Temporal Relationship Between Treatment Burden and Self-Care and Its Impact on Systolic Blood Pressure and Hypertension Control.

Background: Effective blood pressure (BP) control necessitates sustained adherence to self-care regimes; however, adherence can be undermined by excessive treatment burden. The longitudinal dynamics between treatment burden and self-care behaviours remain less understood, with particularly limited understanding of how the temporal relationship may influence BP control. Objective: This study sought to examine the temporal relationship between treatment burden and self-care while investigating their collective longitudinal impact on both systolic BP levels and hypertension control. Methods: We investigated a community-based longitudinal cohort of 1718 hypertensive patients (mean age 54.6 ± 11.9 years; 28.5% with coexisting diabetes). Treatment burden and self-care were measured at two time points (T1 and T2), separated by an approximate 11-month period, with BP measured in the subsequent 14 months (T3). We employed cross-lagged panel modelling and mediation analysis to examine the temporal relationship between treatment burden and self-care (from T1 to T2) and their collective influence on systolic BP and hypertension control (T3). Results: After adjusting for covariates, we observed a significant cross-lagged path coefficient between treatment burden (T1) and self-care (T2) in the total sample (path coefficient = -0.089, Conclusion: Our study findings establish a temporal sequence wherein elevated treatment burden precedes suboptimal self-care capacity, which in turn adversely affects subsequent BP control. The nature of such association opens the door for further primary care research on developing more sustainable hypertension management strategies.