Abstract
Hypertension is prevalent worldwide; both the treatment rate and control rate of blood pressure (BP) are undesirable, 1 and the disease burden is tremendous. Hypertension community management has been implemented to increase the treatment and control rate of hypertension and to reduce cardiovascular complications. The objective is to find risk factors impacting BP control from a 5-year prospective cohort study.
General practitioners (GPs) received training about how to diagnose hypertension, measure BP, prescribe medicinal treatment, and give lifestyle advice for BP control. In addition, a medical team including GPs, clinical pathologists, nurses, and a public health practitioner, performed BP management during follow-up.
A prospective cohort intervention study was performed. Throughout January 2009, using hierarchical clustering sampling, 5283 adults from 20 community health care centers (10 urban and 10 rural) in Chongqing were included, and baseline information of the samples was collected. Samples were 4235 and 3656 in 2012 and in 2014 at follow-up; this study just included 4235 samples. Demographic information, physical, and fasting blood glucose (FBG) measurements, drug treatment for BP control, and history of diabetes, kidney disease, stroke, and cardiovascular disease (CVD) were collected.
A logistic regression model was used to identify covariates that might affect BP control rate in 2014. SAS software, v 9.4 (SAS Institute Inc., Cary NC) was used to perform analysis. Significant difference was determined at α level of 0.05.
Both the systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels decreased significantly in 2014 and 2012 compared with baseline in 2009 (SBP: 137.9(15.7) mmHg, 135.9(14.3) mmHg, 142.2(13.2) mmHg, P < 0.01; DBP: 81.1(10.7) mmHg, 81.0(9.3) mmHg, 82.8(7.5) mmHg, P < 0.01). SBP increased slightly in 2014 compared with 2012 (P < 0.01), whereas DBP was at the same level compared with 2012.
Variables included in the logistic regression model were age; sex; area (urban or rural); medical treatment in 2012; type of antihypertensive medicine in 2014; SBP and DBP at baseline and in 2012; complications of diabetes, stroke, kidney disease, and heart disease; body mass index in 2014; physical activity; alanine aminotransferase/aspartate aminotransferase (AST/ALT); creatinine; blood urea nitrogen; and FBG. Results showed medical treatment in 2012, combined with 2 antihypertension medicines compared with diuretics, and reduced complications of kidney disease and heart disease (related to BP control) would improve BP control rate (all P < 0.05), whereas SBP in 2009, DBP in 2012, and creatinine level in 2014 negatively correlated with BP control rate after the 5-year intervention (all P < 0.05). Moreover, using compound antihypertension medicines compared with diuretics (P = 0.07), complications of diabetes (P = 0.08), and AST/ALT (P = 0.09) have a boundary relationship with BP control rate.
Hypertension management conducted by GPs in community clinical centers achieved excellent results in level of BP control. 2 This study demonstrated that primary health care clinics are ideal scenarios for BP management. Moreover, hypertension management would reduce smoking and drinking behaviors, increased rates of medicinal compliance, 3 and reduced CVD complications. 4
Author Disclosure Statement
The authors declare that there are no conflicts of interest.
Funding Information
This work was supported by Natural Science Foundation of Youth Project [81502826], by China Postdoctoral Science Foundation [2014M562289], and by Chongqing Postdoctoral research funded projects [Xm2014129]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.