Predictors of blood pressure improvement in untreated hypertensive adults in china: a longitudinal analysis of urban-rural differences using CHARLS Data (2015–2020)

While non-pharmacological interventions are fundamental to hypertension management, real-world evidence regarding their effectiveness and the specific populations most likely to benefit remains limited in China. This study investigates the demographic and lifestyle factors associated with self-reported blood pressure improvement among untreated middle-aged and elderly hypertensive patients, utilizing longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2015-2020. Among 502 eligible participants not receiving pharmacological treatment, 41.6% reported blood pressure improvement by the 2018 follow-up. Generalized Estimating Equations (GEE) analysis revealed that residential and lifestyle factors were significantly associated with hypertension management outcomes. Specifically, rural residents had significantly lower odds of improvement compared to their urban counterparts (OR = 0.63, 95% CI: 0.40-0.99, p = 0.047). In contrast, lifestyle modifications showed a clear protective effect: never smokers (OR = 1.82, 95% CI: 1.05-3.13, p = 0.032) and non-drinkers (OR = 1.66, 95% CI: 1.09-2.53, p = 0.017) demonstrated significantly higher odds of blood pressure improvement compared to current smokers and heavy drinkers, respectively. While the 2020 follow-up indicated a lower mortality rate in the improved group (1.9%) compared to the ineffective group (4.1%), this difference did not reach statistical significance. These findings highlight that abstaining from smoking and alcohol remains a cornerstone of non-pharmacological blood pressure management. Furthermore, the observed urban-rural disparity suggests a critical need for targeted public health interventions and enhanced resource allocation to support hypertension control in China's rural communities.