Impact of Community-Based Hypertension Screening on Blood Pressure Management and the Role of Socioeconomic Status

A study was conducted to estimate the impact of hypertension screening on blood pressure measured 1, 2, and 3 years after baseline, as well as how its impact varies across socioeconomic statuses.

Embedded within a subcohort of the ChinaHEART (China Health Evaluation and Risk Reduction Through Nationwide Teamwork) project, blood pressure was measured both at baseline and follow-up visits. Information about socioeconomic factors, including education, annual household income, occupational status, and urbanity, was also collected. A sharp regression discontinuity design was used to estimate the impact of hypertension screening on blood pressure measured 1, 2, and 3 years later. We also explored the role of baseline socioeconomic status by adding the interaction term.

The regression discontinuity analysis found no effect of baseline hypertension screening on the primary outcomes. When stratified by socioeconomic status, regarding systolic blood pressure measured 1 year later, the impact of screening was 5.52 mm Hg (95% CI, -1.55 to 12.59) for individuals with primary or lower education, 0.80 mm Hg (95% CI, -4.00 to 5.59) for middle education, and -7.39 mm Hg (95% CI, -12.03 to -2.75) for high school or above education, with a significant trend observed (P for interaction=0.002). In addition, among individuals with high school or above education, the impact on systolic blood pressure 1, 2, and 3 years later was -7.39 mm Hg (95% CI, -12.03 to -2.75), -8.30 mm Hg (95% CI, -15.79 to -0.81), and -4.63 mm Hg (95% CI, -12.71 to 3.44), respectively. These patterns, although insignificant, were also found for other socioeconomic factors. The impact on diastolic blood pressure was smaller and insignificant.

The impact of community-based hypertension screening on systolic blood pressure was affected by individual's education level and lasted only in the short term.