Bibliometric Analysis of Hypertension Care Research in Primary Care: Insights from Four Decades of Progress

Bibliometric Analysis of Hypertension Care Research in Primary Care: Insights from Four Decades of Progress | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Bibliometric Analysis of Hypertension Care Research in Primary Care: Insights from Four Decades of Progress Sudip Bhattacharya, Alok Singh, Lal Majhi, Debajit Sarkar, Akansha Singh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7609839/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective Hypertension remains a global public health challenge, with significant morbidity, mortality, and economic implications. The role of Primary Health Care (PHC) in hypertension management has gained attention for its potential to enhance prevention, diagnosis, and treatment, especially in resource-constrained settings. This study aims to provide a comprehensive overview of research on PHC’s role in managing hypertension using bibliometric analysis. Methodology Therefore, in the present study, relevant peer-reviewed research articles published from 1984 to 2024 were downloaded from the Scopus databases and later quantitatively analyzed and visualized using Bibliometrix (R package) and VOS viewer. Finally, open challenge areas were identified for future research work. Results The present study revealed that the number of literature studies published in Hypertension Care Research in Primary Care has increased from 14 to 752 between the years 1984 to 2024. Most of the research is concentrated in the field of Medicine. The USA is the most productive country in this field, followed by the United Kingdom, Spain, and Canada.McManus, R.J. from the Jichi Medical University, Kawachi District, Japan, is the most productive author in this field. Harvard Medical School, United States, is the most relevant affiliation in terms of the number of published articles. The top 10 most relevant sources are Q1 and Q2 journals, with BMJ Open, Plos One, and Journal Of General Internal Medicine, which are the leading journals in this field. The National Institutes of Health is the leading funding agency. The United States was the largest contributor. The most important trending topics related to our study, Telehealth, Health Equity, Artificial intelligence, and Primary health care, were identified. Conclusion Hypertension care research in primary care has achieved significant milestones, critical gaps persist in interdisciplinary integration, global representation, and foundational theme development. Addressing these issues requires a concerted effort to diversify research priorities, strengthen international collaborations, and balance innovation with a commitment to addressing the underlying causes of hypertension. Preventive Medicine Hypertension Primary Health Care Hypertension prevention & control Bibliometrics Medical Informatics Public Health Patient-Centered Care Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Hypertension is one of the most prevalent chronic diseases globally and a leading contributor to poor health outcomes. It significantly increases the risk of cardiovascular disease, chronic kidney disease, cognitive decline, and premature death, making it a critical public health concern.( 1 ) The condition affects a large portion of the global population, with one in four adult men and one in five adult women diagnosed with hypertension.( 2 ) Alarmingly, two-thirds of individuals with hypertension reside in low- and middle-income countries, where resources for diagnosis and management are often limited.( 3 ) The global economic burden of hypertension is substantial, accounting for about 10% of healthcare expenditures worldwide.( 4 ) These costs include direct expenses such as medications, laboratory tests, and clinical visits, as well as indirect costs related to complications, disabilities, and premature mortality. Hypertension arises from a mix of genetic predispositions and lifestyle factors, including high calorie and alcohol consumption, smoking, and lack of physical activity.( 5 ) Hypertension also places a significant strain on Primary Health Care (PHC) systems, representing one in every eight patient consultations.( 6 , 7 ) It is a major contributor to non-communicable diseases, accounting for 60% of premature deaths linked to these conditions.( 8 ) However, several barriers hinder effective hypertension control. These include inadequate screening programs, poor awareness among patients, limited access to treatment, challenges in post-treatment management, low medication adherence, and socioeconomic factors such as affordability and accessibility of care.( 9 ) The burden is particularly high in low- and middle-income countries, where three out of four people with hypertension live. Despite this, only 10% of individuals in these regions have their blood pressure effectively managed.( 10 ) In India, for instance, just 15% of hypertensive patients achieve optimal blood pressure control. Effective monitoring and management of hypertension are crucial to reducing the risks of cardiovascular diseases and improving overall health outcomes.( 8 ) To address these challenges, the World Health Organization (WHO), in collaboration with Resolve to Save Lives, launched the WHO HEARTS hypertension service package in 2017. This initiative targeted 32 low- and middle-income countries, emphasizing the role of PHC in managing hypertension. By 2022, it had treated 12.2 million patients across 165,000 PHC facilities. This program demonstrated that hypertension can be effectively managed in resource-limited settings through PHC services, highlighting the importance of integrating hypertension control into primary healthcare frameworks.( 10 ) To understand the research landscape on PHC’s role in managing hypertension, we conducted bibliometric analyses. This method involves the quantitative analysis of research publications to identify patterns, trends, and collaborations in a specific field.( 10 ) Bibliometric tools can uncover key research topics, prominent researchers, leading institutions, and the geographical distribution of studies.( 11 ) Previous bibliometric analyses have explored various aspects of hypertension, such as arterial hypertension,( 12 ) a century of research on hypertension,( 13 ) trends in West Asia,( 14 ) exercise-based interventions,( 15 ) hypoxic pulmonary hypertension,( 16 ) pregnancy-related hypertension,( 17 , 18 ) acupuncture therapy,( 19 ) and epigenetics.( 20 ) [21] Other studies have focused on global research trends,( 21 ) portal hypertension,( 22 ) and the relationship between hypertension and obstructive sleep apnea.( 23 ) As per our knowledge, no previous bibliometric study has specifically examined the intersection of PHC and hypertension management.By leveraging bibliometric analysis, we aimed to provide a comprehensive overview of research in this area. This approach allows us to identify complex patterns, highlight emerging themes, and map collaborative networks within the field. The findings of this study are expected to guide future research on PHC and hypertension, enabling researchers to focus on critical gaps and prioritize effective interventions. Our analysis underscores the need for increased attention to PHC’s role in hypertension control and its potential to reduce the global burden of this condition. Aim The aim of this bibliometric analysis is to evaluate the research landscape surrounding the role of Primary Health Care (PHC) in the management of hypertension. This study seeks to provide insights into research trends, collaborations, and thematic focus areas to guide future studies and inform evidence-based strategies for improving hypertension control through PHC. Objectives To analyze publication trends over time, identifying the growth and distribution of research related to PHC and hypertension. To map the key research themes, including major topics and emerging areas of interest in the field. To identify the most influential authors, institutions, and countries contributing to research on PHC and hypertension. To explore collaborative networks among researchers, institutions, and countries involved in this area of study. To assess the impact of citations and highlight landmark studies that have significantly advanced knowledge on PHC and hypertension. To compare research focus areas in low- and middle-income countries versus high-income countries regarding hypertension management in PHC settings. To highlight gaps in the existing literature and suggest directions for future research to strengthen PHC’s role in addressing the global burden of hypertension. Methodology Searching queries were pinpointed and organised in the preliminary planning stage, as illustrated in Annex Table 1. These queries were divided into two categories Primary search terms. Combinations of primary search terms with Research in Primary Care The primary search terms encompassed " Hypertension ", and the secondary search terms included “Primary Care”. A subset of crucial search queries and their combinations were chosen based on their relevance to Hypertension Care Research in Primary Care. By including criteria for Hypertension with Primary Care, our goal was to investigate the intersection of hypertension management strategies and their implementation within primary care settings, focusing on improving patient outcomes and healthcare delivery efficiency. This data is crucial for understanding the roles of Primary Care in Hypertension. Moreover, specific research questions, outlined in Annex Table 2, were formulated to provide a comprehensive overview of the knowledge structure and the bibliometric and statistical methods used to evaluate Hypertension Care Research in Primary Care from 1094 to 2024. Data collection During the data collection phase, we systematically searched academic articles in the SCOPUS core collection from January 1, 1984, to Dec 21, 2024, focusing on Hypertension Care Research in Primary Care. The keywords employed for data retrieval are listed in Annex Table 1. Additionally, English-language research articles and review papers were included in the study. This search yielded 10412 academic publications from SCOPUS for analysis. Data refinement During the data refinement stage,10395 publications were obtained from Scopus after proper screening of the documents. We excluded books, editorials, letters, conference papers, and non-English academic works from our systematic bibliometric review and obtained 9943 documents. After this initial filtering, we removed 17 non-relevant article duplicates from the remaining list of 9943 publications, resulting in a final total of 9926 articles. ( Annex Fig. 1) Data extraction We extracted metadata from Scopus in the form of a CSV bibliographic information file. The exported data included: (a) authors/editors, (b) full names of authors, (c) titles, (d) sources, (e) authors’ keywords, (f) keywords plus, (g) abstracts, (h) authors' affiliations, (i) corresponding authors' affiliations, (j) cited references, (k) total citations, (l) highly cited papers, (m) usage counts, (n) publication years, (o) DOIs, (p) subject categories, (q) author identifiers, (r) languages, and (s) funding agencies. Bibliometric analysis Bibliometric analysis serves as an objective method for researchers to catalogue, access, and evaluate extensive collections of publications, offering a detailed overview of recent trends in scientific literature within a specific field or research area. In this research, we conduct a bibliometric analysis of publications concerning Hypertension Care Research in Primary Care from 1984 to 2024, addressing the six primary questions presented in Annex Table 2. We employed biblioshiny and Vos viewer for bibliometric data analysis to illustrate publication patterns and research trends in premature mortality due to cardiovascular diseases. Furthermore, we aim to statistically investigate and evaluate the scientific knowledge structure through this bibliometric analysis. The fundamental knowledge framework of a research field comprises three components: Conceptual structure : Central themes and trends in the literature of a specific research area. Intellectual structure : The impact of an author's work within the scientific community. Social structure : Interactions among authors, institutions, and countries. Initially, the conceptual structure is examined statistically using thematic mapping and co-occurrence networks. Subsequently, the intellectual knowledge structure is evaluated through co-citation network analysis. Lastly, the social knowledge structure is scrutinised based on the collaboration network and collaboration world map. By analysing these conceptual, intellectual, and social structures, we aim to comprehend the knowledge framework of telemedicine applications in mental health over the past decades. This analysis will highlight current achievements In preventing and identifying future challenges in Hypertension Care Research in Primary Care. Results A. Fundamental Bibliometric Analysis Annual publications and trends The data presented in Fig. 2 illustrates that a general upward trend has been observed in Hypertension Care Research in Primary Care publications since 1993. Until 1993, annual publication numbers remained between 14 to 26. However, since 2001, exponential growth has indicated that this research area entered a phase of rapid development. The highest output occurred in 2024, with 752 publications in that year. This suggests that Hypertension Care Research in Primary Care has garnered significant attention from the researcher’s community during this period. Analysis of the Subject area The pie chart in Fig. 3 illustrates the distribution of research output related to Hypertension Care Research in Primary Care across various subject areas. Most of the research is concentrated in Medicine, accounting for 73.9.0%, followed by Nursing (6.4%), Biochemistry, Genetics and Molecular Biology (5.2%). Other significant contributions come from Pharmacology Toxicology and Pharmaceutics (3.4%), Health Professions (2.2%), Social Sciences (1.8%), Multidisciplinary (1.7%), Neuroscience (1.2%), Psychology (1.1%), Immunology and Microbiology (0.6%) and others and Others fields contributing (2.7%). A detailed analysis confirms that Medicine is the predominant focus of this research. Analysis of most relevant authors A total of 22510 authors participated in Precision Medicine-related studies, with ten authors contributing 29 or more papers each. Annex Table 3 highlights these prolific authors, who collectively produced 305 publications, accounting for 3% of total submissions. Among them, McManus, R. J. from the Jichi Medical University, Kawachi District, Japan, was the most productive, publishing 59 papers. He was followed by Bosworth, H.B. from the Duke University School of MedicineThe institution will open in a new tab, Durham, United States (43 papers) and also by Hobbs, F.D.R. (36 papers) from the University of Oxford Medical Sciences Division The institution will open in a new tab, Oxford, United Kingdom. The research work by Nirantharakumar Krishnarajah from NIHR Birmingham Biomedical Research, Birmingham, United Kingdom and colleagues had the highest citation count, with 636 citations. The top 10 authors were primarily based in the United States, UK, Singapore, Japan and Germany. Analysis of the Organisations The study analysed contributions from 16614 distinct organisations, with the top 10 institutions contributing 1642 publications. Harvard Medical School, United States, ranked highest with 226 papers, followed by the VA Medical Center, United States (USA) (207 papers), and the University of Toronto, Canada (192 papers). Other significant contributors included the University of Oxford, United Kingdom, with 184 papers; the University of California, San Francisco, United States, with 159 papers. University of Oxford Medical Sciences Division, United Kingdom, 149 papers; Brigham and Women's Hospital, United States, 144 papers; and University of Birmingham, United Kingdom (UK), 137 papers. Johns Hopkins University School of Medicine United States (USA) and University College London United Kingdom (UK), 122 papers ( Annex Table 4). The top 10 organisations contributed 18.5% of total publications. Figure 4 Uses a three-field plot diagram to illustrate the pattern of authors’ publications