The impact of hypertension on NCDs has been recognized for more than 60 years. Evidence showed that when the SBP exceeded 115 mmHg, the incidences for stroke and coronary heart disease began to rise, regardless of the inconsistent criteria for hypertension [31,32,33]. Based on these evidence, we projected death burden related to high SBP in Sichuan, the largest developing province in Southwest China. Comparing with the natural trend in 2030, if the prevalence of high SBP could be reduced by 25%, the deaths of NCDs, CVD and CKD would reduce by 27.1 thousand, 26.2 thousand and 0.8 thousand for people aged 30–69; and the mortality of the three types of diseases would reduce by 10.8, 32.8 and 16.0%; and the premature mortality would reduce by 9.9, 32.0 and 16.0%, respectively.
WHO reported that the prevalence of hypertension in developed countries was declining, but rising rapidly in developing countries [7]. In our study, we found that the population SBP level in Sichuan would be continuously rising, while the death rates of NCDs, CVD and CKD would be declining, which was similar to the national trend [34]. It’s good to see that there would be generally downward trend of deaths, mortality and probability of dying for people aged 30–69. This may be attributed to the improvement of economic, which is closely related to progress of public health services and mortality [4, 35]. While the death number for CVD and CKD would increase mainly due to aging population and increasing of population size, which can be proved by the reducing of premature mortality.
Although the NCDs mortality continued to decline, the high and rising prevalence of high SBP, low awareness and control of hypertension, aging population may bring a large number of non-fatal disease burden in the future [10, 36]. If we ignore this existing circumstances, it will become an obstacle to achieve the “healthy China action plan” and WHO requirement, who demand the standardized management rate of hypertension would be no less than 60 and 70% in 2022 and 2030 respectively, and the premature mortality of CVD would be reduced by 30% [27, 30, 37].
If we can maintain the current prevalence of high SBP and steadily improve our economic and medical circumstance, we would achieve the WHO demand of reducing premature mortality due to CVD. But we need to do more if we want to make sure that our goals can be met or achieved earlier. This study showed the health benefits under different scenarios, which provided a clear vision to government for decision-making. It highlighted the importance of hypertension control for NCDs, CVD and CKD, and also found that men would benefit more than women.
Compared with the areas with relatively good economic conditions in the east and central China, there is still a lot of room for progress in the west regions, while number of hypertension patients under standardized management in the east and central was twice that in the west [38, 39], and management rate of hypertension patients in Sichuan Province was about 40% [40].
There are many international experiences and evident measures in prevention and control of hypertension, such as comprehensive intervention strategies, lifestyle changes and drug therapy [41, 42]. We also hope to emphasize that different regions should choose cost-effective measures based on local conditions. For example, based on the situation in Sichuan, improvements of the following five aspects may be effective. Firstly, we can rely on National Essential Public Health Services (EPHS), which can improve the treatment and control on patients, as well as basic healthcare services to every citizen [43, 44].
Secondly, it is particularly important to take care of the elderly as the population, is aging. Research found that the hypertension control rate was especially low in the elderly [45]. The elderly usually suffered from multiple diseases. Hypertension not only coexisted with common chronic diseases such as diabetes, but also increased the risk of other diseases [46].
Thirdly, providing essential free medicines to the patients in need, especially for the poor. The economic development and distribution of medical resources in Sichuan was unbalanced, and so was the primary care system. If the EPHS or other policies can provide long-term free essential treatments, it may improve hypertension control, especially in the poorer areas.
Fourthly, salt reduction actions. There are many risk factors of hypertension, including personal behaviors and environmental factors [47]. Sichuan dishes is famous for its flavour deep and rich taste, but the high sodium problem is common [48,49,50]. Thus, salt reduction would be the most effective way to reduce blood pressure in the population, which is one of the action strategies recommended by the WHO.
Lastly, the WHO CVD risk charts can be a useful tool to classify the risk of the population and help to design the tailored control strategies [51], which may effectively save the limited medical resources including financial and human resources, especially in underdeveloped areas with large population.
There are few strengths of this study. Firstly, it may be one among few studies to predict the death burden of high HBP toward 2030 and potential health benefits of hypertension control for the large poorer region of China. Secondly, the GBD and WHO study data and methods were adopted in this study, which strengthened the methodological rigorous and international comparability of this study. Other developing countries or regions with similar contexts may adopt the methods and make international or regional comparison with findings from our study to support their health policy making. Thirdly, the comprehensive quantitative prediction and presentation of the death burden NCDs, CVD and CKD of the working age group (30–69) and the benefits of control measures under different scenarios provided governments and the public explicit evidence to empower health communication of hypertension control and support relevant policy making.
There were several limitations of this study. Firstly, the estimation was based on China GBD data. Although the validation of data collecting and prevalence estimation methods were published in other literatures [3, 5]. Its accuracy still could be improved by combining with local survey data in the future. Secondly, this study assumed that all factors except SBP followed natural trend, so many other disease-related variables were not included in the prediction, such as economic, behavioral, environmental factors etc. Further studies would be enhanced to take more risk factors into account to obtain more precise estimation.