Follow-up management service and health outcomes of hypertensive patients in China: A cross-sectional analysis from the national health service survey in Jiangsu province

Long-Term Effects of Sustained Regular Medication in Hypertensive Patients in Yunnan, China: A Cohort Study of 5 Years' Follow-Up

Background: The relationship between different grades of compliance to antihypertensive medication and blood pressure (BP) control rate remains unclear. This study highlighted the Chinese Basic Public Health Service (BPHS) program upgraded antihypertension medication compliance to improve the blood pressure control rate contributing to the UN sustainable development goal of lowering chronic illness fatalities by one-third by 2030. Methods: In 2015, 1254 hypertensive patients aged ≥ 35 years were selected in the baseline survey in Yunnan Province by a multistage stratified random sampling method and followed up from 2018 to 2022. Then, they were divided into three groups by tertiles as antihypertensive medicine compliance "poor," "intermittent," and "sustained" groups. Then, the robust variance Poisson regression models were performed to estimate the association between three groups and the number of referrals. Kaplan-Meier curves calculated the cumulative risk of onset and survival probability of cardiovascular events from three medication compliance groups. Results: A total of 1254 hypertension patients were included in the study; 992, 1218, 1121, 1066, and 999 hypertension patients were followed up annually. From the baseline to last follow-up, systolic BP declined with the largest decrease in the sustained group (2015: 152.88 ± 21.64 mmHg vs. 2022: 134.61 ± 10.49 mmHg, p < 0.05) and the least decrease in the poor group (2015: 157.07 ± 15.37 mmHg vs. 2022: 140.33 ± 12.04 mmHg, p < 0.05). Under the management of BPHS, the BP control rate of all three groups increased significantly. Compared with the baseline, the control rate in the sustained group reached 70% in 2022 (p < 0.01). The number of referrals from the poor group was 11.5%, higher compared with the sustained group (IRR = 1.115 and 95% CI: 1.043-1.193). The poor group also had the highest probability of cardiovascular disease (CVD). The survival probability in the sustained group was the highest and kept at 0.950 at the end of 5 years. Conclusions: High-grade compliance to antihypertensive drugs significantly improves BP control rate and reduces the risk of CVD events and mortality. The decline of medication compliance grades is closely related to decreasing BP control rate and increased risk of CVD and mortality.

Psychometric properties and measurement invariance of the health behavior scale for cancer patients in Chinese cancer population

BACKGROUND

Health behavior plays a major role in the development, progression, and prognosis of cancer. The Health Behavior Scale for Cancer Patients (HBSCP) can be used to assess the level of health behavior in cancer patients. This study aimed to explore its psychometric properties and Measurement Invariance (MI) in the Chinese cancer population.

METHODS

A longitudinal study was conducted with 567 cancer patients across two hospitals, and 428 participants underwent a second assessment three months later. Analyses were performed to evaluate reliability (internal consistency), validity (structural validity, convergent validity, and criterion-related validity), and MI of the Chinese version of the HBSCP.

RESULTS

The two-factor structural model of the 9-item scale demonstrated an excellent fit in Confirmatory Factor Analysis (CFA). Psychometric analyses indicated strong internal consistency, with Cronbach's alpha coefficients ranging from 0.846 to 0.899 and McDonald's Omega values between 0.847 and 0.897. Convergent validity was supported by Composite Reliability (CR > 0.70) and Average Variance Extracted (AVE > 0.50). Criterion-related validity was established via significant correlations with the Health-Promoting Lifestyle Profile II (HPLP-II; r = 0.653 ~ 0.760). Multi-group CFA further confirmed MI across cancer types (ΔCFI&TLI < 0.01; ΔRMSEA < 0.015) and time groups (3-month interval).

CONCLUSIONS

This study provides longitudinal evidence supporting the adequate psychometric properties and temporal stability of the Chinese version of the HBSCP, thus validating its utility for measuring health behavior in Chinese cancer populations. The Chinese HBSCP can serve as a tool for healthcare providers to assess the current status and changes in health behavior among cancer patients.