in different related topics and journals. Analysis of Country Scientific Production Annex Table 5 lists the ten leading countries involved in Precision Medicine research. It provides data on the total number of published articles in this field by different countries. According to Annex Table 5, only the United States and the United Kingdom have published over 1500 papers on Hypertension Care Research in Primary Care from 1984 to 2024. The USA is the leading country in terms of scientific productivity, with 4065 publications, followed by the United Kingdom (n = 1595), Spain (n = 661), Canada (n = 616) and Australia (n = 409). Most preferred Journal A total of 979 academic journals have published research articles on premature mortality due to cardiovascular disease. The Ten most active journals accounted for 1335 out of 9926 papers, contributing 13.4% of the total publications (Annex Table 6). BMJ Open led with 287 articles, followed by Plos One (173), Journal Of General Internal Medicine (156), British Journal Of General Practice (126) and Journal Of Hypertension (116). Other significant contributors were Family Practice (107), BMC Family Practice (105), BMC Health Services Research (97), Journal Of Clinical Hypertension (97), and American Journal Of Hypertension (82) (Annex Table 6). Bradford's Law suggests that a few journals are central to a specific research field. As illustrated in Annex Fig. 5, the ten journals highlighted in Annex Table 6 form this core group, accounting for approximately one-third of the entire collection's documents. Annex Table 6 provides details about the country, quartile, and H index, as well as documents from the top ten periodicals, each contributing more than 80 articles to our bibliographic collection. (Annex Fig. 6) represents Documents per year by source, where the x-axis represents the publication years (1986–2024), while the y-axis represents the number of documents published annually. BMJ Open and PLoS ONE show a significant rise in document count, reflecting their increasing influence or popularity in recent years. Other journals maintain steady trends, indicating niche-specific focus and consistent output. The sharp rise in BMJ Open documents may suggest increased research output in its domain during and after the COVID-19 pandemic period (2020–2021). Analysis of the highly Cited Research Publications in Precision Medicine The ten most frequently cited research publications in the field of Hypertension Care Research in Primary Care, specifically within the analysed collection and published between 1984 and 2024, are listed in Annex Table 7. For instance, Elizabeth J Williamson et al. authored an article titled Factors associated with COVID-19-related death using OpenSAFELY, the highest locally cited publication with 4324 total citations.( 24 ) The second most influential paper, with 1469 total citations, is “The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis” by Zobair M Younossi et al., published in the Journal of Hepatology.( 25 ) The article “Chronic Kidney Disease Diagnosis and Management: A Review” by Teresa K Chen et al. also garnered 951 total citations.( 26 ) Lastly, Kenneth Cusi et al.'s publication, American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD),( 27 ) achieved 497 total citations, as depicted in Annex Table 7. Active Funding Agencies Of the 2723 articles reviewed, 2723 were funded by the top 10 organisations. The National Institutes of Health in the United States was the largest contributor, backing 744 Hypertension Care Research in Primary Care studies. Other major funders included the U.S. Department of Health and Human Services (n = 540), National Heart, Lung, and Blood Institute, The United States (n = 384), Medical Research Council (n = 180), National Institute for Health Research (n = 173), National Institute of Diabetes and Digestive and Kidney Diseases (n = 162), National Institute for Health and Care Research (n = 160) National Center for Advancing Translational Sciences (n = 138), UK Research and Innovation (n = 137), National Institute on Aging (n = 105). Six of the top ten funders were from The United States and Four were from the United Kingdom (UK). (Annex Table 8) B. Conceptual Knowledge Structure Analysis Analysis of the Keywords In this part of our study, we employed keyword and co-occurrence analyses to explore the latest research trends and advancements in Hypertension Care Research in Primary Care. Our objective is to pinpoint research gaps and predict future directions in this domain. The primary keywords are illustrated in Annex Fig. 7, with Hypertension (888), Primary care(856), Primary health care (268 Occurrences), Blood pressure (190 Occurrences), Diabetes (171 Occurrences), Cardiovascular disease (141 Occurrences), Covid-19 (126 Occurrences), Epidemiology (123 Occurrences), Public health (116 Occurrences), Chronic kidney disease (115 Occurrences), Diabetes mellitus (113 Occurrences), Obesity (104 Occurrences), Telemedicine (96 Occurrences), Risk factors (90 Occurrences), Chronic disease (89 Occurrences), Cardiovascular diseases (82 Occurrences), Type 2 diabetes (82 Occurrences), Prevalence (80 Occurrences), Medication adherence (73 Occurrences). The keyword growth in Hypertension Care Research in Primary Care is also depicted using the cumulative occurrence graph in Annex Fig. 8. This graph shows a progressive increase in the annual occurrence of the author’s keywords related to Precision Medicine, such as Hypertension, primary care, primary health care, blood pressure, diabetes, cardiovascular disease, COVID-19, epidemiology, public health, chronic kidney disease, diabetes mellitus, obesity, telemedicine, risk factors, chronic disease, cardiovascular diseases, type 2 diabetes, prevalence and medication adherence have exhibited more dynamic growth compared to others. The cumulative occurrence of the top 15 keywords in the year 2024 includes Hypertension (888), Primary care(856), Primary health care (268 Occurrences), Blood pressure (190 Occurrences), Diabetes (171 Occurrences), Cardiovascular disease (141 Occurrences), Covid-19 (126 Occurrences), Epidemiology (123 Occurrences), Public health (116 Occurrences), Chronic kidney disease (115 Occurrences), Diabetes mellitus (113 Occurrences), Obesity (104 Occurrences), Telemedicine (96 Occurrences), Risk factors (90 Occurrences), Chronic disease (89 Occurrences), have increased significantly, indicating trending or popular research topics in the field, growing interested or emerging trends in that topic. The graph highlights the shifts in research focus. Furthermore, we analysed the co-occurrence of authors’ keywords using Vos Viewer. The co-occurrence network helps understand the thematic areas of the research field and identify the most critical and current issues. It also provides insights into the evolution of these issues over time. We extracted 39 out of 6067 keywords with a frequency of 38 or more for co-occurrence analysis in Vos viewer to explore trends and hotspots in the field of research (Fig. 9 ). The results of the co-occurrence network analysis are presented in Annex Table 9. The visual representations classify keywords into seven clusters, as shown in Annex Table 9. Thematic Map The thematic development of keywords from 1984 to 2024 is examined using the keyword thematic map and Sankey diagram presented in Annex Fig. 10. Analysing the thematic map helps researchers to understand the current landscape of their field, identify key themes, and explore areas that need further investigation. The map divides these themes into four quadrants based on two axes. Centrality (X-axis) Indicates the importance or relevance of the theme in the overall research field, and Density (Y-axis) Indicates the theme's internal development, i.e., how well-developed and mature the theme is.( 28 ) The Upper-Right Quadrant (Motor Themes) is related to High Centrality and High Density. These themes are both important and well-developed. They play a significant role in structuring the research field and are actively developed, serving as "motor" themes. It includes themes like primary care, covid 19, epidemiology, Hypertension, Blood pressure and Medication adherence. Upper-Left Quadrant (Niche Themes) is related to Low Centrality and High Density. These themes are well-developed but not central to the overall research field. They often represent specialised or niche topics that are mature but not crucial to the broad field. It includes themes like Dementia, Implementation, ambulatory blood pressure monitoring and systematic review. The lower-Right Quadrant (Basic and Transversal Themes) is related to High Centrality and low Density. These themes are important but underdeveloped. They represent foundational or emerging areas that have relevance across various subfields but require further development. It includes themes like Primary health care, Diabetes Mellitus, Cardiovascular Disease, Chronic Kidney Disease and Diabetes. The lower-Left Quadrant (Emerging or Declining Themes) is related to Low Centrality and low Density. These themes are neither well-developed nor important to the overall research field. They could represent either emerging themes yet to gain attention or declining themes losing relevance. It includes themes like Obesity, Metabolic Syndrome, Public health, preventive medicine and health policy.( 29 ) (Annex Fig. 11) Trending Topics We focused on two keywords appearing at least five times each year to analyse the trending topics. Since 2001,4 keywords have shown notable increases in frequency. Annex Fig. 12 illustrates. The time zone view of trending topics revealed that from 2018-21, themes like Glaucoma, Global health, Antihypertensive therapy, Diabetes mellitus type 2, Ambulatory blood pressure, monitoring, Quality of care, Arterial hypertension, Diabetes, Epidemiology and Risk factors had been in focus, but after 2022, themes like Hypertension, Primary care, Primary health care, Telehealth, Anxiety, Chronic diseases, Health Equity, Artificial intelligence, Equity, have gained significant attention in the field, which is likely to remain focal points in future research of telemedicine and mental health. C. Analysis of Social Knowledge Structure. Authors’ collaboration network analysis VOS viewer software was employed to map and visualise the relationships between authors based on their co-authored publications. This type of analysis helps researchers understand patterns of academic collaboration, such as which authors frequently work together and how these collaborations form larger clusters of research groups. Each node in the network represents an author. The lines connecting the nodes represent co-authorship relationships, where two authors have worked on one or more publications together. Authors who frequently collaborate with each other are grouped into clusters, which are typically represented by different colours. These clusters reflect collaborative research teams or communities. The size of each node indicates the author's productivity, often based on the number of publications. The thickness of the lines (edges) between authors can indicate the strength of collaboration, i.e., how many times two authors have co-published. This type of analysis is valuable for identifying influential researchers, key collaboration networks, and potential gaps or opportunities for new collaborations in a specific field of study. ( 30 , 31 ) Choosing 12 as a minimum number of documents, out of 22510 authors, 17 met the threshold. Annex Fig. 13 and Annex Table 10 highlight the co-authorship between them. Each set of consists of consists of 3 items, making two different clusters. Institution collaboration network analysis VOS viewer software was employed to visualise co-authorship between institutions, helping to identify collaborative networks and track their evolution over time.( 32 ) The analysis focused on institutions that produced ten or more papers, with the results presented in Annex Fig. 14 and Annex Table 11. In this visualisation, node size represented publication volume, links depicted co-authorship connections, and node colours indicated distinct clusters. From the 16614 organisations, a minimum number of documents was chosen for 8 a total 14 institutions that met the threshold and were included in the analysis. Instead of analysing individual authors, this approach aggregates data at the institutional level, focusing on how organisations collaborate with one another based on their authors’ co-authored papers. The network shows organisations as nodes, with the connections (or edges) representing co-authorship ties. The more papers institutions co-author, the stronger the link between them in the network. The findings suggest that inter-institutional collaborations predominantly occur within national borders. Institutions with higher publication outputs tended to collaborate more frequently with others, indicating that fostering institutional partnerships could enhance the quality and quantity of research outputs. Countries Collaboration network analysis The visualization of collaboration among countries with a minimum productivity of 90 documents is shown in Fig. 15 . The analysis shows how authors from different countries collaborate. Each country is represented as a node, and the node size indicates the number of co-authored papers or the contribution level. The links between nodes (countries) represent collaborative relationships, with thicker links showing stronger or more frequent collaborations.( 33 , 34 ) The map showed 14 countries in two different clusters, each with a different colour. The analysis highlights that the USA has the strongest research collaborations with other countries (link strength = 507), the UK (link strength = 472), Australia (link strength = 193), Canada (link strength = 191), Spain (link strength = 163 ), Italy (link strength = 149 ), Netherlands (link strength = 148), Germany (link strength = 146), Switzerland (link strength = 129), china (link strength = 122 ), India (link strength = 121), Sweden (link strength = 103), singapore (link strength = 81), brazil (link strength = 65). The thickness of the connecting line between any two countries indicates the strength of collaboration. Countries with similar colours form one cluster. Annex Table 12 highlights the different countries forming one cluster. D. Analysis of Intellectual knowledge structure. Analysis of co-cited authors Co-cited authors network analysis refers to examining relationships between authors based on how often they are cited in the same documents. This visualisation or map shows the relationships between authors based on their co-citation frequency. It helps identify groups or clusters of authors who are frequently referenced together, often indicating that they contribute to similar research areas or themes. These clusters of co-cited authors may represent specific research fields or topics in the VOS viewer. Authors within the same cluster are likely to have influenced each other or contributed to a shared body of knowledge. Co-cited authors network analysis can be used to identify leading scholars, influential research collaborations, or emerging trends in a particular academic discipline. Each author's publication is shown in a circle and denoted by the author’s name. The colour of a publication shows the cluster to which the author’s publication belongs. The size of each node in the graph represents the number of citations an author has received, with larger nodes corresponding to higher citation counts and greater influence.