Evaluation of a mobile health–enabled hierarchical care model for hypertension management and health-related quality of life among older adults: a prospective pre–post intervention study

Background Hypertension remains a major public health challenge among older adults, particularly in the context of population ageing and increasing demand for long-term chronic disease management. Although mobile health (mHealth) technologies have demonstrated potential in supporting hypertension self-management, evidence regarding their integration with hierarchical healthcare delivery systems and their association with patient-reported health outcomes remains limited. This study evaluated changes in blood pressure control and health-related quality of life (HRQoL) following implementation of a mHealth-enabled hierarchical care model within regional medical consortia. Objective This study aimed to assess changes in blood pressure indicators and HRQoL following implementation of a mobile health–enabled hierarchical diagnosis and treatment education program (mHealth-HDTEP) among older adults with hypertension. Methods A prospective, single-arm, pre-post evaluation study was conducted from January to December 2025 among older adults with hypertension recruited from regional medical consortia in Shenzhen, China. Participants received a 12-month mHealth-HDTEP program delivered through the Shekangtong WeChat mini program, integrating blood pressure self-monitoring, health education, family doctor follow-up, and specialist consultation pathways. The primary outcome was HRQoL measured using the EQ-5D-5L, while secondary outcomes included systolic blood pressure (SBP) and diastolic blood pressure (DBP). Continuous pre-post changes were assessed using paired t-tests when normality assumptions were satisfied, and changes in EQ-5D-5L dimension levels were assessed using Wilcoxon signed-rank tests with false discovery rate (FDR) correction for multiple comparisons. Pearson correlation analyses were used to examine associations between changes in blood pressure and HRQoL measures. Results Among 225 enrolled participants, 210 completed the 12-month follow-up. Compared with baseline, statistically significant improvements were observed in both blood pressure and HRQoL outcomes. Mean SBP decreased from 145.35 ± 4.18 mmHg to 130.64 ± 5.62 mmHg (mean difference: 14.71 mmHg, 95% CI : 13.68 to 15.74; p < 0.001; Cohen’s d = 2.043), and mean DBP decreased from 68.93 ± 4.85 mmHg to 60.73 ± 4.31 mmHg (mean difference: 8.20 mmHg, 95% CI : 7.28 to 9.12; p < 0.001; Cohen’s d = 1.262). EQ-5D-5L utility values increased from 0.82 ± 0.13 to 0.94 ± 0.06 (mean difference, 0.12; 95% CI , 0.10 to 0.14; p < 0.001; Cohen’s d = 0.850), and EQ-VAS scores increased from 74.16 ± 11.07 to 80.93 ± 8.03 (mean difference, 6.77; 95% CI , 6.18 to 7.36; p < 0.001; Cohen’s d = 1.536). The anxiety/depression dimension showed the most pronounced improvement among the five EQ-5D-5L dimensions (FDR-adjusted p < 0.001). Changes in blood pressure indicators were positively associated with changes in HRQoL measures ( p < 0.001). Reductions in blood pressure were positively correlated with improvements in HRQoL parameters ( r = 0.22 to 0.32, all p < 0.001). Conclusion A mHealth-enabled hierarchical care model integrated within regional healthcare networks was associated with improvements in blood pressure indicators and HRQoL among older adults with hypertension. The findings suggest that combining digital self-management support with primary care coordination may represent a feasible strategy for supporting chronic disease management. Further controlled studies are required to determine effectiveness, sustainability, and scalability across diverse healthcare settings.