| Objective:Cardiovascular disease is a serious public health problem and the leading cause of death and disability in China as well as worldwide.To formulate comprehensive strategies and to plan for the rational use of healthcare resources in those regions,it is important to determine the changes in hypertension and risk factors.Therefore,we aimed to explore the long-term natural trends in the status of hypertension in Liaoning rural areas from 2013 to 2018.However,the control rate of hypertension patients in rural areas of Liaoning Province is low.We use structural equation modeling(SEM)to analyze the factors affecting the low rate of hypertension control,including patient consciousness,compliance,socio-economic background,personal lifestyle,and health status.Moreover,direct and indirect effects between research factors provide practical and theoretical basis for developing hypertension interventions to increase control rates.On this basis,develop targeted comprehensive intervention measures for rural hypertension and conduct empirical research to explore the feasibility,effectiveness and management model of comprehensive intervention for hypertension in rural areas,and provide follow-up,long-term and extensive follow-up,management and intervention.Practical experience provides practical evidence for the development of the basis for comprehensive prevention and treatment strategies for hypertension in government departments.Methods:Two successive cross-sectional surveys were conducted in Liaoning rural areas in 2013 and 2018 and included 10,753 and 10,926 participants aged?40 years from different villages,respectively.A multistage,stratified,and cluster random sampling method was used to ensure that the samples of the two studies were representative.Hypertension was defined as a mean systolic blood pressure(SBP)?140 mmHg or a mean diastolic blood pressure(DBP)?90 mmHg,and/or self-reported use of antihypertensive medication within the past 2 weeks.The related risk factors of hypertension were also evaluated.The prevalence and control rate of hypertension were also estimated according to the 2017 American College of Cardiology(ACC)/American Heart Association(AHA)high blood pressure guideline.From March to April 2018,172 villages in 22 townships were randomly selected in Chaoyang County,Longcheng District,Jianping County,Lingyuan City,Beipiao City,Shuangta District and Kazuo County of Chaoyang City,for all 185 village doctors conducted investigations on knowledge,ability,and health resources related to hypertension prevention,and 180 village doctors completed the survey with a response rate of 97.3%.Among the 172 village-administered hypertensive patients,1190 were randomly selected to carry out hypertension knowledge,beliefs,behaviors,and the investigation of the new rural cooperative medical insurance policy and other aspects,the final 1068 people completed the survey,the response rate was 89.7%.Structural equation modeling was used to analyze the main reasons for poor medication compliance and low control rate in patients with hypertension.Intervention for hypertension in rural areas study was conducted in Chaoyang city,22 townships with 86 rural villages in 7 counties(Chaoyang county,Longcheng district,Jianping county,Lingyuan county,Beipiao city,Shuangta district,Kazuo county)were randomly selected from June 2013 to September 2013,which included 9486hypertensives.The follow-up study was undertaken in January 2019,7563(79.7%)completed the follow-up study.At the 3-month follow-up,the patient's blood pressure level and medication status were collected.In view of the current situation and problems of low blood pressure control rate,intervention measures including strengthening the performance evaluation system of primary hypertension management,establishing a system of chronic disease administrators,reforming the medical insurance system,strengthening the training of village medical ability,and strengthening patient self-management were formulated.Results:Overall,the age-standardized prevalence of hypertension increased 2.5%(52.3%vs 53.6%),mean SBP and DBP increased significantly,especially mean DBP level,with an increased rate of 5.2%(82.4 mmHg vs 86.7 mmHg)during the study period.However,the control rate remained frustratingly low(4.1%vs 3.6%),despite unsatisfied awareness and treatment rates of hypertension in rural northeast China.Older age,male,alcohol drinking,obesity,diabetes,dyslipidemia remained the risk factors for prevalent hypertension.Under the 2017 ACC/AHA guideline,the prevalence of hypertension increased from 73.9%to 79.1%;however,the control rate decreased sharply from 1.8%to 0.5%between 2013 and 2018.The SEM of the relationship between knowledge,belief and behavior in hypertensive patients shows that the normalized path coefficient of direct interaction between knowledge and belief is 0.80(p<0.001),and the coefficient of determination of the internal potential variable R~2 in the model is 0.65,knowledge can influence 65%of the variability of belief;the SEM of the factors affecting drug compliance in hypertensive patients showed that the standardized path coefficient of direct interaction between“patient knowledge belief”and“positive psychological factors”was 0.31,and the coefficient of determination was R~2=0.10,The standardized path coefficient between“the positive psychological factors”and“the medication adherence”is 0.64,R~2=0.44;the SEM of the influencing factors of blood pressure control in hypertensive patients shows that“patient knowledge belief”and“positive psychological factors”normalized path coefficient between direct action is 0.63,R~2=0.39,and the standardized path coefficient between“positive psychological factors”and“blood pressure control compliance”is0.13,R~2=0.02,“village medical knowledge belief”can have a certain indirect effect on“blood pressure control”.Compared with baseline blood pressure levels,the mean systolic blood pressure was significantly lower in hypertensive patients after 3 months of comprehensive intervention(156.5mmHg vs 141.3mmHg),including male(155.9mmHg vs 141.9mmHg)and female(156.9mmHg vs 141.0mmHg);Diastolic blood pressure was also significantly reduced(88.2 mm Hg vs 81.5 mm Hg),including male(89.9 mm Hg vs 82.9 mm Hg),female(87.2 mm Hg vs 80.7 mm Hg)(P<0.001).After 3 months of comprehensive intervention,the control rate of hypertension(control target:140mmHg/90mmHg)increased from 13.0%to 49.6%;males increased from 12.6%to 46.6%,and women increased from 13.2%to 51.4%.Conclusions:1.Despite the high prevalence of hypertension during the past 5 years,blood pressure levels increased significantly,especially the DBP level.Awareness,treatment,and control of hypertension remained unacceptably low.2.Hypertension-related knowledge and cognitive level of hypertension will have a direct impact on their beliefs.There is a direct effect between the two variables of“positive psychological factors”and“consciousness disorder”and“medication compliance”.“Patient knowledge belief”and"village medical knowledge belief"have an indirect impact on"patient medication compliance."3.It is suggested that strengthening the knowledge and ability training of hypertension doctors in villages,strengthening the awareness of self-awareness and management of blood pressure among hypertensive patients will play an active and effective role in the prevention and control of hypertension in rural areas.It should be fully considered and effectively practiced.4.Strengthening the basic performance management system for hypertension management,establishing a system for chronic disease management,reforming the medical insurance system,strengthening the training of village medical ability,and strengthening the intervention techniques for patient self-management have obvious effects on hypertension management in communities of China,which can significantly improve the control rate of hypertension,significantly reduces the blood pressure level of patients and plays an important role in preventing the occurrence of long-term cardiovascular events. |
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