Nurse-Led Strategies for Lifestyle Modification to Control Hypertension in Older Adults: A Scoping Review

High blood pressure in older adults poses significant risks, including cardiovascular disease, stroke, and renal failure; yet, its management is often overlooked. Nurse-led personalised interventions provide essential guidance, helping patients adhere to treatment plans and adopt lifestyle changes, improving outcomes and quality of life. A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). Six electronic databases were searched systematically (CINAHL, MEDLINE, PsycINFO, EMBASE, Web of Science, and Scopus). Five research studies were included in this review, from five countries (India, Korea, China, Turkey and Thailand). Primary data were synthesised using descriptive and thematic analysis methodology. The five main themes from this review relate to nurse-led empowerment strategies for hypertension management, variability in blood pressure outcomes, the importance of tailored education and counselling, the role of regular follow-ups and support, and environmental support. Overall, nurse-led personalised interventions improve blood pressure management and patient engagement in older adults, highlighting the need for research into their long-term effectiveness and broader applicability.

Unintended Consequences of Follow-Up Care: Patient Experiences with Hypertension Management in Chinese Community Nursing

PURPOSE

Community follow-up care is essential for managing hypertension, with Chinese community nurses playing a pivotal role in sustaining long-term management. However, little research has examined how rigid or inappropriate care approaches may inadvertently cause patient discomfort. This study addresses this gap by exploring the unintended consequences of follow-up practices among community nurses caring for hypertensive patients in China.

DESIGN

A qualitative descriptive study.

METHODS

Semi-structured interviews were conducted with 23 hypertensive patients in Shenzhen between June and August 2024. Data were analyzed using iterative thematic analysis.

FINDINGS

Three themes emerged. First, standardized follow-up protocols often clashed with patients' individual needs, leading to frustration with the rigid, one-size-fits-all approach. Second, patients experienced emotional distress, feeling alienated by impersonal, task-oriented nurse communication. Third, health education communication breakdowns were prevalent, with patients finding vague lifestyle recommendations impractical and difficult to apply.

CONCLUSIONS

This study uncovers overlooked complexities in follow-up interactions, critiques the rigidity of current protocols, and challenges the predominantly positive perception of standardized follow-up care.

CLINICAL EVIDENCE

Findings underscore the need for training programs to equip community nurses with patient-centered care skills, emphasizing effective communication and personalized health education to improve patient engagement and clinical outcomes in hypertension management.

Medication adherence and blood pressure control in treated hypertensive patients: first follow-up findings from the PREDIcT-HTN study in Northern Bangladesh

INTRODUCTION

Adherence to antihypertensive medication is crucial to control blood pressure (BP) and hypertension management outcomes. In Bangladesh, as in many other countries, poor adherence to medication represents a challenge to effective hypertension management. This study aims to investigate the prevalence and relationship between medication adherence and BP management among hypertensive patients in Bangladesh.

METHODS

The PREDIcT-HTN study in Northern Bangladesh aims to evaluate major adverse clinical events in treated hypertensive patients. The study involves 2643 hypertensive patients from a medical center, with data collected through baseline information and yearly follow-ups until 2025. The first follow-up visit was conducted between January and March 2021. Following the 2020 ISH-global hypertension guideline, patients were classified as having controlled BP, grade-I, or grade-II uncontrolled BP. Patients were divided into three groups (good, moderate, and poor) based on their 9-item Hill-Bone medication adherence scale. A multinomial regression analysis was conducted to identify the association between medication adherence and BP control after adjusting potential confounders.

RESULTS

Analysis of 2276 hypertensive patients (mean age 51.31 ± 11.58 years) revealed that 36.1% had grade-I and 24.2% had grade-II uncontrolled hypertension. Most patients (78%) displayed moderate adherence, and 15% showed poor medication adherence. Certain patient subgroups had higher rates of poor adherence: females (17.1%) compared to males (12.2%), rural residents (22.4%) compared to city-dwellers (12.2%), and newly diagnosed patients (17.2%) compared to those diagnosed 2-5 years earlier (12.6%). Multivariable analysis found a strong association between medication adherence and BP control. Compared to poor adherence, moderate adherence (relative risk ratio (RRR):0.50, 95%CI:0.36-0.68) and good adherence (RRR:0.56, 95%CI:0.35-0.91) were associated with better control. Increasing age, rural living, and uncontrolled hypertension were also linked. Comorbidities worsened BP control, and managing multiple medications contributed to poor adherence and grade-II hypertension in patients.

CONCLUSION

The high prevalence of uncontrolled hypertension in Bangladesh underscores the need for improved treatment strategies. Addressing medication adherence is essential for better BP control, with particular attention needed for women, rural residents, and newly diagnosed individuals. A comprehensive approach is warranted, including strategies to enhance adherence, early diagnosis, personalized treatment, and simplified medication regimens. These efforts align with the UN's 2030 SDGs, emphasizing targeted interventions for equitable healthcare access and outcomes.

