The integrated management of hypertension in general hospitals and community hospitals

Abstract

Purpose: We sought to investigate and improve the integrated management of hypertension in general and community hospitals in China. Patients and Methods: We carried out a cross-sectional study in 90 centers from 15 cities in China from 2017 to 2018. Patients with primary hypertension were included. Results: Of the total 4286 patients included, 43.2% of them controlled blood pressure (BP) below 140/90 mmHg while only 11.5% controlled BP below 130/80 mmHg. The control rate of low-density lipoprotein-C (LDL-C) in patients with concomitant coronary artery disease (CAD), diabetes (DM), and chronic kidney disease (CKD) was 24.7%, 49.4%, and 40.6%, respectively. Thirty-one percent of the DM patients had HbA1c levels greater than 8% while 21.7% of the non-DM patients had HbA1c≥6.5%. The control rate of body mass index (BMI) was 54.4% in men and 59.8% in women. As compared to patients from community hospitals, patients from general hospitals had poorer control of BP<140/90 mmHg (OR 0.63, 95% CI 0.55–0.73, p<0.001), comparatively better attainment of LDL-C, particularly <1.8 mmol/L in CAD (OR 3.25, 95% CI 2.02–5.24, p<0.001), similar control of HbA1c < 8.0% in diabetes (OR 0.64, 95% CI 0.41–1.00, p=0.052) and comparatively worse achievement of BMI<25 kg/m2 (OR 0.72, 95% CI 0.63–0.83, p<0.001). Conclusion: The integrated management of hypertension needs to be improved. Besides LDL-C, the management of BP, blood glucose (BG), and BMI need to be strengthened in not only community hospitals but also general hospitals.