Jia Zhihui, Niu Zimin, Xie Yao Jie, Su Zhiran, Wang Jia Ji, Hernandez Jose, Li Yu Ting, Wang Harry H X
School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China.
School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR.
Int J Gen Med. 2025 Jul 1;18:3597-3607. doi: 10.2147/IJGM.S517281. eCollection 2025.
BACKGROUND: Effective blood pressure (BP) control necessitates sustained adherence to self-care regimes; however, adherence can be undermined by excessive treatment burden. The longitudinal dynamics between treatment burden and self-care behaviours remain less understood, with particularly limited understanding of how the temporal relationship may influence BP control. OBJECTIVE: This study sought to examine the temporal relationship between treatment burden and self-care while investigating their collective longitudinal impact on both systolic BP levels and hypertension control. METHODS: We investigated a community-based longitudinal cohort of 1718 hypertensive patients (mean age 54.6 ± 11.9 years; 28.5% with coexisting diabetes). Treatment burden and self-care were measured at two time points (T1 and T2), separated by an approximate 11-month period, with BP measured in the subsequent 14 months (T3). We employed cross-lagged panel modelling and mediation analysis to examine the temporal relationship between treatment burden and self-care (from T1 to T2) and their collective influence on systolic BP and hypertension control (T3). RESULTS: After adjusting for covariates, we observed a significant cross-lagged path coefficient between treatment burden (T1) and self-care (T2) in the total sample (path coefficient = -0.089, <0.001). The association remained consistent across subgroups-including individuals aged less than 60 years (path coefficient = -0.083), aged 60 years and above (path coefficient = -0.113), diabetic patients (path coefficient = -0.103), and non-diabetic patients (path coefficient = -0.085), with all <0.001. The mediation analyses demonstrated that self-care (T2) accounted for 10.7% (<0.001) and 11.1% (<0.001) of the total effect of treatment burden (T1) on systolic BP and hypertension control (T3), respectively. CONCLUSION: Our study findings establish a temporal sequence wherein elevated treatment burden precedes suboptimal self-care capacity, which in turn adversely affects subsequent BP control. The nature of such association opens the door for further primary care research on developing more sustainable hypertension management strategies.
背景：有效的血压控制需要持续坚持自我护理方案；然而，过度的治疗负担可能会削弱依从性。治疗负担与自我护理行为之间的纵向动态关系仍不太清楚，尤其是对时间关系如何影响血压控制的了解有限。 目的：本研究旨在探讨治疗负担与自我护理之间的时间关系，同时调查它们对收缩压水平和高血压控制的总体纵向影响。 方法：我们调查了一个基于社区的1718名高血压患者的纵向队列（平均年龄54.6±11.9岁；28.5%患有糖尿病）。在两个时间点（T1和T2）测量治疗负担和自我护理，两个时间点间隔约11个月，随后在14个月内（T3）测量血压。我们采用交叉滞后面板模型和中介分析来研究治疗负担与自我护理（从T1到T2）之间的时间关系，以及它们对收缩压和高血压控制（T3）的总体影响。 结果：在调整协变量后，我们在总样本中观察到治疗负担（T1）与自我护理（T2）之间存在显著的交叉滞后路径系数（路径系数=-0.089，<0.001）。该关联在各亚组中保持一致，包括年龄小于60岁的个体（路径系数=-0.083）、60岁及以上的个体（路径系数=-0.113）、糖尿病患者（路径系数=-0.103）和非糖尿病患者（路径系数=-0.085），均<0.001。中介分析表明，自我护理（T2）分别占治疗负担（T1）对收缩压和高血压控制（T3）总效应的10.7%（<0.001）和11.1%（<0.001）。 结论：我们的研究结果建立了一个时间顺序，即治疗负担升高先于自我护理能力欠佳，而这反过来又会对随后的血压控制产生不利影响。这种关联的性质为进一步开展关于制定更可持续的高血压管理策略的初级保健研究打开了大门。
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