Blood Pressure Control Behaviors and Control Rate and Socioeconomic Status in Chinese Adult Hypertensives in 2013

Background: Hypertension has reached an epidemic proportion in China but is often sub-optimally controlled. Sufficient engagement in BP-lowering strategies can result in effective BP control. However, studies about the pattern of self-management practices and the contribution of antihypertensive strategies to BP control quality by further considering the role of socioeconomic factors in Chinese hypertensive population using nationwide representative data were incompletely investigated. Methods: We used data from a national representative survey which sampled 177,099 adults aged ≥18 in mainland China in 2013-2014. A total of 31,714 diagnosed hypertensives were included in the analyses. Information regarding general characteristic, history of chronic diseases, and profiles of self-care behaviors was collected by questionnaire-based interview. Laboratory tests and physical measurements were undertaken on each participant. The prevalence of BP control behaviors and BP control rate were examined overall and by several SES factors. Rao-Scott chi-square tests were used for comparisons between subgroups. A Venn diagram was used to present the distribution and overlap of behaviors. Findings: 72·9% reported consistent adherence to medication, 12·9% exhibited non-adherence to medication, 21·6% reported adopting lifestyle modifications, 16·0% reported BP monitoring, 8·1% did not use any strategies, and 2·1% reported seeking other agents. People who took medications consistently were more likely to adopt non-pharmaceutical strategies than those who did not adhere to prescription. Those who were older, being higher income and education levels, had urban residency and being widowed/separated status were more likely to use combined medication and non-medication strategies. Consistent medication generated a control rate of 29·3%, higher than occasional medication (24·4%) and lifestyle modification (26·4%). Lifestyle changes worked a little better than taking no measures (26·4% vs· 26·1%). Poor medication adherence worked even worse than taking no measures (24·4% vs. 26·1%), and consistent medication paired with non-pharmacological agents worked better than any single treatment. Socioeconomic status such as age, gender, marital status and geographical region remained confounding factors in terms of causality between strategies and BP control quality. Interpretation: Population-based health education programs and SES-considered interventions were needed to encourage better engagement in prescribed treatment and combined strategies to help address unfavorable BP control profiles. Funding Statement: National Key Research and Development Project (2018YFC1313904). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study protocol was approved by the ethical committee of the Chinese Center for Disease Control and Prevention. All study participants were informed and signed a written consent.