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

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^*

^*Corresponding author for this work

Research output: Journal Publications › Journal Article (refereed) › peer-review

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.

Original language	English
Article number	1120543
Number of pages	10
Journal	Frontiers in Cardiovascular Medicine
Volume	10
DOIs	https://doi.org/10.3389/fcvm.2023.1120543
Publication status	Published - 3 Apr 2023
Externally published	Yes

Bibliographical note

Funding support:
National Natural Science Foundation of China (grants
72061137002 and 71904212); and Basic and Applied Basic
Research Foundation of Guangdong Province (grant
2019A1515011381). The funders had no role in study design,
data collection, data analysis, data interpretation, or writing of
the report.

Acknowledgments:
We wish to acknowledge the tremendous support of the
frontline primary care staff at community health facilities who
were involved in delivering basic public health services,
documenting routine check-up data on the computerised system,
and assisting health-care plans managed by the family doctor team.

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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YU, X., LI, Y. T., CHENG, H., ZHU, S., HU, X.-J., WANG, J. J., MOHAMMED, B. H., XIE, Y. J., HERNANDEZ, J., WU, H.-F., & WANG, H. H. X. (2023). 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. Frontiers in Cardiovascular Medicine, 10, Article 1120543. https://doi.org/10.3389/fcvm.2023.1120543

@article{e706a802673449f5ba1077595efb9996,

title = "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",

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",

author = "Xiao YU and LI, {Yu Ting} and Hui CHENG and Sufen ZHU and Xiu-Jing HU and WANG, {Jia Ji} and MOHAMMED, {Bedru H.} and XIE, {Yao Jie} and Jose HERNANDEZ and Hua-Feng WU and WANG, {Harry H.X.}",

note = "Funding support: National Natural Science Foundation of China (grants 72061137002 and 71904212); and Basic and Applied Basic Research Foundation of Guangdong Province (grant 2019A1515011381). The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Acknowledgments: We wish to acknowledge the tremendous support of the frontline primary care staff at community health facilities who were involved in delivering basic public health services, documenting routine check-up data on the computerised system, and assisting health-care plans managed by the family doctor team.",

year = "2023",

month = apr,

day = "3",

doi = "10.3389/fcvm.2023.1120543",

language = "English",

volume = "10",

journal = "Frontiers in Cardiovascular Medicine",

issn = "2297-055X",

publisher = "Frontiers Media S.A.",

}

YU, X, LI, YT, CHENG, H, ZHU, S, HU, X-J, WANG, JJ, MOHAMMED, BH, XIE, YJ, HERNANDEZ, J, WU, H-F & WANG, HHX 2023, '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', Frontiers in Cardiovascular Medicine, vol. 10, 1120543. https://doi.org/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. / YU, Xiao; LI, Yu Ting; CHENG, Hui et al.
In: Frontiers in Cardiovascular Medicine, Vol. 10, 1120543, 03.04.2023.

Research output: Journal Publications › Journal Article (refereed) › peer-review

TY - JOUR

T1 - 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

AU - YU, Xiao

AU - LI, Yu Ting

AU - CHENG, Hui

AU - ZHU, Sufen

AU - HU, Xiu-Jing

AU - WANG, Jia Ji

AU - MOHAMMED, Bedru H.

AU - XIE, Yao Jie

AU - HERNANDEZ, Jose

AU - WU, Hua-Feng

AU - WANG, Harry H.X.

N1 - Funding support: National Natural Science Foundation of China (grants 72061137002 and 71904212); and Basic and Applied Basic Research Foundation of Guangdong Province (grant 2019A1515011381). The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Acknowledgments: We wish to acknowledge the tremendous support of the frontline primary care staff at community health facilities who were involved in delivering basic public health services, documenting routine check-up data on the computerised system, and assisting health-care plans managed by the family doctor team.

PY - 2023/4/3

Y1 - 2023/4/3

N2 - 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.

AB - 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.

KW - blood pressure

KW - cardiovascular prevention

KW - diabetes

KW - fasting plasma glucose

KW - hypertension

KW - long-term follow-up

KW - routine primary care

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U2 - 10.3389/fcvm.2023.1120543

DO - 10.3389/fcvm.2023.1120543

M3 - Journal Article (refereed)

C2 - 37077741

AN - SCOPUS:85153473511

SN - 2297-055X

VL - 10

JO - Frontiers in Cardiovascular Medicine

JF - Frontiers in Cardiovascular Medicine

M1 - 1120543

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YU X, LI YT, CHENG H, ZHU S, HU XJ, WANG JJ et al. 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. Frontiers in Cardiovascular Medicine. 2023 Apr 3;10:1120543. 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

Abstract

Bibliographical note

Keywords

UN SDGs

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