in the three provinces, and 95% confidence intervals (CIs) were estimated. Furthermore, the cascade of the hypertension care framework [30] was adapted to assess the disengagement of continuum care for hypertension patients. Finally, factors associated with the prevalence, awareness, treatment, and control of hypertension were determined using multivariable logistic regression models. Variables with a p value < 0.10 on univariate analysis qualified for inclusion in the multivariable models, odds ratios (ORs) and 95% CIs were also reported. All statistical analyses were performed using SPSS 26.0 and R 4.0.5 software (https://www.r-project.org/). A two-sided p value of < 0.05 was considered statistically significant.

Results

Participants characteristics

A total of 11,005 participants aged ≥ 18 years were included in this study, including 8859 in Yunnan Province (China), 1039 in Oudomxay Province (Laos), and 1107 in Ratanakiri Province (Cambodia). The mean age of the participants was 44.3 ± 18.0 years in Yunnan Province, 47.2 ± 16.5 years in Oudomxay Province, and 45.1 ± 12.4 years in Ratanakiri Province. Among the three provinces, the proportion of current smokers was higher among males than females. In Yunnan Province (China), the prevalence of inadequate fruit and vegetable intake, overweight or obesity, and hyperuricemia was found to be higher in men than in women, and SBP and DBP were also elevated in men compared with women (p < 0.05). The prevalence of hypercholesterolemia is higher among females than among males in Oudomxay Province (Laos). The proportion of current drinkers and the prevalence of hyperuricemia among females in Ratanakiri Province (Cambodia) were higher than those among males (see Table 1).

Table 1 Demographic and clinical characteristics of participants by sex in Yunnan Province (China), Oudomxay Province (Laos), and Ratanakiri Province (Cambodia), 2021–2023
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Gaps in the cascade of hypertension care

Among hypertensive patients, 1598 (53.7%), 185 (48.4%), and 96 (36.9%) were previously diagnosed with hypertension in Yunnan Province (China), Oudomxay Province (Laos), and Ratanakiri Province (Cambodia), respectively. Furthermore, the loss of care cascade between diagnosis and treatment regimen were 10.7%, 12.8%, and 21.1%, respectively. There were 27.8%, 27.5%, and 10.8% of patients with hypertension who had been treated but whose blood pressure was not controlled in the three provinces, respectively (see Fig. 1).

Fig. 1
figure 1

Hypertension care cascade in Yunnan Province (China), Oudomxay Province (Laos), and Ratanakiri Province (Cambodia), 2021–2023

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Comparison of hypertension prevalence, awareness, treatment, and control

The standardized prevalence of hypertension in Yunnan Province (China), Oudomxay Province (Laos), and Ratanakiri Province (Cambodia) were 33.4%, 34.5%, and 23.6%, respectively. The awareness rates of hypertension were 53.4%, 46.5%, and 39.7%, respectively. The treatment rates of hypertension were 42.4%, 34.5%, and 16.9%, respectively. The control rates of hypertension were 16.9%, 15.3%, and 17.2%, respectively (see Fig. 2). The prevalence of hypertension was higher in males than in females in all three regions (see Additional files 3–5).

Fig. 2
figure 2

Standardized hypertension prevalence, awareness, treatment, and control rates in Yunnan Province (China), Oudomxay Province (Laos), and Ratanakiri Province (Cambodia), 2021–2023

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Age trends of prevalence, awareness, treatment, and control of hypertension

In all three provinces, the prevalence of hypertension increased gradually with increasing age (see Fig. 3A, Additional file 6). Regardless of age, hypertension awareness was higher in Yunnan Province than in the other two Lancang-Mekong provinces, and an increasing trend in awareness with age was observed (p for trend < 0.05) (see Fig. 3B, Additional file 7). For hypertension awareness and control, statistical trends were observed only among participants in Yunnan Province, China, (see Fig. 3C, D, Additional files 8 and 9).

