Evaluation of the implementation effect of the standardized diagnosis and treatment management program for childhood hypertension in primary healthcare institutions in Beijing

Objective  To explore the impact of implementing the standardized diagnosis and treatment management program for childhood hypertension (“COME Program”) in primary healthcare institutions across Beijing on hypertension detection and control rates among children, as well as on the clinical management capacity of primary healthcare professionals, thereby assessing its feasibility and effectiveness.

Methods  Four primary healthcare institutions from four districts in Beijing were selected and randomly divided into an intervention group and a control group (two institutions per group). The intervention group applied the “COME Program” (C: criterion; O: organ damage; M: management; E: evaluation) to manage children with hypertension, while the control group maintained routine care. The follow-up period was one year. A total of 333 children with hypertension were enrolled (166 in the intervention group and 167 in the control group) and followed up for one year. Baseline characteristics and post-intervention outcomes—including blood pressure control rate (＜P₉₀), blood pressure achievement rate (＜P₉₅), reduction in systolic blood pressure and diastolic blood pressure, reduction in body mass index, prevalence of overweight and obesity and target organ damage indicators—were compared between groups. One year after training, the enrolled primary care physicians (13 from the urban intervention group and 4 from the suburban intervention group) were assessed for training effectiveness. Additionally, the implementation effectiveness of the "COME Program" was evaluated.

Results  No significant differences were found in baseline characteristics between groups (P＞0.05). After one year, the intervention group showed significantly higher blood pressure control (76.5% vs 40.1%, χ²=45.32, P＜0.01) and target achievement rates (86.1% vs 55.1%, χ²=38.66, P＜0.01) than the control group. Mean reductions in systolic blood pressure (14.4 95%CI: 13.4 to 15.5 vs 3.7 95%CI: 2.5 to 4.9 mmHg; t=13.03, P＜0.01) and diastolic pressure (8.8 95%CI: 7.6 to 10.1 vs –0.6 95%CI: −2.0 to 0.7 mmHg, t=9.94, P＜0.01) and body mass index (2.6 95%CI: 2.5 to 3.0 vs 1.4 95%CI: 1.2 to 1.6 kg/m², t=8.05, P＜0.01) were greater in the intervention group. Overweight/obesity rates decreased significantly compared with controls (56.6% vs 68.9%, χ² =5.33, P＜0.05).There were also significant statistical differences in the target organ damage indicators—urinary microalbumin, and left ventricular mass index. Theoretical knowledge scores (median P₂₅, P₇₅) of community physicians improved from 39.0% (29.5%, 50.0%) to 67.0% (63.0%, 70.0%) (Z=−4.57, P＜0.01), and operational skill scores from 65.0% (56.0%, 67.0%) to 85.0% (81.5%, 88.0%) (Z=−4.99, P＜0.01). After one year of implementation, the rates of blood pressure screening, hypertension detection, standardized management, and blood pressure control in children reached 99.6%, 5.8%, 89.3%, and 77.1%, respectively.

Conclusion The initial implementation of the "COME Program" in primary healthcare institutions has effectively improved children's blood pressure and obesity rates, significantly enhanced the ability of primary healthcare professionals in the diagnosis, treatment, and management of childhood hypertension, and demonstrates favorable outcomes and potential for promotion.