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. 2019 Jul 11:366:l4064.
doi: 10.1136/bmj.l4064.

Impact of community based screening for hypertension on blood pressure after two years: regression discontinuity analysis in a national cohort of older adults in China

Simiao Chen  1 , Nikkil Sudharsanan  2   3 , Feng Huang  4 , Yuanli Liu  5 , Pascal Geldsetzer  6 , Till Bärnighausen  2   6   7
Affiliations

Impact of community based screening for hypertension on blood pressure after two years: regression discontinuity analysis in a national cohort of older adults in China

Simiao Chen et al. BMJ. .

Abstract

Objective: To estimate the causal impact of community based blood pressure screening on subsequent blood pressure levels among older adults in China.

Design: Regression discontinuity analysis using data from a national cohort study.

Setting: 2011-12 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey, a national cohort of older adults in China.

Participants: 3899 older adults who had previously undiagnosed hypertension.

Intervention: Community based hypertension screening among older adults in 2011-12.

Main outcome measure: Blood pressure two years after initial screening.

Results: The intervention reduced systolic blood pressure: -6.3 mm Hg in the model without covariates (95% confidence interval -11.2 to -1.3) and -8.3 mm Hg (-13.6 to -3.1) in the model that adjusts additionally for demographic, social, and behavioural covariates. The impact on diastolic blood pressure was smaller and non-significant in all models. The results were similar when alternative functional forms were used to estimate the impact and the bandwidths around the intervention threshold were changed. The results did not vary by demographic and social subgroups.

Conclusions: Community based hypertension screening and encouraging people with raised blood pressure to seek care and adopt blood pressure lowering behaviour changes could have important long term impact on systolic blood pressure at the population level. This approach could address the high burden of cardiovascular diseases in China and other countries with large unmet need for hypertension diagnosis and care.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; TB is supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Density of baseline systolic and diastolic blood pressure distribution to test for manipulation of baseline blood pressure at threshold. The dashed line represents the 140 or 90 mm Hg threshold above which field workers encouraged people to seek care and change their lifestyles. Sample size=3899
Fig 2
Fig 2
Blood pressure in 2014 across the range of blood pressure in 2011-12 within the optimal bandwidths. The dashed line indicates blood pressure threshold above which field workers encouraged people to seek care and to make lifestyle changes; bold lines correspond to the linear fit; fine lines represent 95% confidence intervals. The total sample size is 3899; the sample size within the optimal bandwidth is 879 for systolic blood pressure and 886 for diastolic blood pressure
Fig 3
Fig 3
Impact size for systolic and diastolic blood pressure for different bandwidths, smoothing and extrapolating to zero bandwidth
See this image and copyright information in PMC

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