Temporal Relationship Between Treatment Burden and Self-Care and Its Impact on Systolic Blood Pressure and Hypertension Control

Abstract

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, P<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 P<0.001. The mediation analyses demonstrated that self-care (T2) accounted for 10.7% (P<0.001) and 11.1% (P<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.