Impact of the National Essential Public Health Services Policy on Hypertension Control in China

BACKGROUND: Hypertension remains a severe challenge to population health worldwide. This study assessed the impact of a nationwide program in China-Essential Public Health Services (EPHS) on improvement of hypertension treatment and control. METHODS: A cohort of hypertensive patients was identified from the 2011-2013 China Health and Retirement Longitudinal Study. Hypertension was defined based on: (i) an average systolic blood pressure of ≥140 mm Hg, and/or an average diastolic blood pressure of ≥90 mm Hg; and/or (ii) currently taking antihypertensive medications. Outcomes assessed included the rate of hypertension control, medication use, and blood pressure monitoring at a doctor's office. The key independent variable was defined as whether one received services from the EPHS-covered physical examination by 2013. Probit regression models with a difference-in-difference approach were performed for each of the 3 outcomes. Data were analyzed in 2017. RESULTS: Among the 4,958 hypertensive patients, 404 (8.1%) received the EPHS-covered service by 2013. Coverage by the EPHS program was associated with an increase of 7.9% in hypertension control rate (SE = 2.9%, P = 0.020), an increase of 10.3% in the rate of medication use (SE = 2.5%, P < 0.001), and an increase of 10.5% in the rate of blood pressure monitoring (SE = 2.5%, P < 0.001). Results also showed that the EPHS program helped mitigate the geographic disparities in access to health services such as blood pressure monitoring. CONCLUSIONS: The National EPHS program improved the treatment and control among hypertension patients. Expanding its program reach could further benefit the cardiovascular health of the population.