Trends by age and sex and projections of disease prevalence from studying hypertensive heart disease in China over the past three decades

BACKGROUND

Hypertensive heart disease (HHD) is a common cause of cardiovascular disease and mortality worldwide, and its burden is increasing with aging populations.

OBJECTIVES

This study aimed to estimate the prevalence and mortality rates of HHD in mainland China and Taiwan Province using data from the Global Burden of Disease Study 2019 (GBD 2019), and forecast the development trend of HHD from 2020 to 2024.

METHODS

We obtained data on number of cases, deaths, crude prevalence rate, crude death rate, age-standardized prevalence rate (ASPR), and age-standardized death rate (ASDR) for mainland China and Taiwan Province from 1990 to 2019 from the GBD 2019. Joinpoint software was used to estimate average annual percentage change (AAPC) with 95% confidence intervals, and the number of HHD cases in China from 2022 to 2024 was predicted by the exponential smoothing method.

RESULTS

Between 1990 and 2019, HHD cases and deaths increased in mainland China, but the ASPR and ASDR decreased by 5.96% and 48.72%, respectively. In Taiwan Province, ASPR and ASDR decreased by 7.66% and 52.14%, respectively. The number of HHD cases and death rates varied by region, age, and sex, with a higher number of cases in mainland China than in Taiwan Province. By 2024, the number of HHD cases in mainland China was projected to be over 9.6 million cases, and in Taiwan Province, it was projected to surpass 120,000 cases.

CONCLUSION

The differences in HHD cases between mainland China and Taiwan Province in terms of age and sex indicated the need for effective prevention and control measures, especially targeting the elderly population. These findings can inform policymakers and health professionals in the development of targeted prevention and treatment strategies and resource allocation for HHD in China.

The impact of hypertension follow-up management on the choices of signing up family doctor contract services: does socioeconomic status matter?

BACKGROUND

This study aimed to explore the association between hypertension follow-up management and family doctor contract services, as well as to examine whether socioeconomic status (SES) had an interaction effect on this relationship among older adults in China.

METHODS

We used data from the sixth National Health Service Survey of Shandong Province, China, including 3,112 older adults (age ≥ 60 years) with hypertension in 2018. Logistic regression models and a margins plot were used to analyze the role of SES in the relationship between hypertension follow-up management and family doctor contract services.

RESULTS

The regular hypertension follow-up management rate and family doctor contracting rate were 81.8% and 70.9%, respectively, among older adults with hypertension. We found that participants with regular hypertension follow-up management were more likely to sign family doctor contract services (OR=1.28, 95%CI: 1.04, 1.58, P=0.018). The interaction effect occurred in the groups who lived in rural areas (OR=1.55, 95%CI: 1.02, 2.35), with high education level (OR=0.53, 95%CI: 0.32, 0.88) and had high incomes (OR=0.53, 95%CI: 0.35, 0.81).

CONCLUSIONS

Our findings suggested that regular hypertension follow-up management was associated with family doctor contract services and SES influenced this relationship. Primary health care should improve the contracting rate of family doctors by strengthening follow-up management of chronic diseases. Family doctors should focus on improving services quality and enriching the content of service packages especially for older adults with higher income and education level.

Temporal-spatial distribution characteristics and associated socioeconomic factors of visiting frequency for rural patients with hypertension in Fujian Province, Southeast China

BACKGROUND

Regular follow-up and medication can effectively reduce the risk of adverse outcomes for patients with hypertension. This study aimed to explore the temporal-spatial distribution characteristics and associated socioeconomic factors of visiting frequency for rural patients with hypertension in Fujian province from 2011 to 2016.

METHODS

The medical records of patients with hypertension were abstracted from the database of New Rural Cooperative Medical Scheme. Geographically and temporally weighted regression model was used to analyze the associations between percentage of patients whose visiting frequency ≥ 4 times within a year and seven socioeconomic factors at the county level.

RESULTS

The visiting rate of rural patients with hypertension was 0.79%, 1.27%, 1.87%, 2.29%, 2.78%, 3.43% over the six-year study period, respectively. The percentage of patients whose visiting frequency ≥ 4 times within a year gradually increased over time and the percentage ranged from 61 to 80% in a half of the counties by 2016. In general, there was positive association between Gross Domestic Product per capita and the percentage of patients whose visiting frequency ≥ 4 times within a year. The percentage of female patients, percentage of patients who aged ≥ 60 years, percentage of low-income patients, carbon emission intensity, percentage of savings and number of health technicians per 10,000 persons were negatively correlated with the percentage of patients whose visiting frequency ≥ 4 times within a year in most of counties of Fujian Province. In the sensitivity analysis, the percentage of outpatients whose visiting frequency ≥ 4 times within a year was higher than that of all patients. There was positive association between percentage of outpatients who aged ≥ 60 years and the percentage of outpatients whose visiting frequency ≥ 4 times.