( 35 ) Of 256272 authors, using 165 as a minimum number of co-citations, 27 met the threshold. Whelton, Paul K. leads with 493 co-citations, followed by Mancia, Giuseppe, Carey r.m, and Muntner, Paul, with 461, 410, and 315 co-citations, respectively ( Annex Table 13) and Annex Fig. 16. The top 10 co-cited authors amassed over 3319 co-citations, underscoring their significant impact on premature mortality due to cardiovascular disease research. Analysis of co-cited journals Co-cited journal network analysis examines relationships between journals based on how frequently they are co-cited together in other academic papers. Co-citation occurs when two journals are cited together by a third, meaning they are both referenced in the same document. The relationships between journals are visualised as a network, where journals are represented as nodes, and the strength of co-citations forms the edges connecting these nodes. Frequently, co-cited journals tend to form clusters, indicating that they share similar or related topics, research areas, or disciplines. The analysis helps identify core journals in a field and relationships between journals, revealing trends, disciplines, or interdisciplinary connections, as well as research fronts, showing emerging fields of study. The larger the number of co-citations, the stronger the relationship between the journals, and this is reflected in the distance between nodes and the thickness of the connecting lines in the network visualisation. From the 28486 sources, a minimum number of citation of a source was chosen for 550 a total 18 sources met the threshold and were included in the analysis. Three of the journals listed in Annex Table 14 have been cited more than 2800 times. Annex Fig. 17 illustrates that the five core journals in the field are The Lancet (Q1, H index = 895), JAMA-Journal of Medical Association (Q1, H index = 768), Plos One (Q1, H index = 435), Circulation (Q1, H index = 674). Analysis of co-cited references Co-cited reference network analysis visualises a research field's intellectual structure by showing which references are frequently cited together, reflecting thematic relationships within the literature. In co-cited reference network analysis, nodes represent the references, and the links (edges) between them represent how frequently they are co-cited. A dense cluster of nodes in such a network suggests that the references in that cluster are often co-cited together, implying a close intellectual relationship or a thematic similarity. Groups of studies that are frequently cited together could reveal key themes, methodologies, or theories in a specific domain. Highly co-cited references often indicate foundational or highly influential works in a particular research area (Annex Fig. 18) .( 36 , 37 ) From the 144516 cited reference, a minimum number of citations of a cited reference was chosen for 18 a total 10 references that met the threshold and were included in the analysis. Our analysis reveals that these ten articles primarily focus on four main research themes: 1. Global Guidelines and Policy Frameworks for Hypertension Management. 2. Epidemiological Trends and Burden of Hypertension. 3. Primary Care as a Key Setting for Hypertension Management. 4. Hypertension as a Component of Noncommunicable Disease Control. (Annex Table 15) Discussion The bibliometric analysis of hypertension care research in primary care reveals significant insights into the field's evolution, thematic focus, and collaboration patterns. The upward trend in annual publications underscores the increasing recognition of hypertension as a critical public health issue, aligning with global efforts to improve primary care systems and mitigate cardiovascular risks. For instance, the World Health Organization (WHO) launched the Global Hearts Initiative, which includes the HEARTS technical package aimed at improving hypertension management in primary care settings through evidence-based protocols, access to affordable medications, and health worker training.( 38 , 39 ) Similarly, in the United States, the Million Hearts initiative seeks to prevent one million heart attacks and strokes by emphasizing hypertension control as a cornerstone of cardiovascular health.( 40 , 41 ) Moreover, countries like Canada have implemented community-based programs such as Hypertension Canada’s CHEP (Canadian Hypertension Education Program) guidelines, which focus on lifestyle interventions and systematic management within primary care networks.( 42 , 43 ) These examples highlight a global commitment to addressing hypertension through integrated care, policy support, and public awareness campaigns. However, this growth also reflects broader dynamics in research prioritization, including funding shifts, technological advancements, and an emphasis on non-communicable diseases. For instance, the exponential growth phase post-2000 could be attributed to increased awareness of hypertension's role in global morbidity and the expanded use of electronic health records for population-level studies. For example, initiatives like the National Health and Nutrition Examination Survey (NHANES) in the United States have leveraged EHRs to monitor hypertension prevalence and management trends.( 44 ) Similarly, the United Kingdom's Clinical Practice Research Datalink (CPRD) has enabled large-scale analyses of hypertension treatment and outcomes, contributing to evidence-based interventions.( 45 ) In low- and middle-income countries, the WHO STEPwise approach to surveillance (STEPS) has promoted systematic data collection on non-communicable diseases, including hypertension, aiding global public health strategies.( 46 ) These advancements underscore how technological and methodological progress has enhanced our ability to track and address hypertension as a major health concern. Yet, the sustainability and equitable distribution of this research output warrant further scrutiny. The dominance of medicine as the primary subject area emphasizes the clinical and therapeutic focus of hypertension research. While this aligns with the immediate goal of improving patient outcomes, the relatively lower contributions from disciplines like social sciences and health professions highlight potential gaps in addressing the broader determinants of hypertension. For example, social sciences research focusing on socioeconomic factors such as income, education, and access to healthcare could offer deeper insights into the root causes of hypertension. Studies on the social determinants of health, such as those conducted by the WHO Commission on Social Determinants of Health, emphasize how factors like living conditions, community support, and stress levels can influence hypertension risk.( 47 , 48 ) Studies such as those exploring community-based interventions or policy-driven approaches remain underrepresented despite their critical role in comprehensive hypertension management. Studies on community-based interventions and policy-driven approaches remain underrepresented, despite their crucial role in hypertension management. Programs like the "Community Hypertension Prevention Program" in rural areas improve awareness and lifestyle changes, while policy initiatives, such as salt reduction and sugar-sweetened beverage taxes, can reduce hypertension risk at a population level. The focus of research on clinical trials and pharmacological treatments has limited exploration of these broader strategies.( 49 , 50 ) Expanding research to include community and policy approaches would enhance comprehensive hypertension management, especially in vulnerable populations. This imbalance suggests an opportunity for interdisciplinary collaboration to bridge the divide between clinical research and public health implementation. The analysis of prolific authors and institutions highlights the concentrated nature of research output, with a few key contributors driving a significant portion of the literature. While this concentration ensures expertise and quality, it may also indicate limited diversity in research perspectives. For example, leading institutions and authors, predominantly from high-income countries, suggest a possible underrepresentation of research addressing hypertension care challenges in low- and middle-income regions. Hypertension care research in low- and middle-income countries (LMICs) is underrepresented, despite the higher burden in these regions. Studies like the "Hypertension in Africa" report highlight challenges such as limited access to diagnosis and treatment.( 51 ) Research from high-income countries often focuses on advanced tools and treatments not suited for LMICs, creating a gap in addressing regional needs.( 52 , 53 ) Expanding research in LMICs would promote more equitable global hypertension care. Given the global burden of hypertension, fostering research capacity in underrepresented settings is crucial to ensuring that findings are universally applicable.( Collaboration networks reveal strong national clusters, with limited international linkages in certain cases. This pattern indicates that while institutional and national collaborations are robust, there is untapped potential for fostering global partnerships to address hypertension as a transnational challenge. For instance, the United States and the United Kingdom lead in productivity and collaboration, but connections with countries bearing a disproportionate burden of hypertension remain sparse. Limited collaboration between high-income countries (HICs) like the U.S. and the UK, and low- and middle-income countries (LMICs) such as India and Sub-Saharan African nations, can be attributed to several factors. Research funding predominantly supports HICs, where advanced treatments like those for drug-resistant hypertension are prioritized,( 54 , 55 ) while LMICs face challenges such as limited access to affordable medications and diagnostic tools. In LMICs, inadequate healthcare infrastructure, like in rural parts of Africa,( 56 , 57 ) restricts large-scale hypertension studies, and logistical barriers such as lack of transportation impede research efforts. Additionally, political instability, seen in regions like Venezuela, disrupts health research projects, making international collaborations difficult.( 58 ) These factors contribute to the underrepresentation of hypertension research in high-burden countries. ( 59 – 67 ) Expanding these networks could enhance the global applicability of research findings and promote equitable knowledge exchange. The analysis of thematic areas provides a nuanced understanding of the field's intellectual landscape. High-centrality and high-density themes such as primary care, hypertension, and blood pressure reflect the core focus of the field, whereas niche themes like ambulatory blood pressure monitoring and systematic reviews underscore areas of advanced, yet specialized, inquiry. Notably, emerging themes like telemedicine and health equity highlight shifts toward addressing contemporary challenges, such as the integration of digital health tools and the pursuit of equitable care delivery. However, the underdevelopment of foundational themes, including preventive medicine and public health, signals the need for more investment in these areas to support sustainable hypertension management strategies. The keyword co-occurrence and thematic maps further illustrate evolving research priorities. The prominence of terms like COVID-19, telehealth, and artificial intelligence reflects adaptive responses to external events and technological innovation. While these developments are promising, they also pose the risk of diverting attention from foundational issues, such as improving access to primary care and addressing social determinants of health. For instance, the surge in telemedicine research during the pandemic must be critically evaluated for its long-term impact on health equity and care continuity. Highly cited publications and journals provide insight into the field's influential works and dissemination platforms. The prominence of journals like “BMJ Open” and “PLOS ONE” suggests an increasing preference for open-access dissemination, which enhances the accessibility of research findings. However, reliance on a narrow set of journals may limit the diversity of published perspectives. Encouraging submissions to a broader range of journals could help disseminate varied methodologies and regional insights. Conclusion In conclusion, while hypertension care research in primary care has achieved significant milestones, critical gaps persist in interdisciplinary integration, global representation, and foundational theme development. Addressing these issues requires a concerted effort to diversify research priorities, strengthen international collaborations, and balance innovation with a commitment to addressing underlying causes of hypertension. By critically evaluating these aspects, the field can evolve toward more inclusive, impactful, and sustainable research practices. Limitations of this study: This bibliometric analysis has several limitations. First, reliance on a single database (Scopus) may exclude relevant studies, particularly those from regional or non-English journals. Second, keyword-based data retrieval may introduce bias due to variability in terminology and indexing practices. Third, citation-based metrics, while indicative of impact, can be skewed by factors like journal prestige or self-citations and may overlook recent or less prominent studies. Fourth, automated thematic mapping may oversimplify complex relationships, potentially missing nuanced research insights. Lastly, the analysis does not explore qualitative aspects of collaboration networks, such as disparities in research capacity or contributions. Addressing these limitations in future studies would provide a more comprehensive understanding of hypertension care research. Declarations Authors Contribution: Dr Sudip Bhattacharya: Conceptualization, writing original draft, review and editing. Dr Alok Singh and Dr Akanksha Singh: Data visualization, Data curation, writing – original draft and review. Conflict of interest: Nil Funding: Nil Ethical clearance: NA References Yasli G, Damar M, Özbiçakci Ş, Alici S, Pinto AD. Primary care research on hypertension: A bibliometric analysis using machine-learning. Medicine (Baltimore). 2024;103(47):e40482. Kochanek KD, Murphy SL, Xu J, Arias E. Deaths: Final Data for 2017. Natl Vital Stat Rep Cent Dis Control Prev Natl Cent Health Stat Natl Vital Stat Syst. 2019;68(9):1–77. Hypertension [Internet]. [cited 2024 Dec 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223–37. Pazoki R, Dehghan A, Evangelou E, Warren H, Gao H, Caulfield M, et al. Genetic Predisposition to High Blood Pressure and Lifestyle Factors: Associations With Midlife Blood Pressure Levels and Cardiovascular Events. Circulation. 2018;137(7):653–61. Yurekli AA, Bilir N, Husain MJ. Projecting burden of hypertension and its management in Turkey, 2015-2030. PloS One. 2019;14(9):e0221556. Hypertension management in primary health care: a survey in eight regions of Sweden - PubMed [Internet]. [cited 2024 Dec 22]. Available from: https://pubmed.ncbi.nlm.nih.gov/37561134/ Arora A, Gola A, Loganathan V, Lakshminarayanan S, Kar SS. Hypertension Control Status Among Patients Receiving Treatment From Selected Primary Health Centres in Puducherry: A Cohort-Analysis Approach. Cureus. 2023;15(9):e45042. Identifying trends, patterns, and collaborations in nursing career research: A bibliometric snapshot (1980–2017) - ScienceDirect [Internet]. [cited 2024 Dec 22]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1322769618303858 Moran AE, Gupta R, Global Hearts Initiative Collaborators. Implementation of Global Hearts Hypertension Control Programs in 32 Low- and Middle-Income Countries: JACC International. J Am Coll Cardiol. 2023;82(19):1868–84. Damar HT, Bilik O, Ozdagoglu G, Ozdagoglu A, Damar M. Scientometric overview of nursing research on pain management. Rev Lat Am Enfermagem. 2018;26:e3051. Karabaeva RZ, Vochshenkova TA, Zare A, Jafari N, Baneshi H, Mussin NM, et al. Genetic and epigenetic factors of arterial hypertension: a bibliometric- and in-silico-based analyses. Front Mol Biosci. 2023;10:1221337. Abba M, Nduka C, Anjorin S, Mohamed S, Agogo E, Uthman O. One Hundred Years of Hypertension Research: Topic Modeling Study. JMIR Form Res. 2022;6(5):e31292. Rezapour M, Yazdinejad M, Rajabi Kouchi F, Habibi Baghi M, Khorrami Z, Khavanin Zadeh M, et al. Text mining of hypertension researches in the west Asia region: a 12-year trend analysis. Ren Fail. 2024;46(1):2337285. Lou Y, Sun N, Zhang M, Qiu Y, Wang J, Chen J. Trends in exercise for hypertension: a bibliometric analysis. Front Cardiovasc Med. 2023;10:1260569. Yang W, Shen J, Shi G, Zhang T, Wei W, Wang C, et al. Bibliometric and visual analysis of hypoxic pulmonary hypertension from 2013 to 2022. Heliyon. 2023;9(11):e22044. Alam MS, Islam MM. Bibliometric Study of Placenta in Pregnancy-Induced Hypertension. J Sci Soc. 2022;49(3):298. Salmani D, Purushothaman S, Somashekara SC, Gnanagurudasan E, Sumangaladevi K, Harikishan R, et al. Study of structural changes in placenta in pregnancy-induced hypertension. J Nat Sci Biol Med. 2014;5(2):352–5. Man TM, Wu L, Zhang JY, Dong YT, Sun YT, Luo L. Research trends of acupuncture therapy for hypertension over the past two decades: a bibliometric analysis. Cardiovasc Diagn Ther. 2023;13(1):67–82. Liu N, Xia L. Investigation of epigenetics insights of hypertension: A bibliometric analysis. Medicine (Baltimore). 