Fig. 3
figure 3

The prevalence, awareness, treatment, and control of hypertension by age in Yunnan Province (China), Oudomxay Province (Laos), and Ratanakiri Province (Cambodia), 2021–2023. p values for the trend were calculated via the Cochran‒Armitage trend test. ** p for trend < 0.01, *** p for trend < 0.001

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Factors associated with hypertension prevalence and awareness

Hypercholesterolemia was a risk factor for hypertension in the three provinces. Patients who were overweight or obese in Yunnan Province, China (OR, 2.837; 95% CI, 2.531–3.180), and Oudomxay Province (Laos) were at higher risk of hypertension (OR, 1.703; 95% CI, 1.220–2.378). In addition, ethnic minorities, current drinkers, and hyperuricemic individuals in Yunnan Province (China) increased the risk of developing high blood pressure. Current smokers in Ratanakiri Province (Cambodia) were more likely to develop hypertension than non-smokers (OR, 1.379; 95% CI, (1.004–1.893) (see Table 2).

The results revealed that the awareness and treatment rates of hypertension in the three provinces of the Lancang-Mekong Basin gradually increased with increasing age (see Additional files 10 and 11). Current drinkers was a risk factor for hypertension control in Yunnan Province, China (OR, 0.675; 95% CI, 0.508–0.897), and inadequate intake of fruits and vegetables was a risk factor for blood pressure control in Ratanakiri Province, Cambodia (OR, 0.590; 95% CI, 0.293–0.990) (see Additional file 12).

Table 2 Factors associated with hypertension prevalence by logistic regression models in Yunnan Province (China) and Oudomxay Province (Laos) and Ratanakiri Province (Cambodia), 2021–2023
Full size table

Discussions

To our knowledge, this is the first study to assess the prevalence, awareness, treatment, and control of hypertension in the Lancang–Mekong region. This study innovatively compared the prevalence, awareness, treatment, and control of hypertension using unified survey protocols and approaches in three provinces of the region. The study revealed that the standardized prevalence of hypertension in the three provinces was high (23.6-34.5%). However, the awareness rate was low (39.7-53.4%). Furthermore, the hypertension care cascade indicated that 46.3%, 51.6%, and 63.1% of patients in Yunnan (China), Oudomxay (Laos), and Ratanakiri (Cambodia) were not diagnosed, and 10.7%, 12.8% and 21.1% of patients did not receive treatment, respectively.

Compared with those reported in globally representative studies [31], the prevalence was higher in Yunnan Province, China (33.4%) and Oudomxay province of Laos (34.5%), and lower in Cambodia (23.6%), which was significantly higher than China’s national level in 2018 (27.5%) [32] and Laos (20%) [7]. These findings suggest that a few years of national economic development and lifestyle change may potentially lead to a rapid increase in the prevalence of hypertension in the provinces. Furthermore, the awareness rate of hypertension is the highest in Yunnan Province (China), and awareness rates have been observed to increase with age. These findings align with previous research on hypertension awareness rates in LMICs, such as Nepal (43.2%) and Kenya (29.4%) [33, 34], but are significantly lower than those reported in Canada, which is more economically advanced (84%) [35]. The potential reasons could be that hypertension awareness was associated with medical services and the economic development of related countries. In these three regions, the prevention and treatment of hypertension is urgent. National health systems should expand testing for hypertension by engaging widely and regularly with health services to increase awareness of hypertension.