CONCLUSIONS

The visiting rate and the visiting frequency within a year for rural patients with hypertension in Fujian province need to be improved. Female and elderly patients should be the focus of health management. Effectively implementing the family doctor services, providing several kinds of free antihypertensive drugs, improving energy utilization efficiency and reasonably allocating the health resources may be the effective strategies to improve the follow-up compliance of patients.

The Role of Noncommunicable Disease Clinics in Improving Control of Hypertension and Diabetes Among Adults Residing in Rural Ballabgarh, Haryana

Introduction High systolic blood pressure (SBP) and raised plasma glucose are major attributable and preventable causes of death worldwide. The objective of this study was to estimate the control rates and identify determinants of control of hypertension and diabetes among adults. Methods A longitudinal follow-up study was conducted among all the adults registered at the noncommunicable disease (NCD) clinics under the national program at two primary health centers in Faridabad, Haryana. Data were collected every month from the individual booklet generated for registered adults. Two monthly visits in three months and four in six months were considered adequate follow-ups at the NCD clinic. Results In the study, 495 (82.2%) adults had hypertension, and 242 (40.2%) had diabetes. The control rates at the third and sixth months were 37.1% (95% confidence interval (CI): 31.4-42.7) and 53.6% (95% CI: 43.4-59.8) among hypertensives and 28.7% (95% CI: 21.7-35.7) and 35.9% (95% CI: 27.5-44.4) among diabetics. Among hypertensives, six-month control status was associated with adequate follow-up at the NCD clinic (adjusted odds ratio (AOR) 2.3; 95% CI: 1.4-4.0; p-value: 0.002), male sex (AOR 0.5; 95% CI: 0.3-0.9; p-value: 0.02) and high SBP (AOR 0.5; 95% CI: 0.3-0.9; p-value: 0.017). Conclusions Control status was achieved in half of the adults with hypertension and one-third of adults with diabetes after six months of regular follow-up. Adequate follow-up at the NCD clinic, male sex, and raised SBP emerged as determinants of control among hypertensives.

Dawning public health services dogma: An indigenous Southwest Chinese perspective in managing hypertension-with or without the "BPHS"?

Background

To alleviate the rising mortality burden due to hypertension and other non-communicable diseases, a new public health policy initiative in 2009 called the Basic Public Health Services (BPHS). Program was introduced by the Chinese government. The goal of the study is to assess the feasibility and impact of a nationwide health care service-the "BPHS".

Methods

From January to December 2021, a stratified multistage random sampling method in the survey was conducted to select 6,456 people from 8 cities/districts in Yunnan Province, China, who were above the age of 35 years. 1,521 hypertensive patients were previously aware of their high blood pressure status were matched to the BPHS program database based on ID number and then further divided into BPHS group and non-BPHS (control) group. The results of the current study are based on their responses to a short structured questionnaire, a physical examination, and laboratory tests. The association between BPHS management and its effect on the control of hypertension was estimated using multivariable logistic regression models. We evaluated the accessibility and efficacy of BPHS health care services by analyzing various variables such as blood pressure, BMI, lifestyle modification, anti-hypertensive drugs taken, and cardiovascular risk factors.

Results

Among the 1,521 hypertensive patients included in this study, 1,011 (66.5%) were managed by BPHS programme. The multivariable logistic regression model demonstrated that the BPHS facilitated hypertension control (OR = 1.640, 95% CI: 1.237-2.175). A higher proportion of participants receiving lifestyle guidance from the BPHS management showed lowering of total cholesterol. In comparison to the non-BPHS group, those under BPHS management adhered better to antihypertensive medications either single drug (54.3%) or in combination (17.3%) of drugs. Additionally, we also noticed that urban areas with centralized and well-established digital information management system had better hypertension treatment and control.

Conclusions

Nearly two-thirds of the hypertensive patients in Yunnan Province were included in BPHS management. The impact of the national BPHS program was evident in lowering risk factors for cardiovascular diseases, promoting healthy lifestyles, lowering blood pressure, increasing medication adherence, and the better control rate of hypertension.