2023;102(36):e35125. Trends in Worldwide Research in Hypertension Over the Period 1999-2018: A Bibliometric Study - PubMed [Internet]. [cited 2024 Dec 22]. Available from: https://pubmed.ncbi.nlm.nih.gov/32862706/ Kaplan K, Solak Y. Portal hypertension research activity: A bibliometric analysis. Cukurova Med J. 2022 Dec 28;47(4):1709–21. Y N, H C, W Z, H X, X D, S Z, et al. Research trends in hypertension associated with obstructive sleep apnea: a bibliometric analysis. Sleep Breath Schlaf Atm [Internet]. 2023 May [cited 2024 Dec 22];27(2). Available from: https://pubmed.ncbi.nlm.nih.gov/35579792/ Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584(7821):430–6. Younossi ZM, Golabi P, de Avila L, Paik JM, Srishord M, Fukui N, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis. J Hepatol. 2019;71(4):793–801. Chen TK, Knicely DH, Grams ME. Chronic Kidney Disease Diagnosis and Management: A Review. JAMA. 2019;322(13):1294–304. American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD) - PubMed [Internet]. [cited 2024 Dec 22]. Available from: https://pubmed.ncbi.nlm.nih.gov/35569886/ Yu J, Muñoz J. A Bibliometric Overview of Twitter-Related Studies Indexed in Web of Science. Future Internet. 2020;12:91. Wilczewski M, Alon I. Language and communication in international students’ adaptation: a bibliometric and content analysis review. High Educ. 2022;85:1–22. Su M, Peng H, Li S. A visualized bibliometric analysis of mapping research trends of machine learning in engineering (MLE). Expert Syst Appl. 2021;186:115728. Kirby A. Exploratory Bibliometrics: Using VOSviewer as a Preliminary Research Tool. Publications. 2023;11(1):10. VOSviewer - an overview | ScienceDirect Topics [Internet]. [cited 2024 Dec 22]. Available from: https://www.sciencedirect.com/topics/economics-econometrics-and-finance/vosviewer Okonta DE. The scientometric analysis and visualization of sustainable procurement. Heliyon. 2023;9(10):e20985. Li L, Wan N, He Y, Zhang Y, He X, Lu L. A global bibliometric and visualized analysis of the status and trends of bone metastasis in breast cancer research from 2002 to 2021. J Bone Oncol. 2023;42:100500. Kleminski R, Kazienko P, Kajdanowicz T. Analysis of direct citation, co-citation and bibliographic coupling in scientific topic identification. J Inf Sci. 2022;48(3):349–73. Citation Network - an overview | ScienceDirect Topics [Internet]. [cited 2024 Dec 22]. Available from: https://www.sciencedirect.com/topics/computer-science/citation-network Small H. Co-Citation in the Scientific Literature: A New Measure of the Relationship Between Two Documents. J Am Soc Inf Sci. 1973;24:265–9. HEARTS: Technical package for cardiovascular disease management in primary health care: Risk-based CVD management [Internet]. [cited 2024 Dec 22]. Available from: https://www.who.int/publications/i/item/9789240001367 Moran AE, Gupta R, Pathni A, Osi K, Dessie G, Zhang X, et al. Implementation of Global Hearts Hypertension Control Programs in 32 Low- and Middle-Income Countries: JACC International. J Am Coll Cardiol. 2023 Nov 7;82(19):1868–84. Benjamin RM. The Million Hearts TM Initiative: Progress in Preventing Heart Attacks and Strokes. Public Health Rep. 2012;127(6):558–60. CDC. Centers for Disease Control and Prevention. 2024 [cited 2024 Dec 22]. About Million Hearts® 2027 | Million Hearts®. Available from: https://millionhearts.hhs.gov/about-million-hearts/index.html impact of the Canadian Hypertension Education Programme in its first decade | European Heart Journal | Oxford Academic [Internet]. [cited 2024 Dec 22]. Available from: https://academic.oup.com/eurheartj/article-abstract/30/12/1434/550995?redirectedFrom=fulltext Feldman RD, Campbell NR, Wyard K. Canadian Hypertension Education Program: The evolution of hypertension management guidelines in Canada. Can J Cardiol. 2008;24(6):477–81. Hohman KH, Zambarano B, Klompas M, Wall HK, Kraus EM, Carton TW, et al. Development of a Hypertension Electronic Phenotype for Chronic Disease Surveillance in Electronic Health Records: Key Analytic Decisions and Their Effects. Prev Chronic Dis. 2023;20:E80. Clinical Practice Research Datalink [Internet]. [cited 2024 Dec 22]. Available from: https://www.cprd.com/ STEPwise approach to NCD risk factor surveillance (STEPS) [Internet]. [cited 2024 Dec 22]. Available from: https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps Braveman P, Gottlieb L. The Social Determinants of Health: It’s Time to Consider the Causes of the Causes. Public Health Rep. 2014;129(Suppl 2):19–31. Chaturvedi A, Zhu A, Gadela NV, Prabhakaran D, Jafar TH. Social Determinants of Health and Disparities in Hypertension and Cardiovascular Diseases. Hypertens Dallas Tex 1979. 2024;81(3):387–99. Ferdinand KC, Patterson KP, Taylor C, Fergus IV, Nasser SA, Ferdinand DP. Community-based approaches to prevention and management of hypertension and cardiovascular disease. J Clin Hypertens Greenwich Conn. 2012;14(5):336–43. Valdés González Y, Campbell NRC, Pons Barrera E, Calderón Martínez M, Pérez Carrera A, Morales Rigau JM, et al. Implementation of a community‐based hypertension control program in Matanzas, Cuba. J Clin Hypertens. 2020;22(2):142–9. van de Vijver S, Akinyi H, Oti S, Olajide A, Agyemang C, Aboderin I, et al. Status report on hypertension in Africa - Consultative review for the 6th Session of the African Union Conference of Ministers of Health on NCD’s. Pan Afr Med J. 2013;16:38. Pramesh CS, Badwe RA, Bhoo-Pathy N, Booth CM, Chinnaswamy G, Dare AJ, et al. Priorities for cancer research in low- and middle-income countries: a global perspective. Nat Med. 2022;28(4):649–57. Malekzadeh A, Michels K, Wolfman C, Anand N, Sturke R. Strengthening research capacity in LMICs to address the global NCD burden. Glob Health Action. 13(1):1846904. Kotchen TA. Establishing funding priorities for hypertension research: a modest proposal. Hypertens Dallas Tex 1979. 2017;70(5):893–6. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223–37. Yenet A, Nibret G, Tegegne BA. Challenges to the Availability and Affordability of Essential Medicines in African Countries: A Scoping Review. Clin Outcomes Res CEOR. 2023;15:443–58. Oleribe OO, Momoh J, Uzochukwu BS, Mbofana F, Adebiyi A, Barbera T, et al. Identifying Key Challenges Facing Healthcare Systems In Africa And Potential Solutions. Int J Gen Med. 2019;12:395–403. Kohrt BA, Mistry AS, Anand N, Beecroft B, Nuwayhid I. Health research in humanitarian crises: an urgent global imperative. BMJ Glob Health. 2019;4(6):e001870. Bhattacharya S, Bera OP, Majhi L, Sarkar D, Bhardwaj P, Joshi KJ, Mondal H, Venkatesh U, Aggarwal P. Hypertension Management in Tribal Primary Health Centers: Advancing Equity and Access. Cureus. 2025;17(6):e85535. Bhattacharya S, Varshney S, Hossain MM, Saleem SM, Gupta P, Singh A. “Taste modification” strategy for prevention and control of hypertension in India: need for robust clinical trials. Lancet Reg Health - Southeast Asia. 2023 ;14:100206. Bera OP, Mondal H, Bhattacharya S. Empowering Communities: A Review of Community-Based Outreach Programs in Controlling Hypertension in India. Cureus. 2023 Dec 18;15(12):e50722. Bhattacharya S, Thakur JS, Singh A. Knowledge attitude, and practice regarding dietary salt intake among urban slum population of North India. J Family Med Prim Care 2018;7:526-30. Bhattacharya S, Heidler P, Varshney S. Incorporating neglected non-communicable diseases into the national health program-A review. Front Public Health. 2023;10:1093170. Bhattacharya S, Bera OP. Neglected Non-Communicable Diseases-Looking beyond the BIG FOUR. Indian J Comm Health.2022;34(2):317-318. Bhattacharya S, Thakur JS. Implementation of Global NCD Monitoring Framework in Punjab, Haryana and Chandigarh–A Feasibility study. Indian J Comm Health. 2017; 29, 1: 17-22. Bhattacharya S, Singh A, Kashyap A. Digital horizons in non-communicable disease care: a bibliometric exploration of intervention impact and innovation. Front Digit Health. 2025;7:1528711. Singh A, Singh A, Bhattacharya S. Front-of-package food labelling and noncommunicable disease prevention: A comprehensive bibliometric analysis of three decades. Med J Armed Forces India. 2025;81(2):126-138. Additional Declarations The authors declare no competing interests. Supplementary Files Annexures.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7609839","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":514704886,"identity":"e5fd0a96-2461-43f6-a6e3-ee28a3fbcd06","order_by":0,"name":"Sudip Bhattacharya","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYDCCA0DMY8Agx8beAGQZWBCvxZiPB8QykCBWCwND4jyJBBCXCC18t48/k3hTcMeYTfL51Q0/CiQY+Nu7E/BqkTyXYyY5x+CZHJt0TtnNHqDDJM6c3YBXi8EZHjZpHoPDxkAtaTd4gFoMJHIJaWF/BtKS2CZ5Ju3mH+K0MJhBtEiwH7tNlC2SZ3iMLYF+MWbjyWG7LWMgwUPQL3xn2B/eePPnjpx8+/FnN9/8sZHjb+/FrwUKDjCAI5QBHEfEAZAW9gfEqh4Fo2AUjIIRBgBgBEYERZgH0gAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-7935-9013","institution":"All India Institute of Medical Sciences, Deoghar, Jharkhand, India","correspondingAuthor":true,"prefix":"","firstName":"Sudip","middleName":"","lastName":"Bhattacharya","suffix":""},{"id":514704887,"identity":"00babc14-411f-4e51-b3de-f868b3fd1157","order_by":1,"name":"Alok Singh","email":"","orcid":"","institution":"SGT University, Haryana, India","correspondingAuthor":false,"prefix":"","firstName":"Alok","middleName":"","lastName":"Singh","suffix":""},{"id":514704888,"identity":"293cb3b8-0ba5-45dc-b6e3-15a9d359afa0","order_by":2,"name":"Lal Majhi","email":"","orcid":"","institution":"Nodal Office of Non-communicable Diseases, National Health Mission, Jharkhand Government, Ranchi, IND.","correspondingAuthor":false,"prefix":"","firstName":"Lal","middleName":"","lastName":"Majhi","suffix":""},{"id":514704889,"identity":"9504fff1-d12e-4ec3-a240-9e8196ee7067","order_by":3,"name":"Debajit Sarkar","email":"","orcid":"","institution":"State Non-communicable Disease Consultancy, World Health Organization, Ranchi, IND","correspondingAuthor":false,"prefix":"","firstName":"Debajit","middleName":"","lastName":"Sarkar","suffix":""},{"id":514704890,"identity":"95486ccc-1f2d-448a-8b55-cacf72b2f4c7","order_by":4,"name":"Akansha Singh","email":"","orcid":"","institution":"MGKVP University, Lucknow, india","correspondingAuthor":false,"prefix":"","firstName":"Akansha","middleName":"","lastName":"Singh","suffix":""}],"badges":[],"createdAt":"2025-09-14 01:34:15","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7609839/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7609839/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91402399,"identity":"1537141c-47b5-4b86-b517-90493546a9a4","added_by":"auto","created_at":"2025-09-16 07:12:41","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50115,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 2: Annual Scientific Production (Source; SCOPUS)\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7609839/v1/a23ed2d1620144fd7fc20969.jpg"},{"id":91403666,"identity":"02deafc6-cc3a-4e60-aeae-3a5c77818c1f","added_by":"auto","created_at":"2025-09-16 07:28:43","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":72652,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3: Documents by Subject area (Source: SCOPUS)\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7609839/v1/2623f4e9d14856ed3d814c84.jpg"},{"id":91402812,"identity":"ea65c8f2-f697-4f99-b7d1-fba1ebe7835a","added_by":"auto","created_at":"2025-09-16 07:20:41","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":117743,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 4: Three Field Plot\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7609839/v1/4b626e97ed4cc30c6ef6fe5e.jpg"},{"id":91402405,"identity":"0520df35-812d-424d-aaac-d57489241f86","added_by":"auto","created_at":"2025-09-16 07:12:41","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":232147,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 9: The network visualisation map of keywords Co-occurrence.\u003c/p\u003e","description":"","filename":"9.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7609839/v1/8f8d990987a9676680b03ee7.jpg"},{"id":91402403,"identity":"ffeb10aa-0aa3-43df-9bab-6deba33b634e","added_by":"auto","created_at":"2025-09-16 07:12:41","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":139356,"visible":true,"origin":"","legend":"\u003cp\u003eFig 15: Snapshot of the bibliometric map representing Co-authorship analysis of countries in network visualisation mode\u003c/p\u003e","description":"","filename":"15.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7609839/v1/272d94c32f989d06c0a17e96.jpg"},{"id":91404288,"identity":"44a4beff-c444-4231-b498-7d10039d8dd1","added_by":"auto","created_at":"2025-09-16 07:37:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1483378,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7609839/v1/3475f45b-0815-4633-9894-d41413666194.pdf"},{"id":91403664,"identity":"3a506403-2d07-4465-961c-939dd85a7db4","added_by":"auto","created_at":"2025-09-16 07:28:42","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1847581,"visible":true,"origin":"","legend":"","description":"","filename":"Annexures.docx","url":"https://assets-eu.researchsquare.com/files/rs-7609839/v1/22f92f9cbe9a9e488809bc11.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eBibliometric Analysis of Hypertension Care Research in Primary Care: Insights from Four Decades of Progress\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHypertension is one of the most prevalent chronic diseases globally and a leading contributor to poor health outcomes. It significantly increases the risk of cardiovascular disease, chronic kidney disease, cognitive decline, and premature death, making it a critical public health concern.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) The condition affects a large portion of the global population, with one in four adult men and one in five adult women diagnosed with hypertension.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Alarmingly, two-thirds of individuals with hypertension reside in low- and middle-income countries, where resources for diagnosis and management are often limited.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) The global economic burden of hypertension is substantial, accounting for about 10% of healthcare expenditures worldwide.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) These costs include direct expenses such as medications, laboratory tests, and clinical visits, as well as indirect costs related to complications, disabilities, and premature mortality. Hypertension arises from a mix of genetic predispositions and lifestyle factors, including high calorie and alcohol consumption, smoking, and lack of physical activity.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Hypertension also places a significant strain on Primary Health Care (PHC) systems, representing one in every eight patient consultations.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) It is a major contributor to non-communicable diseases, accounting for 60% of premature deaths linked to these conditions.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) However, several barriers hinder effective hypertension control. These include inadequate screening programs, poor awareness among patients, limited access to treatment, challenges in post-treatment management, low medication adherence, and socioeconomic factors such as affordability and accessibility of care.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) The burden is particularly high in low- and middle-income countries, where three out of four people with hypertension live. Despite this, only 10% of individuals in these regions have their blood pressure effectively managed.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) In India, for instance, just 15% of hypertensive patients achieve optimal blood pressure control. Effective monitoring and management of hypertension are crucial to reducing the risks of cardiovascular diseases and improving overall health outcomes.