Hypertension management in transition: gains, gaps, and growing challenges in a high-altitude multi-ethnic region of China (2019–2024)

Hypertension remains a major public health challenge in China, particularly in socioeconomically transitioning regions. This study aims to evaluate changes in hypertension prevalence, awareness, treatment, and control rates between 2019 and 2024 in a Tibetan-predominant area of Sichuan Province.
Two cross-sectional surveys were conducted in 2019 (n = 1,880) and 2024 (n = 1,870). Inverse probability of treatment weighting (IPTW) and age-standardization were applied to enhance comparability. Subgroup analyses were performed to examine disparities across gender, residence, age, and education groups.
Age-standardized hypertension prevalence decreased significantly from 22.86% to 15.53%. Awareness, treatment, and control rates all improved markedly, from 24.63% to 53.43%, 16.08% to 43.93%, and 3.98% to 17.37%, respectively. Health inequities narrowed substantially between urban and rural areas and between genders. However, absolute control rates remained suboptimal (18.14% in 2024). Rising obesity prevalence (5.11% to 11.44%) and persistent gaps in treatment quality were observed.
Substantial progress in hypertension management and health equity was observed in the area between 2019 and 2024. However, persistently low control rates and rising obesity highlight the need to enhance treatment quality and implement integrated cardiovascular risk reduction strategies. These findings provide important insights for chronic disease management in similar transitioning regions.

Significant advances in hypertension care equity: Between 2019 and 2024, Aba Prefecture showed marked increases in awareness and treatment rates, with pronounced narrowing of urban–rural and gender gaps.
Persistently low control and the trend of youthfulness crisis: Despite improved access, age-standardized control rate remained <20%, while rising obesity and therapeutic inertia in primary care shifted the hypertension burden toward younger, working-age adults.
Region–specific barriers: The study identifies a high prevalence of “aware but untreated” (particularly among women) and “treated but uncontrolled” patients, pointing to the interplay between culturally shaped health beliefs and systemic weaknesses in primary care quality (e.g., therapeutic inertia) as key obstacles.
Transferable policy model: The study provides real-world evidence that the National Essential Public Health Services Program can be effectively implemented in resource-limited, multi-ethnic highland settings, offering an evidence-based template for precise hypertension interventions and policy design in comparable regions.

Significant advances in hypertension care equity: Between 2019 and 2024, Aba Prefecture showed marked increases in awareness and treatment rates, with pronounced narrowing of urban–rural and gender gaps.
Persistently low control and the trend of youthfulness crisis: Despite improved access, age-standardized control rate remained <20%, while rising obesity and therapeutic inertia in primary care shifted the hypertension burden toward younger, working-age adults.
Region–specific barriers: The study identifies a high prevalence of “aware but untreated” (particularly among women) and “treated but uncontrolled” patients, pointing to the interplay between culturally shaped health beliefs and systemic weaknesses in primary care quality (e.g., therapeutic inertia) as key obstacles.
Transferable policy model: The study provides real-world evidence that the National Essential Public Health Services Program can be effectively implemented in resource-limited, multi-ethnic highland settings, offering an evidence-based template for precise hypertension interventions and policy design in comparable regions.

高血压仍是中国面临的重大公共卫生挑战，在社会经济转型地区尤为突出。本研究旨在评估四川省藏族聚居地区2019年至2024年间高血压患病率、知晓率、治疗率及控制率的变化情况。
本研究于2019年（样本量n=1880）与2024年（样本量n=1870）分别开展两项横断面调查。采用治疗权重逆概率法（Inverse Probability of Treatment Weighting, IPTW）与年龄标准化法以提升研究的可比性，并通过亚组分析检验不同性别、居住地、年龄及教育水平群体间的差异。
年龄标准化后的高血压患病率从22.86%显著下降至15.53%；知晓率、治疗率与控制率均实现明显提升，分别从24.63%升至53.43%、16.08%升至43.93%，以及3.98%升至17.37%。城乡与性别间的健康不公平性已大幅缩小，但2024年的绝对控制率仍未达理想水平（仅为18.14%）。同时观察到肥胖患病率从5.11%升至11.44%，且治疗质量仍存在持续性差距。
2019年至2024年间，该地区高血压管理与健康公平性已取得显著进展，但持续偏低的控制率与不断上升的肥胖率提示，仍需强化治疗质量优化并落实整合式心血管风险防控策略。本研究结果为同类转型地区的慢性病管理提供了重要参考。

高血压诊疗公平性的显著提升：2019年至2024年间，阿坝州（Aba Prefecture）的高血压知晓率与治疗率均实现明显增长，城乡及性别间的差距已显著缩小。
持续偏低的控制率与年轻化趋势：尽管诊疗可及性有所提升，但年龄标准化后的控制率仍低于20%；同时，肥胖率上升与基层医疗的治疗惰性（therapeutic inertia）使得高血压负担向更年轻的劳动年龄人群转移。
区域特异性障碍：本研究发现，“知晓但未治疗”（尤其在女性群体中）与“接受治疗但未达标控制”的患者比例较高，提示文化塑造的健康信念与基层医疗质量的系统性缺陷（如治疗惰性）之间的相互作用是关键阻碍因素。
可推广的政策模式：本研究提供了真实世界证据，证明国家基本公共卫生服务项目（National Essential Public Health Services Program）可在资源有限的多民族高原地区有效落地，为同类地区的精准高血压干预与政策制定提供了循证参考模板。

高血压诊疗公平性的显著提升：2019年至2024年间，阿坝州的高血压知晓率与治疗率均实现明显增长，城乡及性别间的差距已显著缩小。
持续偏低的控制率与年轻化趋势：尽管诊疗可及性有所提升，但年龄标准化后的控制率仍低于20%；同时，肥胖率上升与基层医疗的治疗惰性使得高血压负担向更年轻的劳动年龄人群转移。
区域特异性障碍：本研究发现，“知晓但未治疗”（尤其在女性群体中）与“接受治疗但未达标控制”的患者比例较高，提示文化塑造的健康信念与基层医疗质量的系统性缺陷（如治疗惰性）之间的相互作用是关键阻碍因素。
可推广的政策模式：本研究提供了真实世界证据，证明国家基本公共卫生服务项目可在资源有限的多民族高原地区有效落地，为同类地区的精准高血压干预与政策制定提供了循证参考模板。