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 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 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.