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) To address these challenges, the World Health Organization (WHO), in collaboration with Resolve to Save Lives, launched the WHO HEARTS hypertension service package in 2017. This initiative targeted 32 low- and middle-income countries, emphasizing the role of PHC in managing hypertension. By 2022, it had treated 12.2\u0026nbsp;million patients across 165,000 PHC facilities. This program demonstrated that hypertension can be effectively managed in resource-limited settings through PHC services, highlighting the importance of integrating hypertension control into primary healthcare frameworks.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) To understand the research landscape on PHC’s role in managing hypertension, we conducted bibliometric analyses. This method involves the quantitative analysis of research publications to identify patterns, trends, and collaborations in a specific field.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Bibliometric tools can uncover key research topics, prominent researchers, leading institutions, and the geographical distribution of studies.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Previous bibliometric analyses have explored various aspects of hypertension, such as arterial hypertension,(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) a century of research on hypertension,(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) trends in West Asia,(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) exercise-based interventions,(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) hypoxic pulmonary hypertension,(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) pregnancy-related hypertension,(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) acupuncture therapy,(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and epigenetics.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) [21] Other studies have focused on global research trends,(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) portal hypertension,(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and the relationship between hypertension and obstructive sleep apnea.(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) As per our knowledge, no previous bibliometric study has specifically examined the intersection of PHC and hypertension management.By leveraging bibliometric analysis, we aimed to provide a comprehensive overview of research in this area. This approach allows us to identify complex patterns, highlight emerging themes, and map collaborative networks within the field. The findings of this study are expected to guide future research on PHC and hypertension, enabling researchers to focus on critical gaps and prioritize effective interventions. Our analysis underscores the need for increased attention to PHC’s role in hypertension control and its potential to reduce the global burden of this condition.\u003c/p\u003e\n\u003ch3\u003eAim\u003c/h3\u003e\n\u003cp\u003eThe aim of this bibliometric analysis is to evaluate the research landscape surrounding the role of Primary Health Care (PHC) in the management of hypertension. This study seeks to provide insights into research trends, collaborations, and thematic focus areas to guide future studies and inform evidence-based strategies for improving hypertension control through PHC.\u003c/p\u003e\u003cp\u003e\u003cb\u003eObjectives\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo analyze publication trends over time, identifying the growth and distribution of research related to PHC and hypertension.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo map the key research themes, including major topics and emerging areas of interest in the field.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo identify the most influential authors, institutions, and countries contributing to research on PHC and hypertension.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo explore collaborative networks among researchers, institutions, and countries involved in this area of study.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo assess the impact of citations and highlight landmark studies that have significantly advanced knowledge on PHC and hypertension.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo compare research focus areas in low- and middle-income countries versus high-income countries regarding hypertension management in PHC settings.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo highlight gaps in the existing literature and suggest directions for future research to strengthen PHC’s role in addressing the global burden of hypertension.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e"},{"header":"Methodology","content":"\u003cp\u003eSearching queries were pinpointed and organised in the preliminary planning stage, as illustrated in Annex Table\u0026nbsp;1. These queries were divided into two categories\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePrimary search terms.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCombinations of primary search terms with Research in Primary Care\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003eThe primary search terms encompassed \" Hypertension \", and the secondary search terms included “Primary Care”. A subset of crucial search queries and their combinations were chosen based on their relevance to Hypertension Care Research in Primary Care. By including criteria for Hypertension with Primary Care, our goal was to investigate the intersection of hypertension management strategies and their implementation within primary care settings, focusing on improving patient outcomes and healthcare delivery efficiency. This data is crucial for understanding the roles of Primary Care in Hypertension. Moreover, specific research questions, outlined in Annex Table\u0026nbsp;2, were formulated to provide a comprehensive overview of the knowledge structure and the bibliometric and statistical methods used to evaluate Hypertension Care Research in Primary Care from 1094 to 2024.\u003c/p\u003e\u003ch3\u003eData collection\u003c/h3\u003e\u003cp\u003eDuring the data collection phase, we systematically searched academic articles in the SCOPUS core collection from January 1, 1984, to Dec 21, 2024, focusing on Hypertension Care Research in Primary Care. The keywords employed for data retrieval are listed in Annex Table\u0026nbsp;1. Additionally, English-language research articles and review papers were included in the study. This search yielded 10412 academic publications from SCOPUS for analysis.\u003c/p\u003e\u003ch3\u003eData refinement\u003c/h3\u003e\u003cp\u003eDuring the data refinement stage,10395 publications were obtained from Scopus after proper screening of the documents. We excluded books, editorials, letters, conference papers, and non-English academic works from our systematic bibliometric review and obtained 9943 documents. After this initial filtering, we removed 17 non-relevant article duplicates from the remaining list of 9943 publications, resulting in a final total of 9926 articles. ( Annex Fig.\u0026nbsp;1)\u003c/p\u003e\u003ch3\u003eData extraction\u003c/h3\u003e\u003cp\u003eWe extracted metadata from Scopus in the form of a CSV bibliographic information file. The exported data included: (a) authors/editors, (b) full names of authors, (c) titles, (d) sources, (e) authors’ keywords, (f) keywords plus, (g) abstracts, (h) authors' affiliations, (i) corresponding authors' affiliations, (j) cited references, (k) total citations, (l) highly cited papers, (m) usage counts, (n) publication years, (o) DOIs, (p) subject categories, (q) author identifiers, (r) languages, and (s) funding agencies.\u003c/p\u003e\u003ch3\u003eBibliometric analysis\u003c/h3\u003e\u003cp\u003eBibliometric analysis serves as an objective method for researchers to catalogue, access, and evaluate extensive collections of publications, offering a detailed overview of recent trends in scientific literature within a specific field or research area.\u003c/p\u003e\u003cp\u003eIn this research, we conduct a bibliometric analysis of publications concerning Hypertension Care Research in Primary Care from 1984 to 2024, addressing the six primary questions presented in Annex Table\u0026nbsp;2. We employed biblioshiny and Vos viewer for bibliometric data analysis to illustrate publication patterns and research trends in premature mortality due to cardiovascular diseases. Furthermore, we aim to statistically investigate and evaluate the scientific knowledge structure through this bibliometric analysis. The fundamental knowledge framework of a research field comprises three components:\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eConceptual structure\u003c/b\u003e: Central themes and trends in the literature of a specific research area.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eIntellectual structure\u003c/b\u003e: The impact of an author's work within the scientific community.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSocial structure\u003c/b\u003e: Interactions among authors, institutions, and countries.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003eInitially, the conceptual structure is examined statistically using thematic mapping and co-occurrence networks. Subsequently, the intellectual knowledge structure is evaluated through co-citation network analysis. Lastly, the social knowledge structure is scrutinised based on the collaboration network and collaboration world map. By analysing these conceptual, intellectual, and social structures, we aim to comprehend the knowledge framework of telemedicine applications in mental health over the past decades. This analysis will highlight current achievements In preventing and identifying future challenges in Hypertension Care Research in Primary Care.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA. Fundamental Bibliometric Analysis\u003c/p\u003e\n\u003ch3\u003eAnnual publications and trends\u003c/h3\u003e\n\u003cp\u003eThe data presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates that a general upward trend has been observed in Hypertension Care Research in Primary Care publications since 1993. Until 1993, annual publication numbers remained between 14 to 26. However, since 2001, exponential growth has indicated that this research area entered a phase of rapid development. The highest output occurred in 2024, with 752 publications in that year. This suggests that Hypertension Care Research in Primary Care has garnered significant attention from the researcher\u0026rsquo;s community during this period.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eAnalysis of the Subject area\u003c/h3\u003e\n\u003cp\u003eThe pie chart in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e illustrates the distribution of research output related to Hypertension Care Research in Primary Care across various subject areas. Most of the research is concentrated in Medicine, accounting for 73.9.0%, followed by Nursing (6.4%), Biochemistry, Genetics and Molecular Biology (5.2%). Other significant contributions come from Pharmacology Toxicology and Pharmaceutics (3.4%), Health Professions (2.2%), Social Sciences (1.8%), Multidisciplinary (1.7%), Neuroscience (1.2%), Psychology (1.1%), Immunology and Microbiology (0.6%) and others and Others fields contributing (2.7%). A detailed analysis confirms that Medicine is the predominant focus of this research.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eAnalysis of most relevant authors\u003c/h2\u003e\u003cp\u003eA total of 22510 authors participated in Precision Medicine-related studies, with ten authors contributing 29 or more papers each. Annex Table\u0026nbsp;3 highlights these prolific authors, who collectively produced 305 publications, accounting for 3% of total submissions. Among them, McManus, R. J. from the Jichi Medical University, Kawachi District, Japan, was the most productive, publishing 59 papers. He was followed by Bosworth, H.B. from the Duke University School of MedicineThe institution will open in a new tab, Durham, United States (43 papers) and also by Hobbs, F.D.R. (36 papers) from the University of Oxford Medical Sciences Division The institution will open in a new tab, Oxford, United Kingdom. The research work by Nirantharakumar Krishnarajah from NIHR Birmingham Biomedical Research, Birmingham, United Kingdom and colleagues had the highest citation count, with 636 citations. The top 10 authors were primarily based in the United States, UK, Singapore, Japan and Germany.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eAnalysis of the Organisations\u003c/h2\u003e\u003cp\u003eThe study analysed contributions from 16614 distinct organisations, with the top 10 institutions contributing 1642 publications. Harvard Medical School, United States, ranked highest with 226 papers, followed by the VA Medical Center, United States (USA) (207 papers), and the University of Toronto, Canada (192 papers). Other significant contributors included the University of Oxford, United Kingdom, with 184 papers; the University of California, San Francisco, United States, with 159 papers. University of Oxford Medical Sciences Division, United Kingdom, 149 papers; Brigham and Women's Hospital, United States, 144 papers; and University of Birmingham, United Kingdom (UK), 137 papers. Johns Hopkins University School of Medicine United States (USA) and University College London United Kingdom (UK), 122 papers ( Annex Table\u0026nbsp;4). The top 10 organisations contributed 18.5% of total publications. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e Uses a three-field plot diagram to illustrate the pattern of authors\u0026rsquo; publications in different related topics and journals.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eAnalysis of Country Scientific Production\u003c/h2\u003e\u003cp\u003eAnnex Table\u0026nbsp;5 lists the ten leading countries involved in Precision Medicine research. It provides data on the total number of published articles in this field by different countries. According to Annex Table\u0026nbsp;5, only the United States and the United Kingdom have published over 1500 papers on Hypertension Care Research in Primary Care from 1984 to 2024. The USA is the leading country in terms of scientific productivity, with 4065 publications, followed by the United Kingdom (n\u0026thinsp;=\u0026thinsp;1595), Spain (n\u0026thinsp;=\u0026thinsp;661), Canada (n\u0026thinsp;=\u0026thinsp;616) and Australia (n\u0026thinsp;=\u0026thinsp;409).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eMost preferred Journal\u003c/h2\u003e\u003cp\u003eA total of 979 academic journals have published research articles on premature mortality due to cardiovascular disease. The Ten most active journals accounted for 1335 out of 9926 papers, contributing 13.4% of the total publications (Annex Table\u0026nbsp;6). BMJ Open led with 287 articles, followed by Plos One (173), Journal Of General Internal Medicine (156), British Journal Of General Practice (126) and Journal Of Hypertension (116). Other significant contributors were Family Practice (107), BMC Family Practice (105), BMC Health Services Research (97), Journal Of Clinical Hypertension (97), and American Journal Of Hypertension (82) (Annex Table\u0026nbsp;6). Bradford's Law suggests that a few journals are central to a specific research field. As illustrated in Annex Fig.\u0026nbsp;5, the ten journals highlighted in Annex Table\u0026nbsp;6 form this core group, accounting for approximately one-third of the entire collection's documents. Annex Table\u0026nbsp;6 provides details about the country, quartile, and H index, as well as documents from the top ten periodicals, each contributing more than 80 articles to our bibliographic collection.\u003c/p\u003e\u003cp\u003e(Annex Fig.\u0026nbsp;6) represents Documents per year by source, where the x-axis represents the publication years (1986\u0026ndash;2024), while the y-axis represents the number of documents published annually.\u003cb\u003eBMJ Open\u003c/b\u003e and \u003cb\u003ePLoS ONE\u003c/b\u003e show a significant rise in document count, reflecting their increasing influence or popularity in recent years. Other journals maintain steady trends, indicating niche-specific focus and consistent output. The sharp rise in \u003cb\u003eBMJ Open\u003c/b\u003e documents may suggest increased research output in its domain during and after the COVID-19 pandemic period (2020\u0026ndash;2021).