Background: Home blood pressure monitoring (HBPM) is recommended for diagnosis, treatment adjustment and management of most hypertension cases in hypertension guidelines from multiple countries. This study aimed to evaluate HBPM behaviour and explore the routine-practice gap in HBPM among Chinese adults with hypertension. Methods: Data were collected from 20 communities across three cities and six townships in three provinces (Beijing, Shandong and Jiangsu) in China between October 2014 and November 2014. In total, 2272 patients with hypertension aged ≥35 years that were registered with a primary health station in their local communities were selected by simple random sampling. Results: Among the 2272 participants, 45.3% owned a home blood pressure (BP) monitor. In addition, 27.5% (625/2272) engaged in HBPM weekly or more frequently. Healthcare providers’ advice was the strongest factor contributing to home BP monitor ownership and weekly HBPM behaviour, with odds ratios of 13.50 and 8.97, respectively. Approximately 4.4% of participants had achieved optimal HBPM regimens (duplicate measurements in the morning and evening for 7 days). Patients with uncontrolled office-measured BP were more likely to conduct HBPM regularly in the morning and evening, measure their BP two or three times in each session and maintain 7 consecutive days of HBPM than patients with controlled office BP (8.8% vs. 5.8%, P = 0.042; 14.3% vs. 8.1%, P = 0.002; and 19.9% vs. 12.4%, P = 0.005, respectively). Only 16.0% (165/1030) of participants actively reported their HBPM readings to doctors. Conclusion: The HBPM strategies specified in hypertension guidelines are seldom achieved in actual practice in China. Only a small proportion of patients actively participate in using HBPM to enhance their hypertension care. HBPM may be improved by healthcare providers offering specific advice and training.

Background: A shortage of health professionals in rural areas is a major problem facing China, as more than 60% of the population lives in such areas. Strategies have been developed by the government to improve the recruitment of rural doctors. However, the inequitable distribution of doctors working in China has not improved significantly. The objective of this study was to explore the reasons for the poor recruitment and to propose possible strategies to improve the situation. Methods: Between September 2009 and November 2009 data were collected from 2778 rural doctors in Beijing, China. A quantitative survey was used to explore health workers’ perceptions as to what factors would have the greatest impact on recruitment and whether access to training had been effective in increasing their confidence, enhancing their interest in practicing medicine and increasing their commitment to recruitment. Results: Rural doctors were generally older than average in China. Of the 2778 participants, only 7.23% had obtained a license as a qualified doctor. For 53% of the rural doctors, the job was part-time work. The survey showed that rural doctors considered the training strategy to be inadequate. In general, the initiatives identified by rural doctors as being of most value in the recruitment of doctors were those targeting retirement pension and income. Conclusions: From the perspective of rural doctors, specific initiatives that promised a secure retirement pension and an increased income were considered most likely to assist in the recruitment of rural doctors in Beijing.

Background: Community health services have played an important role in the prevention and control of diabetes in China. The aims of this study were to examine the frequency of visits to community clinics for diabetic care services, to assess factors correlated with infrequent primary care visits and to identify barriers to regular follow-up visits for urban and rural patients. Methods: Between October 2014 and November 2014, data were collected from 17 communities in two cities and four townships located in Shandong and Jiangsu Provinces in China. A total of 1598 diabetic patients aged 18 years or older who were registered with a primary health station in local communities were selected by simple random sampling. Each participant was required to complete an interviewer-led questionnaire. Univariate and multivariate analyses were used to identify significant factors for infrequent visitor status using multivariable logistic regression analysis. Results: After being clearly informed of the study protocol, 1508/1598 (94.4%) patients agreed to participate in this survey. Among the 1508 subjects (mean age 64.4 ± 10.6), 683 (45.3%) were classified as infrequent visitors. The following were significant factors determining infrequent visitor status: urban residence, lack of health insurance, per-capita household income< 20,000 (yuan), lack of telephone follow-up and lack of household visit. From the patients’ perspectives, the reasons for infrequent visits among urban patients included drug scarcity and longer travel time to clinics. For rural patients, worries about medical expenses and drug scarcity were the most common barriers to clinic visits. Conclusion: Determinants of infrequent community visits in diabetes patients include urban residence, lower household income, lack of health insurance, lack of telephone follow-up and lack of household visit services. Strategies aimed at enhancing the utilization of community health care should be implemented in China.

