Association of age and blood pressure among 3.3 million adults: insights from China PEACE million persons project

Objective: To assess the association between blood pressure (BP) with age and its heterogeneity across various sociodemographic subgroups in China. Methods: In this cross-sectional study, we analysed the data from nearly 3.3 million individuals aged 35-75 years from all 31 provinces in mainland China collected from September 2014 through August 2019. On the basis of possible combinations of eight characteristics and antihypertensive status, subgroups of at least 10 000 individuals were created and the age--blood pressure relationship was determined for each group. Results: The study included 3 291 058 participants (59.6% women), with a mean age of 55.8 +/- 9.8 years. The prevalence of hypertension was 47.6%, of which 30.0% were taking antihypertensive medications. The mean SBP was 135.9 +/- 20.2 mmHg. SBP increased at a mean unadjusted rate of 0.639 +/- 0.001 mmHg/year. For 95% of the 25 145 subgroups, the SBP increased by 0.28--0.85 mmHg/year. The most common characteristics in the subgroups with the steepest association were female sex, rural area, low education, low-income family, Tibet region, and farmer occupation. The increase in SBP ranged from 0.13 to 0.41 mmHg/year for 95% of the treated subgroups and from 0.33 to 0.82 mmHg/year for 95% of the untreated subgroups. Conclusion: Blood pressure is positively associated with age in this study, with almost three-fold variation across subgroups, indicating subgroup differences in biology, behaviour, or exposures. Antihypertension strongly blunts the association of age and blood pressure and diminishes the variation.