Study on the effect of community intervention on patients with hypertension in high-normal blood pressure

Among patients with hypertension, maintaining blood pressure within the high-normal range is a common clinical scenario, often misinterpreted as adequate control. However, this level remains associated with cardiovascular risk and progression of target organ damage. Yet, evidence is lacking regarding effective community-based interventions in this population. This study aimed to evaluate the effects of a 12-month, community physician-led standardized health management intervention on blood pressure control rates, lifestyle improvements, and influencing factors in hypertensive patients with high-normal blood pressure, and to explore effective management strategies for this key population.

A series of information surveys and health interventions were conducted among 721 patients (aged 18-80 years) with high-normal blood pressure from communities in Shenyang. Descriptive analysis and multivariable logistic regression analysis were used as primary analytical methods.

After 1 year of community intervention, both systolic and diastolic blood pressure significantly decreased in 721 individuals with high-normal blood pressure (P < 0.05). Knowledge about hypertension, awareness of prevention, medication adherence, and behavioral adherence also improved compared to pre-intervention levels (P < 0.05). A repeated-measures analysis of variance revealed a statistically significant main effect of time on both systolic and diastolic blood pressure [SBP: F _(1.90, _{1, 369.92)} = 135.833, partial η² = 0.159; DBP: F _(1.995, _{1, 436.10)} = 50.181, partial η² = 0.065, both P < 0.05]. Analysis of factors influencing blood pressure control at the end of the intervention demonstrated that poor medication adherence due to adverse drug reactions was associated with inadequate blood pressure control [OR (95% CI): 3.222 (1.169-8.878), P < 0.05]. Additionally, after the intervention, not reducing smoking was identified as a factor inversely associated with uncontrolled diastolic blood pressure [OR (95% CI): 0.192 (0.068-0.562), P < 0.05], while higher body weight remained associated with uncontrolled diastolic blood pressure [OR (95% CI): 1.018 (1.003-1.035), P < 0.05]. Furthermore, using non-drink-reducers as the reference group, alcohol reduction was identified as an influencing factor for uncontrolled systolic blood pressure [OR (95% CI): 2.550 (1.419-4.583), P < 0.05].

Community-based interventions by primary care physicians targeting individuals with high-normal blood pressure can effectively modify unhealthy lifestyle habits and improve blood pressure control.