Aim. Obesity paradox remains a point of debate in ST‐segment elevation myocardial infarction (STEMI) patients. The aim of this study was to examine the relationship between body mass index (BMI) and clinical outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Methods. Outcomes were assessed in 1429 STEMI patients undergoing PPCI between January 2009 and January 2010 in Beijing. Patients were classified into 6 groups according to age (the younger and elderly groups consisting of patients ≤65 and > 65 years old) and baseline BMI (normal weight, BMI < 24 kg/m²; overweight, 24 kg/m² ≤BMI < 28 kg/m²; obese, BMI ≥ 28 kg/m²). The primary outcome was death, acute myocardial infarction (AMI), or revascularization. Results. On long‐term follow‐up (mean follow‐up of 59 months), 13.9% of patients experienced the adverse event. Multivariate logistic regression analyses showed that low BMI was a significant predictor of the primary outcome only in the younger group. The odds ratio for overweight in comparison with normal weight was 0.741 (95% CI: 0.413–0.979; p = 0.038), the odds radio for obesity in comparison with normal‐weight patients was 0.508 (95% CI: 0.344–0.750; p = 0.016) in the younger group. In the elderly group, diabetes, hypertension, triple disease, regular exercise, angiotensin‐converting enzyme inhibitor (ACEI) or angiotensin II receptor blockers (ARBs) use after discharge, and bleeding complication were associated with primary outcome. Conclusion. The obesity paradox was recognized only in the younger age group in STEMI patients undergoing PPCI.

Objective: We sought to determine the association between mental stress-induced myocardial ischaemia (MSIMI) and quality of life (QoL) in patients with coronary artery disease (CAD) after coronary revascularization. Methods: This cohort study involved patients with high-risk MSIMI who received coronary revascularization between Dec 2018 and Dec 2019. Patients who screened positive for depression/anxiety were enrolled in this study. Mental stress was induced by the Stroop Colour and Word Test 1 month after coronary revascularization. All participants underwent single photon emission computed tomography (SPECT) scans at rest and under mental stress. MSIMI was defined as the presence of four abnormal SPECT phenomena. QoL was assessed using the Seattle Angina Questionnaire (SAQ) prior to treatment and 1 month after coronary revascularization. Results: Of the 1845 consecutive patients who received coronary revascularization, 590 (31.9%) had depression/anxiety, and 205 agreed to accept the mental stress test. During the average observation period of 33 days, 105 (51.2%) patients exhibited MSIMI. All SAQ subscales showed significant improvement, except for QoL, in the MSIMI group. The QoL score was lower (− 0.2 ± 32.7 vs. 13.1 ± 29.9, P = 0.005), and the proportion of deterioration in QoL was higher (50.5% vs. 31.9%, P = 0.010) in the MSIMI group than in the non-MSIMI group. Those with a deterioration in QoL had approximately twice the rate of MSIMI than those with an improvement in QoL (unadjusted OR: 2.019, 95% CI 1.122–3.634, P = 0.026; adjusted OR: 1.968, 95% CI 1.083–3.578, P = 0.017). Conclusion: Among patients with CAD who received coronary revascularization and had depression/anxiety, deterioration in QoL increased the likelihood of MSIMI. Hence, our results indicate that deterioration in QoL is a predictor of MSIMI. Trail Registration ChiCTR2200055792, retrospectively registered, 2022.1.20, www.medresman.org.cn