Analysis of Blood Pressure Trajectories and Distribution Characteristics in Community-based Hypertension Management Population Aged 35 Years and Above

Abstract

Background As the population suffering from hypertension tends to be younger, the National Basic Public Health Service Project focuses on monitoring individuals aged 35 and above. Presently, the number of hypertensive patients in the community is increasing annually, which significantly increasing the burden of community healthcare. However, few longitudinal studies have been conducted in recent years to investigate the changes in blood pressure and distribution of hypertensive patients after community management. Objective To explore the trends in blood pressure changes among hypertensive individuals aged 35 and above in community management, unveiling the trajectory and distribution characteristics of hypertension in this population. Methods This study relied on a retrospective cohort study established from 2020 to 2022 under the National Basic Public Health Service Project. From January 2020 to December 2022, hypertensive patients meeting the diagnostic criteria in the National Basic Public Health Service Specification (The Third Edition) were selected from community health service centers/stations in a certain district in Guiyang City responsible for basic public health services. Baseline data were collected using personal basic information forms (gender, age, and duration of hypertension). Follow-up data, including height, BMI, blood pressure, waist circumference (WC), follow-up methods, medication adherence, and control satisfaction, were collected using follow-up record forms. BMI, waist-to-height ratio (WHtR) of the research subjects were calculated. Follow-up was conducted every six months for a total of five times. Latent growth curve models (LGCM) and growth mixture models (GMM) were employed to explore the trajectories of blood pressure values during follow-up among hypertensive individuals aged 35 and above, and to identify latent clusters with similar trajectories. Further analysis was conducted to examine the distribution characteristics of different blood pressure trajectory groups. Results A total of 15 958 hypertensive patients were included in the study, and both the baseline level and change rate of blood pressure in the hypertensive population were associated with the baseline level and change rate of BMI. Both systolic and diastolic pressures presented three similar trajectories of change. The three trajectories of systolic and diastolic blood pressure were defined and accounted for as 2.1% (332/15 958) /19.1% (3 052/15 958) in the group of low blood pressure increase, 5.7% (905/15 958) /6.1% (975/15 958) in the group of high blood pressure decrease, and 92.2% (14 721/15 958) /74.8% (11 931/15 958) in the group of stable mid-range blood pressure. Differences in disease duration, medication adherence, follow-up methods, control satisfaction, BMI, WHtR, and WC were statistically significant among different systolic pressure trajectory groups (P<0.05). Similarly, differences in gender, age, disease duration, medication adherence, follow-up methods, control satisfaction, BMI, WHtR and WC were statistically significant among different diastolic pressure trajectory groups (P<0.05) . Conclusion Blood pressure trajectory changes in the community-based management of hypertensive individuals aged 35 and above were primarily characterized by stable mid-range blood pressure. The trajectory of blood pressure change in people with different characteristics manifested differently, suggesting that tailored management measures should be targeted for community healthcare workers managing hypertensive populations.

Keywords

• hypertension|community management|longitudinal studies|change trajectory|distribution characteristics|retrospective queue