Prevalence and Risk Factor Analysis of Hypertension in Rural Adults: A Novel 7-Category Blood Pressure System and Generalized Linear Mixed-Effects Model Approach

Abstract Background Hypertension (HTN) is a major health risk factor for heart disease. This study explored HTN prevalence, awareness, treatment, and control in rural China using the Henan Rural Cohort Study. We also aimed to identify risk factors for developing HTN. Methods We surveyed 39,224 adults (aged 18–79) between 2015–2017 (response rate: 93.7%) and followed up with 28,621 in 2018–2022. Surveys assessed HTN status (categorized by age and sex) using a novel 7-category blood pressure system. To identify HTN risk factors, we employed a novel generalised linear mixed-effects model (GLMM) that accounts for individual variations within the study population. Results Overall HTN prevalence was around 33% (first survey: 32.73%, second survey: 33.85%). Awareness (20.09–25.31%) and treatment (18.77–24.42%) improved significantly (p < 0.05) between surveys, but control remained low (6.15–12.30%). Our GLMM analysis identified several factors associated with an increased risk of HTN. These included older age (OR: 1.23, 95% CI: 1.18–1.28), female gender (OR: 1.882, 95% CI: 1.669–2.121), ever having consumed alcohol (OR: 1.519, 95% CI: 1.342–1.719), and having a waist-to-hip ratio in the "Yes" category (WHRgrpYes) (OR: 1.161, 95% CI: 1.076–1.252). Conclusions Despite improvements, HTN prevalence remained high. The 7-category system aided HTN diagnosis. This study's application of a novel GLMM to predict HTN risk based on various factors, including age, sex, and body mass index, can inform future research to improve HTN management in rural China. Clinical Trial Registration: The Henan Rural Cohort Study was registered at the Chinese Clinical Trial Register (registration number: ChiCTR-OOC-15006699). Date of registration: July 06, 2015. http://www.chictr.org.cn/showproj.aspx?proj=11375