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eAnalysis of the highly Cited Research Publications in Precision Medicine\u003c/h2\u003e\u003cp\u003eThe ten most frequently cited research publications in the field of Hypertension Care Research in Primary Care, specifically within the analysed collection and published between 1984 and 2024, are listed in Annex Table\u0026nbsp;7. For instance, Elizabeth J Williamson et al. authored an article titled Factors associated with COVID-19-related death using OpenSAFELY, the highest locally cited publication with 4324 total citations.(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) The second most influential paper, with 1469 total citations, is \u0026ldquo;The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis\u0026rdquo; by Zobair M Younossi et al., published in the Journal of Hepatology.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) The article \u0026ldquo;Chronic Kidney Disease Diagnosis and Management: A Review\u0026rdquo; by Teresa K Chen et al. also garnered 951 total citations.(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) Lastly, Kenneth Cusi et al.'s publication, American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD),(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) achieved 497 total citations, as depicted in Annex Table\u0026nbsp;7.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eActive Funding Agencies\u003c/h2\u003e\u003cp\u003eOf the 2723 articles reviewed, 2723 were funded by the top 10 organisations. The National Institutes of Health in the United States was the largest contributor, backing 744 Hypertension Care Research in Primary Care studies. Other major funders included the U.S. Department of Health and Human Services (n\u0026thinsp;=\u0026thinsp;540), National Heart, Lung, and Blood Institute, The United States (n\u0026thinsp;=\u0026thinsp;384), Medical Research Council (n\u0026thinsp;=\u0026thinsp;180), National Institute for Health Research (n\u0026thinsp;=\u0026thinsp;173), National Institute of Diabetes and Digestive and Kidney Diseases (n\u0026thinsp;=\u0026thinsp;162), National Institute for Health and Care Research (n\u0026thinsp;=\u0026thinsp;160) National Center for Advancing Translational Sciences (n\u0026thinsp;=\u0026thinsp;138), UK Research and Innovation (n\u0026thinsp;=\u0026thinsp;137), National Institute on Aging (n\u0026thinsp;=\u0026thinsp;105). Six of the top ten funders were from The United States and Four were from the United Kingdom (UK). (Annex Table\u0026nbsp;8)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eB. Conceptual Knowledge Structure Analysis\u003c/h2\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003eAnalysis of the Keywords\u003c/h2\u003e\u003cp\u003e In this part of our study, we employed keyword and co-occurrence analyses to explore the latest research trends and advancements in Hypertension Care Research in Primary Care. Our objective is to pinpoint research gaps and predict future directions in this domain. The primary keywords are illustrated in Annex Fig.\u0026nbsp;7, with Hypertension (888), Primary care(856), Primary health care (268 Occurrences), Blood pressure (190 Occurrences), Diabetes (171 Occurrences), Cardiovascular disease (141 Occurrences), Covid-19 (126 Occurrences), Epidemiology (123 Occurrences), Public health (116 Occurrences), Chronic kidney disease (115 Occurrences), Diabetes mellitus (113 Occurrences), Obesity (104 Occurrences), Telemedicine (96 Occurrences), Risk factors (90 Occurrences), Chronic disease (89 Occurrences), Cardiovascular diseases (82 Occurrences), Type 2 diabetes (82 Occurrences), Prevalence (80 Occurrences), Medication adherence (73 Occurrences). The keyword growth in Hypertension Care Research in Primary Care is also depicted using the cumulative occurrence graph in Annex Fig.\u0026nbsp;8.\u003c/p\u003e\u003cp\u003eThis graph shows a progressive increase in the annual occurrence of the author\u0026rsquo;s keywords related to Precision Medicine, such as Hypertension, primary care, primary health care, blood pressure, diabetes, cardiovascular disease, COVID-19, epidemiology, public health, chronic kidney disease, diabetes mellitus, obesity, telemedicine, risk factors, chronic disease, cardiovascular diseases, type 2 diabetes, prevalence and medication adherence have exhibited more dynamic growth compared to others. The cumulative occurrence of the top 15 keywords in the year 2024 includes Hypertension (888), Primary care(856), Primary health care (268 Occurrences), Blood pressure (190 Occurrences), Diabetes (171 Occurrences), Cardiovascular disease (141 Occurrences), Covid-19 (126 Occurrences), Epidemiology (123 Occurrences), Public health (116 Occurrences), Chronic kidney disease (115 Occurrences), Diabetes mellitus (113 Occurrences), Obesity (104 Occurrences), Telemedicine (96 Occurrences), Risk factors (90 Occurrences), Chronic disease (89 Occurrences), have increased significantly, indicating trending or popular research topics in the field, growing interested or emerging trends in that topic. The graph highlights the shifts in research focus. Furthermore, we analysed the co-occurrence of authors\u0026rsquo; keywords using Vos Viewer. The co-occurrence network helps understand the thematic areas of the research field and identify the most critical and current issues. It also provides insights into the evolution of these issues over time.\u003c/p\u003e\u003cp\u003eWe extracted 39 out of 6067 keywords with a frequency of 38 or more for co-occurrence analysis in Vos viewer to explore trends and hotspots in the field of research (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e9\u003c/span\u003e). The results of the co-occurrence network analysis are presented in Annex Table\u0026nbsp;9. The visual representations classify keywords into seven clusters, as shown in Annex Table\u0026nbsp;9.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eThematic Map\u003c/h2\u003e\u003cp\u003eThe thematic development of keywords from 1984 to 2024 is examined using the keyword thematic map and Sankey diagram presented in Annex Fig.\u0026nbsp;10. Analysing the thematic map helps researchers to understand the current landscape of their field, identify key themes, and explore areas that need further investigation. The map divides these themes into four quadrants based on two axes. Centrality (X-axis) Indicates the importance or relevance of the theme in the overall research field, and Density (Y-axis) Indicates the theme's internal development, i.e., how well-developed and mature the theme is.(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe Upper-Right Quadrant (Motor Themes) is related to High Centrality and High Density. These themes are both important and well-developed. They play a significant role in structuring the research field and are actively developed, serving as \"motor\" themes. It includes themes like primary care, covid 19, epidemiology, Hypertension, Blood pressure and Medication adherence. Upper-Left Quadrant (Niche Themes) is related to Low Centrality and High Density. These themes are well-developed but not central to the overall research field. They often represent specialised or niche topics that are mature but not crucial to the broad field. It includes themes like Dementia, Implementation, ambulatory blood pressure monitoring and systematic review.\u003c/p\u003e\u003cp\u003eThe lower-Right Quadrant (Basic and Transversal Themes) is related to High Centrality and low Density. These themes are important but underdeveloped. They represent foundational or emerging areas that have relevance across various subfields but require further development. It includes themes like Primary health care, Diabetes Mellitus, Cardiovascular Disease, Chronic Kidney Disease and Diabetes. The lower-Left Quadrant (Emerging or Declining Themes) is related to Low Centrality and low Density. These themes are neither well-developed nor important to the overall research field. They could represent either emerging themes yet to gain attention or declining themes losing relevance. It includes themes like Obesity, Metabolic Syndrome, Public health, preventive medicine and health policy.(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) (Annex Fig.\u0026nbsp;11)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eTrending Topics\u003c/h2\u003e\u003cp\u003eWe focused on two keywords appearing at least five times each year to analyse the trending topics. Since 2001,4 keywords have shown notable increases in frequency. Annex Fig.\u0026nbsp;12 illustrates. The time zone view of trending topics revealed that from 2018-21, themes like Glaucoma, Global health, Antihypertensive therapy, Diabetes mellitus type 2, Ambulatory blood pressure, monitoring, Quality of care, Arterial hypertension, Diabetes, Epidemiology and Risk factors had been in focus, but after 2022, themes like Hypertension, Primary care, Primary health care, Telehealth, Anxiety, Chronic diseases, Health Equity, Artificial intelligence, Equity, have gained significant attention in the field, which is likely to remain focal points in future research of telemedicine and mental health.\u003c/p\u003e\u003cp\u003e\u003cb\u003eC. Analysis of Social Knowledge Structure.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eAuthors\u0026rsquo; collaboration network analysis\u003c/h2\u003e\u003cp\u003eVOS viewer software was employed to map and visualise the relationships between authors based on their co-authored publications. This type of analysis helps researchers understand patterns of academic collaboration, such as which authors frequently work together and how these collaborations form larger clusters of research groups. Each node in the network represents an author. The lines connecting the nodes represent co-authorship relationships, where two authors have worked on one or more publications together. Authors who frequently collaborate with each other are grouped into clusters, which are typically represented by different colours. These clusters reflect collaborative research teams or communities. The size of each node indicates the author's productivity, often based on the number of publications. The thickness of the lines (edges) between authors can indicate the strength of collaboration, i.e., how many times two authors have co-published. This type of analysis is valuable for identifying influential researchers, key collaboration networks, and potential gaps or opportunities for new collaborations in a specific field of study. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eChoosing 12 as a minimum number of documents, out of 22510 authors, 17 met the threshold. Annex Fig.\u0026nbsp;13 and Annex Table\u0026nbsp;10 highlight the co-authorship between them. Each set of consists of consists of 3 items, making two different clusters.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eInstitution collaboration network analysis\u003c/h2\u003e\u003cp\u003eVOS viewer software was employed to visualise co-authorship between institutions, helping to identify collaborative networks and track their evolution over time.(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) The analysis focused on institutions that produced ten or more papers, with the results presented in Annex Fig.\u0026nbsp;14 and Annex Table\u0026nbsp;11. In this visualisation, node size represented publication volume, links depicted co-authorship connections, and node colours indicated distinct clusters.\u003c/p\u003e\u003cp\u003eFrom the 16614 organisations, a minimum number of documents was chosen for 8 a total 14 institutions that met the threshold and were included in the analysis. Instead of analysing individual authors, this approach aggregates data at the institutional level, focusing on how organisations collaborate with one another based on their authors\u0026rsquo; co-authored papers. The network shows organisations as nodes, with the connections (or edges) representing co-authorship ties. The more papers institutions co-author, the stronger the link between them in the network. The findings suggest that inter-institutional collaborations predominantly occur within national borders. Institutions with higher publication outputs tended to collaborate more frequently with others, indicating that fostering institutional partnerships could enhance the quality and quantity of research outputs.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eCountries Collaboration network analysis\u003c/h2\u003e\u003cp\u003eThe visualization of collaboration among countries with a minimum productivity of 90 documents is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e15\u003c/span\u003e. The analysis shows how authors from different countries collaborate. Each country is represented as a node, and the node size indicates the number of co-authored papers or the contribution level. The links between nodes (countries) represent collaborative relationships, with thicker links showing stronger or more frequent collaborations.(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) The map showed 14 countries in two different clusters, each with a different colour. The analysis highlights that the USA has the strongest research collaborations with other countries (link strength\u0026thinsp;=\u0026thinsp;507), the UK (link strength\u0026thinsp;=\u0026thinsp;472), Australia (link strength\u0026thinsp;=\u0026thinsp;193), Canada (link strength\u0026thinsp;=\u0026thinsp;191), Spain (link strength\u0026thinsp;=\u0026thinsp;163 ), Italy (link strength\u0026thinsp;=\u0026thinsp;149 ), Netherlands (link strength\u0026thinsp;=\u0026thinsp;148), Germany (link strength\u0026thinsp;=\u0026thinsp;146), Switzerland (link strength\u0026thinsp;=\u0026thinsp;129), china (link strength\u0026thinsp;=\u0026thinsp;122 ), India (link strength\u0026thinsp;=\u0026thinsp;121), Sweden (link strength\u0026thinsp;=\u0026thinsp;103), singapore (link strength\u0026thinsp;=\u0026thinsp;81), brazil (link strength\u0026thinsp;=\u0026thinsp;65). The thickness of the connecting line between any two countries indicates the strength of collaboration. Countries with similar colours form one cluster. Annex Table\u0026nbsp;12 highlights the different countries forming one cluster.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eD. Analysis of Intellectual knowledge structure.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eAnalysis of co-cited authors\u003c/h2\u003e\u003cp\u003eCo-cited authors network analysis refers to examining relationships between authors based on how often they are cited in the same documents. This visualisation or map shows the relationships between authors based on their co-citation frequency. It helps identify groups or clusters of authors who are frequently referenced together, often indicating that they contribute to similar research areas or themes. These clusters of co-cited authors may represent specific research fields or topics in the VOS viewer. Authors within the same cluster are likely to have influenced each other or contributed to a shared body of knowledge. Co-cited authors network analysis can be used to identify leading scholars, influential research collaborations, or emerging trends in a particular academic discipline. Each author's publication is shown in a circle and denoted by the author\u0026rsquo;s name. The colour of a publication shows the cluster to which the author\u0026rsquo;s publication belongs. The size of each node in the graph represents the number of citations an author has received, with larger nodes corresponding to higher citation counts and greater influence.(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eOf 256272 authors, using 165 as a minimum number of co-citations, 27 met the threshold. Whelton, Paul K. leads with 493 co-citations, followed by Mancia, Giuseppe, Carey r.m, and Muntner, Paul, with 461, 410, and 315 co-citations, respectively ( Annex Table\u0026nbsp;13) and Annex Fig.\u0026nbsp;16. The top 10 co-cited authors amassed over 3319 co-citations, underscoring their significant impact on premature mortality due to cardiovascular disease research.