In addition, several studies reported that being aware of hypertension could help patients receive prevention and treatment education, lifestyle guidance, and disease diagnosis and treatment in the medical unit and improve the control of hypertension, and a higher awareness rate could reduce the risk of cardiovascular events or death [36, 37]. All three countries need to strengthen their future efforts to improve the awareness rate of hypertension. In this study, the treatment rate of hypertension in Yunnan Province, China (42.4%), was higher than that in Cambodia (16.9%), similar to the reported treatment rates of 47% in the Middle East [38] and Ecuador in South America (40%) [39]. China’s relatively higher treatment rate should be related to free community screening and management from basic public health services, which are followed up and managed by primary care physicians [40]. In China, hypertension is included in the management of basic public health services, and guidelines for the prevention and treatment of hypertension are constantly being updated [41, 42]; however, Laos and Cambodia lack comprehensive guidelines, and it is recommended that the health systems of Laos and Cambodia should develop comprehensive guidelines for the individualized management of patients with hypertension according to the European Society of Hypertension and the European Society of Cardiology.

However, less than 18% of patients in the three provinces had their blood pressure under control. These findings are similar to previous reports from LMICs (8.0%) and Cambodia (28.6%) [43, 44]. In Korea, Canada and Iceland, more than half of the adults with hypertension had their conditions under control, which suggests that the Lancang–Mekong region faces a greater challenge in providing adequate hypertension care [31].

The control rate of hypertension was found to be suboptimal in all three countries, potentially due to poor medication adherence, as reported previously [45]. The study also revealed that hypercholesterolemia increased the risk of hypertension in three countries, usually with increasing age. This finding is similar to the reported results of Santosa [46] and Chow [47]. The three national health systems should develop and improve policies and guidelines to urge people with hypertension to change their health behaviors, such as antihypertensive medication adaptation, reduction of tobacco and alcohol use, and increased physical activity and consumption of fruits and vegetables, such as integrating online and offline management of the internet.

The study showed a significant loss of patients at each step of the hypertension care cascade, especially in Laos and Cambodia, where only 8.1% and 5.0% of patients were screened, diagnosed, treated, and controlled. Studies from Nigeria (60%) [48] and Selangor (26%) [49] showed that the greatest loss of care occurs at the screening and diagnosis stages (60%). In a global study [3] and India [50], the loss of hypertension care tends to be greatest at the diagnosis stage and the control stage. This ascertains that the existing care cascades are inadequate to effectively prevent and manage hypertension, with a particular focus on the prevalence of hypertension and awareness of the hypertension stage. Universal health coverage and primary health care in Laos and Cambodia should be expanded to increase screening rates and provide opportunities to improve hypertension care. In the future, work should still be aimed at treatment adherence and blood pressure control for patients. Focused on strengthening the management of hypertensive patients and providing medication guidance, lifestyle modifications, and other services through reported primary health care to reduce risk factors [51].

Future research should aim to develop interventions across regional cooperation to decrease the burden of NCDs [46], which will help achieve Cambodia’s goal of reducing the prevalence of hypertension to 9.3% by 2027 [52]. It also has value for the Lao Ministry of Health objectives in 2014 for the prevention and treatment of chronic diseases to increase the prevalence of hypertension to 13.7% by 2025 [53]. China proposed the “Belt and Road” initiative in 2013, and Laos and Cambodia, as partner countries, are working together to build a “Healthy Silk Road”, with the control of chronic diseases being the vision of each country. The survey contributes to the Lancang-Mekong River’s achievement of the United Nations Sustainable Development Goals, which aims to reduce chronic disease mortality by one-third by 2030 [54].

This study has certain limitations. First, the participants came from three provinces in the three Lancang-Mekong River countries. The sample sizes in Oudomxay and Ratanakiri province compared to Yunnan province, because Oudomxay and Ratanakiri province have lower population densities and mostly live in mountainous areas; another reason may be that the project was conducted during the COVID-19 pandemic, which limited sample selection and multicounty collaboration. Second, the analysis of the factors influencing the prevalence, awareness, treatment, and control of hypertension in various countries was based on reference groups of 18–34 years of age, and the OR value and 95% CI may be overestimated. Third, participants may experience a white coat effect and blood pressure was measured three times in China and two times in Laos and Cambodia. Consequently, better representative cohort studies are needed to reduce potential bias and improve the quality of the research.

