Longitudinal changes in blood pressure and fasting plasma glucose among 5,398 primary care patients with concomitant hypertension and diabetes: An observational study and implications for community-based cardiovascular prevention

Xiao Yu; Yu Ting Li; Hui Cheng; Sufen Zhu; Xiu-Jing Hu; Jia Ji Wang; Bedru H Mohammed; Yao Jie Xie; Jose Hernandez; Hua-Feng Wu; Harry H X Wang

doi:10.3389/fcvm.2023.1120543

Longitudinal changes in blood pressure and fasting plasma glucose among 5,398 primary care patients with concomitant hypertension and diabetes: An observational study and implications for community-based cardiovascular prevention

Front Cardiovasc Med. 2023 Apr 3:10:1120543. doi: 10.3389/fcvm.2023.1120543. eCollection 2023.

Authors

Xiao Yu¹, Yu Ting Li², Hui Cheng¹, Sufen Zhu³, Xiu-Jing Hu⁴, Jia Ji Wang^{5

6}, Bedru H Mohammed⁷, Yao Jie Xie⁸, Jose Hernandez^{9

10}, Hua-Feng Wu¹¹, Harry H X Wang^{1

12

13}

Affiliations

¹ School of Public Health, Sun Yat-Sen University, Guangzhou, China.
² Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.
³ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
⁴ Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
⁵ Centre for General Practice, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China.
⁶ Guangdong-provincial Primary Healthcare Association, Guangzhou, China.
⁷ School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR.
⁸ School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR.
⁹ Faculty of Medicine and Health, EDU, Digital Education Holdings Ltd., Kalkara, Malta.
¹⁰ Green Templeton College, University of Oxford, Oxford, United Kingdom.
¹¹ Shishan Community Health Centre of Nanhai, Foshan, China.
¹² JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
¹³ Usher Institute, Deanery of Molecular, Genetic & Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom.

Abstract

Aims: To assess longitudinal changes in blood pressure (BP) and fasting plasma glucose (FPG) in primary care patients with concomitant hypertension and type 2 diabetes mellitus (T2DM), and to explore factors associated with patients' inability to improve BP and FPG at follow-up.

Methods: We constructed a closed cohort in the context of the national basic public health (BPH) service provision in an urbanised township in southern China. Primary care patients who had concomitant hypertension and T2DM were retrospectively followed up from 2016 to 2019. Data were retrieved electronically from the computerised BPH platform. Patient-level risk factors were explored using multivariable logistic regression analysis.

Results: We included 5,398 patients (mean age 66 years; range 28.9 to 96.1 years). At baseline, almost half [48.3% (2,608/5,398)] of patients had uncontrolled BP or FPG. During follow-up, more than one-fourth [27.2% (1,467/5,398)] of patients had no improvement in both BP and FPG. Among all patients, we observed significant increases in systolic BP [2.31 mmHg, 95% confidence interval (CI): 2.04 to 2.59, p < 0.001], diastolic BP (0.73 mmHg, 0.54 to 0.92, p < 0.001), and FPG (0.12 mmol/l, 0.09 to 0.15, p < 0.001) at follow-up compared to baseline. In addition to changes in body mass index [adjusted odds ratio (aOR)=1.045, 1.003 to 1.089, p = 0.037], poor adherence to lifestyle advice (aOR = 1.548, 1.356 to 1.766, p < 0.001), and unwillingness to actively enrol in health-care plans managed by the family doctor team (aOR = 1.379, 1.128 to 1.685, p = 0.001) were factors associated with no improvement in BP and FPG at follow-up.

Conclusion: A suboptimal control of BP and FPG remains an ongoing challenge to primary care patients with concomitant hypertension and T2DM in real-world community settings. Tailored actions aiming to improve patients' adherence to healthy lifestyles, expand the delivery of team-based care, and encourage weight control should be incorporated into routine healthcare planning for community-based cardiovascular prevention.

Keywords: blood pressure; cardiovascular prevention; diabetes; fasting plasma glucose; hypertension; long-term follow-up; routine primary care.