\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eAnalysis of co-cited journals\u003c/h2\u003e\u003cp\u003eCo-cited journal network analysis examines relationships between journals based on how frequently they are co-cited together in other academic papers. Co-citation occurs when two journals are cited together by a third, meaning they are both referenced in the same document. The relationships between journals are visualised as a network, where journals are represented as nodes, and the strength of co-citations forms the edges connecting these nodes. Frequently, co-cited journals tend to form clusters, indicating that they share similar or related topics, research areas, or disciplines. The analysis helps identify core journals in a field and relationships between journals, revealing trends, disciplines, or interdisciplinary connections, as well as research fronts, showing emerging fields of study. The larger the number of co-citations, the stronger the relationship between the journals, and this is reflected in the distance between nodes and the thickness of the connecting lines in the network visualisation.\u003c/p\u003e\u003cp\u003eFrom the 28486 sources, a minimum number of citation of a source was chosen for 550 a total 18 sources met the threshold and were included in the analysis. Three of the journals listed in Annex Table\u0026nbsp;14 have been cited more than 2800 times. Annex Fig.\u0026nbsp;17 illustrates that the five core journals in the field are The Lancet (Q1, H index\u0026thinsp;=\u0026thinsp;895), JAMA-Journal of Medical Association (Q1, H index\u0026thinsp;=\u0026thinsp;768), Plos One (Q1, H index\u0026thinsp;=\u0026thinsp;435), Circulation (Q1, H index\u0026thinsp;=\u0026thinsp;674).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003eAnalysis of co-cited references\u003c/h2\u003e\u003cp\u003eCo-cited reference network analysis visualises a research field's intellectual structure by showing which references are frequently cited together, reflecting thematic relationships within the literature. In co-cited reference network analysis, nodes represent the references, and the links (edges) between them represent how frequently they are co-cited. A dense cluster of nodes in such a network suggests that the references in that cluster are often co-cited together, implying a close intellectual relationship or a thematic similarity. Groups of studies that are frequently cited together could reveal key themes, methodologies, or theories in a specific domain. Highly co-cited references often indicate foundational or highly influential works in a particular research area (Annex Fig.\u0026nbsp;18) .(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) From the 144516 cited reference, a minimum number of citations of a cited reference was chosen for 18 a total 10 references that met the threshold and were included in the analysis. Our analysis reveals that these ten articles primarily focus on four main research themes: 1. Global Guidelines and Policy Frameworks for Hypertension Management. 2. Epidemiological Trends and Burden of Hypertension. 3. Primary Care as a Key Setting for Hypertension Management. 4. Hypertension as a Component of Noncommunicable Disease Control. (Annex Table\u0026nbsp;15)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe bibliometric analysis of hypertension care research in primary care reveals significant insights into the field's evolution, thematic focus, and collaboration patterns. The upward trend in annual publications underscores the increasing recognition of hypertension as a critical public health issue, aligning with global efforts to improve primary care systems and mitigate cardiovascular risks. For instance, the World Health Organization (WHO) launched the Global Hearts Initiative, which includes the HEARTS technical package aimed at improving hypertension management in primary care settings through evidence-based protocols, access to affordable medications, and health worker training.(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) Similarly, in the United States, the Million Hearts initiative seeks to prevent one million heart attacks and strokes by emphasizing hypertension control as a cornerstone of cardiovascular health.(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) Moreover, countries like Canada have implemented community-based programs such as Hypertension Canada\u0026rsquo;s CHEP (Canadian Hypertension Education Program) guidelines, which focus on lifestyle interventions and systematic management within primary care networks.(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) These examples highlight a global commitment to addressing hypertension through integrated care, policy support, and public awareness campaigns. However, this growth also reflects broader dynamics in research prioritization, including funding shifts, technological advancements, and an emphasis on non-communicable diseases. For instance, the exponential growth phase post-2000 could be attributed to increased awareness of hypertension's role in global morbidity and the expanded use of electronic health records for population-level studies. For example, initiatives like the National Health and Nutrition Examination Survey (NHANES) in the United States have leveraged EHRs to monitor hypertension prevalence and management trends.(\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) Similarly, the United Kingdom's Clinical Practice Research Datalink (CPRD) has enabled large-scale analyses of hypertension treatment and outcomes, contributing to evidence-based interventions.(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) In low- and middle-income countries, the WHO STEPwise approach to surveillance (STEPS) has promoted systematic data collection on non-communicable diseases, including hypertension, aiding global public health strategies.(\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) These advancements underscore how technological and methodological progress has enhanced our ability to track and address hypertension as a major health concern. Yet, the sustainability and equitable distribution of this research output warrant further scrutiny.\u003c/p\u003e\u003cp\u003eThe dominance of medicine as the primary subject area emphasizes the clinical and therapeutic focus of hypertension research. While this aligns with the immediate goal of improving patient outcomes, the relatively lower contributions from disciplines like social sciences and health professions highlight potential gaps in addressing the broader determinants of hypertension. For example, social sciences research focusing on socioeconomic factors such as income, education, and access to healthcare could offer deeper insights into the root causes of hypertension. Studies on the social determinants of health, such as those conducted by the WHO Commission on Social Determinants of Health, emphasize how factors like living conditions, community support, and stress levels can influence hypertension risk.(\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e) Studies such as those exploring community-based interventions or policy-driven approaches remain underrepresented despite their critical role in comprehensive hypertension management. Studies on community-based interventions and policy-driven approaches remain underrepresented, despite their crucial role in hypertension management. Programs like the \"Community Hypertension Prevention Program\" in rural areas improve awareness and lifestyle changes, while policy initiatives, such as salt reduction and sugar-sweetened beverage taxes, can reduce hypertension risk at a population level. The focus of research on clinical trials and pharmacological treatments has limited exploration of these broader strategies.(\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e) Expanding research to include community and policy approaches would enhance comprehensive hypertension management, especially in vulnerable populations. This imbalance suggests an opportunity for interdisciplinary collaboration to bridge the divide between clinical research and public health implementation.\u003c/p\u003e\u003cp\u003eThe analysis of prolific authors and institutions highlights the concentrated nature of research output, with a few key contributors driving a significant portion of the literature. While this concentration ensures expertise and quality, it may also indicate limited diversity in research perspectives. For example, leading institutions and authors, predominantly from high-income countries, suggest a possible underrepresentation of research addressing hypertension care challenges in low- and middle-income regions. Hypertension care research in low- and middle-income countries (LMICs) is underrepresented, despite the higher burden in these regions. Studies like the \"Hypertension in Africa\" report highlight challenges such as limited access to diagnosis and treatment.(\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e) Research from high-income countries often focuses on advanced tools and treatments not suited for LMICs, creating a gap in addressing regional needs.(\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e) Expanding research in LMICs would promote more equitable global hypertension care. Given the global burden of hypertension, fostering research capacity in underrepresented settings is crucial to ensuring that findings are universally applicable.(\u003c/p\u003e\u003cp\u003eCollaboration networks reveal strong national clusters, with limited international linkages in certain cases. This pattern indicates that while institutional and national collaborations are robust, there is untapped potential for fostering global partnerships to address hypertension as a transnational challenge. For instance, the United States and the United Kingdom lead in productivity and collaboration, but connections with countries bearing a disproportionate burden of hypertension remain sparse. Limited collaboration between high-income countries (HICs) like the U.S. and the UK, and low- and middle-income countries (LMICs) such as India and Sub-Saharan African nations, can be attributed to several factors. Research funding predominantly supports HICs, where advanced treatments like those for drug-resistant hypertension are prioritized,(\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e) while LMICs face challenges such as limited access to affordable medications and diagnostic tools. In LMICs, inadequate healthcare infrastructure, like in rural parts of Africa,(\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e) restricts large-scale hypertension studies, and logistical barriers such as lack of transportation impede research efforts. Additionally, political instability, seen in regions like Venezuela, disrupts health research projects, making international collaborations difficult.(\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e) These factors contribute to the underrepresentation of hypertension research in high-burden countries. (\u003cspan additionalcitationids=\"CR60 CR61 CR62 CR63 CR64 CR65 CR66\" citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e) Expanding these networks could enhance the global applicability of research findings and promote equitable knowledge exchange.\u003c/p\u003e\u003cp\u003eThe analysis of thematic areas provides a nuanced understanding of the field's intellectual landscape. High-centrality and high-density themes such as primary care, hypertension, and blood pressure reflect the core focus of the field, whereas niche themes like ambulatory blood pressure monitoring and systematic reviews underscore areas of advanced, yet specialized, inquiry. Notably, emerging themes like telemedicine and health equity highlight shifts toward addressing contemporary challenges, such as the integration of digital health tools and the pursuit of equitable care delivery. However, the underdevelopment of foundational themes, including preventive medicine and public health, signals the need for more investment in these areas to support sustainable hypertension management strategies.\u003c/p\u003e\u003cp\u003eThe keyword co-occurrence and thematic maps further illustrate evolving research priorities. The prominence of terms like COVID-19, telehealth, and artificial intelligence reflects adaptive responses to external events and technological innovation. While these developments are promising, they also pose the risk of diverting attention from foundational issues, such as improving access to primary care and addressing social determinants of health. For instance, the surge in telemedicine research during the pandemic must be critically evaluated for its long-term impact on health equity and care continuity.\u003c/p\u003e\u003cp\u003eHighly cited publications and journals provide insight into the field's influential works and dissemination platforms. The prominence of journals like \u0026ldquo;BMJ Open\u0026rdquo; and \u0026ldquo;PLOS ONE\u0026rdquo; suggests an increasing preference for open-access dissemination, which enhances the accessibility of research findings. However, reliance on a narrow set of journals may limit the diversity of published perspectives. Encouraging submissions to a broader range of journals could help disseminate varied methodologies and regional insights.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, while hypertension care research in primary care has achieved significant milestones, critical gaps persist in interdisciplinary integration, global representation, and foundational theme development. Addressing these issues requires a concerted effort to diversify research priorities, strengthen international collaborations, and balance innovation with a commitment to addressing underlying causes of hypertension. By critically evaluating these aspects, the field can evolve toward more inclusive, impactful, and sustainable research practices.\u003c/p\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eLimitations of this study:\u003c/h2\u003e\u003cp\u003eThis bibliometric analysis has several limitations. First, reliance on a single database (Scopus) may exclude relevant studies, particularly those from regional or non-English journals. Second, keyword-based data retrieval may introduce bias due to variability in terminology and indexing practices. Third, citation-based metrics, while indicative of impact, can be skewed by factors like journal prestige or self-citations and may overlook recent or less prominent studies. Fourth, automated thematic mapping may oversimplify complex relationships, potentially missing nuanced research insights. Lastly, the analysis does not explore qualitative aspects of collaboration networks, such as disparities in research capacity or contributions. Addressing these limitations in future studies would provide a more comprehensive understanding of hypertension care research.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors Contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr Sudip Bhattacharya: Conceptualization, writing original draft, review and editing.\u003c/p\u003e\n\u003cp\u003eDr Alok Singh and Dr Akanksha Singh: Data visualization, Data curation, writing – original draft and review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest: Nil\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: Nil\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical clearance: NA\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003eYasli G, Damar M, \u0026Ouml;zbi\u0026ccedil;akci Ş, Alici S, Pinto AD. Primary care research on hypertension: A bibliometric analysis using machine-learning. Medicine (Baltimore). 2024;103(47):e40482. \u003c/li\u003e\n\u003cli\u003eKochanek KD, Murphy SL, Xu J, Arias E. Deaths: Final Data for 2017. Natl Vital Stat Rep Cent Dis Control Prev Natl Cent Health Stat Natl Vital Stat Syst. 2019;68(9):1\u0026ndash;77. \u003c/li\u003e\n\u003cli\u003eHypertension [Internet]. [cited 2024 Dec 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension\u003c/li\u003e\n\u003cli\u003eMills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223\u0026ndash;37. \u003c/li\u003e\n\u003cli\u003ePazoki R, Dehghan A, Evangelou E, Warren H, Gao H, Caulfield M, et al. Genetic Predisposition to High Blood Pressure and Lifestyle Factors: Associations With Midlife Blood Pressure Levels and Cardiovascular Events. Circulation. 2018;137(7):653\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eYurekli AA, Bilir N, Husain MJ. Projecting burden of hypertension and its management in Turkey, 2015-2030. PloS One. 2019;14(9):e0221556. \u003c/li\u003e\n\u003cli\u003eHypertension management in primary health care: a survey in eight regions of Sweden - PubMed [Internet]. [cited 2024 Dec 22]. Available from: https://pubmed.ncbi.nlm.nih.gov/37561134/\u003c/li\u003e\n\u003cli\u003eArora A, Gola A, Loganathan V, Lakshminarayanan S, Kar SS. Hypertension Control Status Among Patients Receiving Treatment From Selected Primary Health Centres in Puducherry: A Cohort-Analysis Approach. Cureus. 