Conclusion

Our study indicated a high prevalence of hypertension and low rates of awareness, treatment, and control in the three provinces of the Lancang-Mekong Region. There is a significant loss of patients at each step of the hypertension care cascade, especially in two provinces in Laos and Cambodia, where only 8.1% and 5.0% of patients were screened, diagnosed, treated, and controlled. The Lancang-Mekong River countries should also develop and implement targeted interventions and precision management of hypertensive patients to improve the control of hypertension and ultimately reduce the mortality and burden of NCDs.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

NCDs :

Non-communicable diseases

GDP:

Gross domestic product

WHO:

World Health Organization

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

TC:

Total cholesterol

SD:

Standard deviation

CI:

Confidence interval

OR:

Odds ratio

STEPS:

STEPwise approach to surveillance

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Acknowledgements

We would like to extend our sincere gratitude to the National Center for Cardiovascular Disease in China, the Ministry of Health and Medical Institutions in Oudomxay province of Laos, and Ratanakiri Province of Cambodia, for their invaluable support. We would also like to express our appreciation to the dedicated staff, medical personnel, and volunteers who participated in this field survey, as well as the departments and researchers involved.

Funding

This work was supported by Yunnan Provincial Department of Science and Technology Key R&D Programme Projects (202103AF140002), the Major science and technology special plan project of Yunnan Province (202302AA310045), Yunnan Provincial Department of Science and Technology Kunming Medical University Joint Special Project on Applied Basic Research (202301AY070001-045), Yunnan Provincial Key R&D Programme-Special Project for Social Development (202103AC100004), the National Key Project of Research and Development Plan during the fourteenth Five-year Plan Period (2022YFC2503400), and Yunnan Provincial Department of Science and Technology Major Science and Technology Special Programme Projects (202102AA310002).

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Author notes

  1. Huadan Wang and Liping He contributed equally to this work.

Authors and Affiliations

  1. Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China

    Huadan Wang, Min Ma, Mingjing Tang, Jiang Lu, Manli Sun, Teng Wang, Da Zhu, Lin Duo, Linhong Pang & Xiangbin Pan

  2. School of Public Health, Kunming Medical University, Kunming, China

    Huadan Wang, Liping He, Zhongjie Wang & Yu Xia

  3. Saimangkorm International Hospital, Muang Xai, Oudomxay Province, Laos

    Labee Sikanha

  4. Referal Hospital, Borkeo, Ratanakiri Province, Cambodia

    Sokha Darapiseth

  5. Yunnan Provincial Center for Disease Control and Prevention, Kunming, China

    Qiuyan Zhu

  6. Department of Structure Heart Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Xiangbin Pan

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  1. Huadan Wang
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Contributions

LP and LD contributed to the conception, design, and direction design of the study. LD, QZ, and LP guided the analysis and revised the article. HW and MT were co-first authors and drafted the manuscript. MM, LP, TW, and YX participated in the data compilation and analysis. LS and SD completed the field implementation and coordinated all departments. JL, MS, DZ and MM checked the data for completeness. XP and LD critically reviewed and edited the manuscript. All authors have read and approved the final version of the manuscript.

Corresponding authors

Correspondence to Linhong Pang or Xiangbin Pan.

Ethics declarations

Ethics approval and consent to participate

The study involving human participants was reviewed and approved by the Central Ethics Committee of Fuwai Hospital (Beijing), the Ethics Committee of Saimangkorn International Hospital in Laos, and the Ethics Committee of Referal Hospital in Cambodia. The survey was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Before the survey, the participants provided written informed consent and their signatures.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Linhong Pang and Xiangbin Pan are joint corresponding authors.

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Wang, H., He, L., Ma, M. et al. The comparison of the prevalence, awareness, treatment and control of hypertension among adults along the three provinces of the Lancang–Mekong River countries—China, Laos and Cambodia. Arch Public Health 82, 224 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13690-024-01458-3

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Keywords

Archives of Public Health

ISSN: 2049-3258