Effect of Comprehensive Health Management on Medication Adherence and Healthy Lifestyle Behavior of Patients With Hypertension

Abstract

Suboptimal medication adherence and unhealthy lifestyle behaviors are well-recognized contributing factors to poor blood pressure control in hypertension patients. We evaluated the effectiveness of comprehensive health management in improving medication adherence and promoting healthy lifestyle behaviors among hypertension patients in China. A cluster randomized trial was implemented in rural areas of three provinces of China. Participants were individuals aged ≥ 40 years with uncontrolled hypertension. The intervention group received multidimensional health management measures codeveloped by healthcare organizations, village doctors, and patients, while the control group received standard care. The coprimary outcomes included the proportion of patients demonstrating good medication adherence and adherence to ≥ 3 healthy lifestyle components. Secondary outcomes comprised the proportion achieving controlled hypertension (BP < 140/90 mm Hg). From May 8th to November 28th, 2018, 9204 participants were enrolled. At 18-month follow-up, significantly higher medication adherence was observed in the intervention group compared with the control group, with an absolute difference of 5.0% (95% confidence interval (CI): 2.8–7.2; p < 0.001). Similarly, adherence to ≥ 3 healthy lifestyles was achieved by 45.8% in the intervention group versus 33.7% in controls, yielding a 12.1% between-group difference (95% CI: 9.9–14.3; p < 0.001). Hypertension control rates differed significantly between groups (43.2% vs. 23.9%; absolute difference 19.2% and 95% CI: 17.2–21.3; p < 0.001). Hypertension patients receiving comprehensive health management in rural China demonstrated superior medication adherence and healthier lifestyle behaviors compared with those receiving standard care over 18 months. Further investigations are warranted to evaluate the cost-effectiveness and generalizability of this intervention. Trial Registration: ClinicalTrials.gov identifier: NCT03527719.