2023;15(9):e45042. \u003c/li\u003e\n\u003cli\u003eIdentifying trends, patterns, and collaborations in nursing career research: A bibliometric snapshot (1980\u0026ndash;2017) - ScienceDirect [Internet]. [cited 2024 Dec 22]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1322769618303858\u003c/li\u003e\n\u003cli\u003eMoran AE, Gupta R, Global Hearts Initiative Collaborators. Implementation of Global Hearts Hypertension Control Programs in 32 Low- and Middle-Income Countries: JACC International. J Am Coll Cardiol. 2023;82(19):1868\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eDamar HT, Bilik O, Ozdagoglu G, Ozdagoglu A, Damar M. Scientometric overview of nursing research on pain management. Rev Lat Am Enfermagem. 2018;26:e3051. \u003c/li\u003e\n\u003cli\u003eKarabaeva RZ, Vochshenkova TA, Zare A, Jafari N, Baneshi H, Mussin NM, et al. Genetic and epigenetic factors of arterial hypertension: a bibliometric- and in-silico-based analyses. Front Mol Biosci. 2023;10:1221337. \u003c/li\u003e\n\u003cli\u003eAbba M, Nduka C, Anjorin S, Mohamed S, Agogo E, Uthman O. One Hundred Years of Hypertension Research: Topic Modeling Study. JMIR Form Res. 2022;6(5):e31292. \u003c/li\u003e\n\u003cli\u003eRezapour M, Yazdinejad M, Rajabi Kouchi F, Habibi Baghi M, Khorrami Z, Khavanin Zadeh M, et al. Text mining of hypertension researches in the west Asia region: a 12-year trend analysis. Ren Fail. 2024;46(1):2337285. \u003c/li\u003e\n\u003cli\u003eLou Y, Sun N, Zhang M, Qiu Y, Wang J, Chen J. Trends in exercise for hypertension: a bibliometric analysis. Front Cardiovasc Med. 2023;10:1260569. \u003c/li\u003e\n\u003cli\u003eYang W, Shen J, Shi G, Zhang T, Wei W, Wang C, et al. Bibliometric and visual analysis of hypoxic pulmonary hypertension from 2013 to 2022. Heliyon. 2023;9(11):e22044. \u003c/li\u003e\n\u003cli\u003eAlam MS, Islam MM. Bibliometric Study of Placenta in Pregnancy-Induced Hypertension. J Sci Soc. 2022;49(3):298. \u003c/li\u003e\n\u003cli\u003eSalmani D, Purushothaman S, Somashekara SC, Gnanagurudasan E, Sumangaladevi K, Harikishan R, et al. Study of structural changes in placenta in pregnancy-induced hypertension. J Nat Sci Biol Med. 2014;5(2):352\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eMan TM, Wu L, Zhang JY, Dong YT, Sun YT, Luo L. Research trends of acupuncture therapy for hypertension over the past two decades: a bibliometric analysis. Cardiovasc Diagn Ther. 2023;13(1):67\u0026ndash;82. \u003c/li\u003e\n\u003cli\u003eLiu N, Xia L. Investigation of epigenetics insights of hypertension: A bibliometric analysis. Medicine (Baltimore). 2023;102(36):e35125. \u003c/li\u003e\n\u003cli\u003eTrends in Worldwide Research in Hypertension Over the Period 1999-2018: A Bibliometric Study - PubMed [Internet]. [cited 2024 Dec 22]. Available from: https://pubmed.ncbi.nlm.nih.gov/32862706/\u003c/li\u003e\n\u003cli\u003eKaplan K, Solak Y. Portal hypertension research activity: A bibliometric analysis. Cukurova Med J. 2022 Dec 28;47(4):1709\u0026ndash;21. \u003c/li\u003e\n\u003cli\u003eY N, H C, W Z, H X, X D, S Z, et al. Research trends in hypertension associated with obstructive sleep apnea: a bibliometric analysis. Sleep Breath Schlaf Atm [Internet]. 2023 May [cited 2024 Dec 22];27(2). Available from: https://pubmed.ncbi.nlm.nih.gov/35579792/\u003c/li\u003e\n\u003cli\u003eWilliamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584(7821):430\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eYounossi ZM, Golabi P, de Avila L, Paik JM, Srishord M, Fukui N, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis. J Hepatol. 2019;71(4):793\u0026ndash;801. \u003c/li\u003e\n\u003cli\u003eChen TK, Knicely DH, Grams ME. Chronic Kidney Disease Diagnosis and Management: A Review. JAMA. 2019;322(13):1294\u0026ndash;304. \u003c/li\u003e\n\u003cli\u003eAmerican Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD) - PubMed [Internet]. [cited 2024 Dec 22]. Available from: https://pubmed.ncbi.nlm.nih.gov/35569886/\u003c/li\u003e\n\u003cli\u003eYu J, Mu\u0026ntilde;oz J. A Bibliometric Overview of Twitter-Related Studies Indexed in Web of Science. Future Internet. 2020;12:91. \u003c/li\u003e\n\u003cli\u003eWilczewski M, Alon I. Language and communication in international students\u0026rsquo; adaptation: a bibliometric and content analysis review. High Educ. 2022;85:1\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eSu M, Peng H, Li S. A visualized bibliometric analysis of mapping research trends of machine learning in engineering (MLE). Expert Syst Appl. 2021;186:115728. \u003c/li\u003e\n\u003cli\u003eKirby A. Exploratory Bibliometrics: Using VOSviewer as a Preliminary Research Tool. Publications. 2023;11(1):10. \u003c/li\u003e\n\u003cli\u003eVOSviewer - an overview | ScienceDirect Topics [Internet]. [cited 2024 Dec 22]. Available from: https://www.sciencedirect.com/topics/economics-econometrics-and-finance/vosviewer\u003c/li\u003e\n\u003cli\u003eOkonta DE. The scientometric analysis and visualization of sustainable procurement. Heliyon. 2023;9(10):e20985. \u003c/li\u003e\n\u003cli\u003eLi L, Wan N, He Y, Zhang Y, He X, Lu L. A global bibliometric and visualized analysis of the status and trends of bone metastasis in breast cancer research from 2002 to 2021. J Bone Oncol. 2023;42:100500. \u003c/li\u003e\n\u003cli\u003eKleminski R, Kazienko P, Kajdanowicz T. Analysis of direct citation, co-citation and bibliographic coupling in scientific topic identification. J Inf Sci. 2022;48(3):349\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eCitation Network - an overview | ScienceDirect Topics [Internet]. [cited 2024 Dec 22]. Available from: https://www.sciencedirect.com/topics/computer-science/citation-network\u003c/li\u003e\n\u003cli\u003eSmall H. Co-Citation in the Scientific Literature: A New Measure of the Relationship Between Two Documents. J Am Soc Inf Sci. 1973;24:265\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eHEARTS: Technical package for cardiovascular disease management in primary health care: Risk-based CVD management [Internet]. [cited 2024 Dec 22]. Available from: https://www.who.int/publications/i/item/9789240001367\u003c/li\u003e\n\u003cli\u003eMoran AE, Gupta R, Pathni A, Osi K, Dessie G, Zhang X, et al. Implementation of Global Hearts Hypertension Control Programs in 32 Low- and Middle-Income Countries: JACC International. J Am Coll Cardiol. 2023 Nov 7;82(19):1868\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eBenjamin RM. The Million Hearts\u003csup\u003eTM\u003c/sup\u003e Initiative: Progress in Preventing Heart Attacks and Strokes. Public Health Rep. 2012;127(6):558\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eCDC. Centers for Disease Control and Prevention. 2024 [cited 2024 Dec 22]. About Million Hearts\u0026reg; 2027 | Million Hearts\u0026reg;. Available from: https://millionhearts.hhs.gov/about-million-hearts/index.html\u003c/li\u003e\n\u003cli\u003eimpact of the Canadian Hypertension Education Programme in its first decade | European Heart Journal | Oxford Academic [Internet]. [cited 2024 Dec 22]. Available from: https://academic.oup.com/eurheartj/article-abstract/30/12/1434/550995?redirectedFrom=fulltext\u003c/li\u003e\n\u003cli\u003eFeldman RD, Campbell NR, Wyard K. Canadian Hypertension Education Program: The evolution of hypertension management guidelines in Canada. Can J Cardiol. 2008;24(6):477\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eHohman KH, Zambarano B, Klompas M, Wall HK, Kraus EM, Carton TW, et al. Development of a Hypertension Electronic Phenotype for Chronic Disease Surveillance in Electronic Health Records: Key Analytic Decisions and Their Effects. Prev Chronic Dis. 2023;20:E80. \u003c/li\u003e\n\u003cli\u003eClinical Practice Research Datalink [Internet]. [cited 2024 Dec 22]. Available from: https://www.cprd.com/\u003c/li\u003e\n\u003cli\u003eSTEPwise approach to NCD risk factor surveillance (STEPS) [Internet]. [cited 2024 Dec 22]. Available from: https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps\u003c/li\u003e\n\u003cli\u003eBraveman P, Gottlieb L. The Social Determinants of Health: It\u0026rsquo;s Time to Consider the Causes of the Causes. Public Health Rep. 2014;129(Suppl 2):19\u0026ndash;31. \u003c/li\u003e\n\u003cli\u003eChaturvedi A, Zhu A, Gadela NV, Prabhakaran D, Jafar TH. Social Determinants of Health and Disparities in Hypertension and Cardiovascular Diseases. Hypertens Dallas Tex 1979. 2024;81(3):387\u0026ndash;99. \u003c/li\u003e\n\u003cli\u003eFerdinand KC, Patterson KP, Taylor C, Fergus IV, Nasser SA, Ferdinand DP. Community-based approaches to prevention and management of hypertension and cardiovascular disease. J Clin Hypertens Greenwich Conn. 2012;14(5):336\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eVald\u0026eacute;s Gonz\u0026aacute;lez Y, Campbell NRC, Pons Barrera E, Calder\u0026oacute;n Mart\u0026iacute;nez M, P\u0026eacute;rez Carrera A, Morales Rigau JM, et al. Implementation of a community‐based hypertension control program in Matanzas, Cuba. J Clin Hypertens. 2020;22(2):142\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003evan de Vijver S, Akinyi H, Oti S, Olajide A, Agyemang C, Aboderin I, et al. Status report on hypertension in Africa - Consultative review for the 6th Session of the African Union Conference of Ministers of Health on NCD\u0026rsquo;s. Pan Afr Med J. 2013;16:38. \u003c/li\u003e\n\u003cli\u003ePramesh CS, Badwe RA, Bhoo-Pathy N, Booth CM, Chinnaswamy G, Dare AJ, et al. Priorities for cancer research in low- and middle-income countries: a global perspective. Nat Med. 2022;28(4):649\u0026ndash;57. \u003c/li\u003e\n\u003cli\u003eMalekzadeh A, Michels K, Wolfman C, Anand N, Sturke R. Strengthening research capacity in LMICs to address the global NCD burden. Glob Health Action. 13(1):1846904. \u003c/li\u003e\n\u003cli\u003eKotchen TA. Establishing funding priorities for hypertension research: a modest proposal. Hypertens Dallas Tex 1979. 2017;70(5):893\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eMills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223\u0026ndash;37. \u003c/li\u003e\n\u003cli\u003eYenet A, Nibret G, Tegegne BA. Challenges to the Availability and Affordability of Essential Medicines in African Countries: A Scoping Review. Clin Outcomes Res CEOR. 2023;15:443\u0026ndash;58. \u003c/li\u003e\n\u003cli\u003eOleribe OO, Momoh J, Uzochukwu BS, Mbofana F, Adebiyi A, Barbera T, et al. Identifying Key Challenges Facing Healthcare Systems In Africa And Potential Solutions. Int J Gen Med. 2019;12:395\u0026ndash;403. \u003c/li\u003e\n\u003cli\u003eKohrt BA, Mistry AS, Anand N, Beecroft B, Nuwayhid I. Health research in humanitarian crises: an urgent global imperative. BMJ Glob Health. 2019;4(6):e001870. \u003c/li\u003e\n\u003cli\u003eBhattacharya S, Bera OP, Majhi L, Sarkar D, Bhardwaj P, Joshi KJ, Mondal H, Venkatesh U, Aggarwal P. Hypertension Management in Tribal Primary Health Centers: Advancing Equity and Access. Cureus. 2025;17(6):e85535. \u003c/li\u003e\n\u003cli\u003eBhattacharya S, Varshney S, Hossain MM, Saleem SM, Gupta P, Singh A. \u0026ldquo;Taste modification\u0026rdquo; strategy for prevention and control of hypertension in India: need for robust clinical trials. Lancet Reg Health - Southeast Asia. 2023 ;14:100206. \u003c/li\u003e\n\u003cli\u003eBera OP, Mondal H, Bhattacharya S. Empowering Communities: A Review of Community-Based Outreach Programs in Controlling Hypertension in India. Cureus. 2023 Dec 18;15(12):e50722. \u003c/li\u003e\n\u003cli\u003eBhattacharya S, Thakur JS, Singh A. Knowledge attitude, and practice regarding dietary salt intake among urban slum population of North India. J Family Med Prim Care 2018;7:526-30.\u003c/li\u003e\n\u003cli\u003eBhattacharya S, Heidler P, Varshney S. Incorporating neglected non-communicable diseases into the national health program-A review. Front Public Health. 2023;10:1093170. \u003c/li\u003e\n\u003cli\u003eBhattacharya S, Bera OP. Neglected Non-Communicable Diseases-Looking beyond the BIG FOUR. Indian J Comm Health.2022;34(2):317-318.\u003c/li\u003e\n\u003cli\u003eBhattacharya S, Thakur JS. Implementation of Global NCD Monitoring Framework in Punjab, Haryana and Chandigarh\u0026ndash;A Feasibility study. Indian J Comm Health. 2017; 29, 1: 17-22.\u003c/li\u003e\n\u003cli\u003eBhattacharya S, Singh A, Kashyap A. Digital horizons in non-communicable disease care: a bibliometric exploration of intervention impact and innovation. Front Digit Health. 2025;7:1528711. \u003c/li\u003e\n\u003cli\u003eSingh A, Singh A, Bhattacharya S. Front-of-package food labelling and noncommunicable disease prevention: A comprehensive bibliometric analysis of three decades. Med J Armed Forces India. 2025;81(2):126-138.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hypertension, Primary Health Care, Hypertension prevention \u0026 control, Bibliometrics, Medical Informatics, Public Health, Patient-Centered Care","lastPublishedDoi":"10.21203/rs.3.rs-7609839/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7609839/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHypertension remains a global public health challenge, with significant morbidity, mortality, and economic implications. The role of Primary Health Care (PHC) in hypertension management has gained attention for its potential to enhance prevention, diagnosis, and treatment, especially in resource-constrained settings. This study aims to provide a comprehensive overview of research on PHC’s role in managing hypertension using bibliometric analysis. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherefore, in the present study, relevant peer-reviewed research articles published from 1984 to 2024 were downloaded from the Scopus databases and later quantitatively analyzed and visualized using Bibliometrix (R package) and VOS viewer. Finally, open challenge areas were identified for future research work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study revealed that the number of literature studies published in Hypertension Care Research in Primary Care has increased from 14 to 752 \u0026nbsp;between the years 1984 to 2024. Most of the research is concentrated in the field of Medicine. The USA is the most productive country in this field, followed by the United Kingdom, Spain, and Canada.McManus, R.J. from the Jichi Medical University, Kawachi District, Japan, is the most productive author in this field. Harvard Medical School, United States, is the most relevant affiliation in terms of the number of published articles. The top 10 most relevant sources are Q1 and Q2 journals, with BMJ Open, Plos One, and Journal Of General Internal Medicine, which are the leading journals in this field. The National Institutes of Health is the leading funding agency. The United States was the largest contributor. The most important trending topics related to our study, Telehealth, Health Equity, Artificial intelligence, and Primary health care, were identified.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHypertension care research in primary care has achieved significant milestones, critical gaps persist in interdisciplinary integration, global representation, and foundational theme development. Addressing these issues requires a concerted effort to diversify research priorities, strengthen international collaborations, and balance innovation with a commitment to addressing the underlying causes of hypertension.\u003c/p\u003e","manuscriptTitle":"Bibliometric Analysis of Hypertension Care Research in Primary Care: Insights from Four Decades of Progress","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-16 07:12:36","doi":"10.21203/rs.3.rs-7609839/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"290d1acd-34a3-4104-a8d7-58b75f97ab9e","owner":[],"postedDate":"September 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":54676735,"name":"Preventive Medicine"}],"tags":[],"updatedAt":"2025-09-16T07:12:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-16 07:12:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7609839","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7609839","identity":"rs-7609839","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}