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

Zhihui Jia,1 Zimin Niu,1 Yao Jie Xie,2 Zhiran Su,3 Jia Ji Wang,4 Jose Hernandez,5,6 Yu Ting Li,7 Harry HX Wang1 1School of Public Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China; 2School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR; 3Faculty of Education, Monash University, Melbourne, Australia; 4School of Public Health, Guangzhou Medical University, Guangzhou, People’s Republic of China; 5Green Templeton College, University of Oxford, Oxford, UK; 6Department of Precision Health, Luxembourg Institute of Health, Luxembourg, Luxembourg; 7Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People’s Republic of ChinaCorrespondence: Yu Ting Li, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, People’s Republic of China, Email liyuting3@mail.sysu.edu.cn Harry HX Wang, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of China, Email haoxiangwang@163.com; wanghx27@mail.sysu.edu.cnBackground: 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 ...