Although it is well known that patients with hypertension tend to have a lower health-related quality of life (HRQoL) compared to normotensive patients. To the best of our knowledge, this was the first study which evaluates HRQoL of middle-aged and elderly with hypertension in Chinese rural area, and further identifies the important correlates of their HRQoL. The SF-12 was the most frequently used HRQoL instrument for studies looking specifically into patients with hypertension. These findings provide new insights to optimize patients’ HRQoL by considering the complicated relationships among socio-demographic characteristics, lifestyle habits, sleep quality, and physical and mental HRQoL. The study found that the health-related quality of life of middle-aged and elderly patients in Xuan’en County was generally low. The scores of PCS and MCS of the participants were 31.66 and 41.38, respectively, which were lower than normal.
In multivariable analyses, age has a significant relationship with PCS, and the results show that younger residents have higher PCS than older residents. With the increase of age, people’s physical function is gradually degraded, and the influence of hypertension on patients is gradually deepened. For the elderly patients, we should pay more attention to the problems of physical health. It may be helpful to use the power of modern technology to invent some facilities that are beneficial to the elderly, such as wearing wearable devices that can feedback blood pressure values to the mobile terminal in real-time, and intelligently measure blood pressure. Our results show that hypertensive patients with a higher educational level have better HRQoL, which is in agreement with previous research [26, 27]. The reason may be that the self-care awareness of middle-aged and elderly people is weak. The psychological adjustment and social adaptability are better than those without education. They can grasp their physical condition better and can seek more ways to improve their physical condition.
Compared with those who did not drink tea, the MCS scores of patients who drank tea regularly was higher, but had no significant effect on PCS. Previous data showed that five or more cups per day of black tea was related to a lower blood pressure[28]. However, observations from epidemiological studies investigating the effects of regular consumption of tea on hypertension remain unclear[29]. It is a huge regret for us that we had not considered the tea consumption in the study. In addition, the family monthly income had a significant association with the MCS scores of the participants. The middle-aged and elderly people have poor economic independence and low labor capacity, especially in the rural area. Many research questions in this series have been put forward, which have led to a series of problems such as the elderly's diet and medical treatment. A certain economic foundation can bring psychological protection to the residents.
Another noteworthy finding of this study is that sleep quality and physical exercise played an important role in HRQoL of hypertensive patients. Studies have shown that sleep is an important determinant of health because it is closely related to mortality[30] and morbidity[31]. Poor sleep quality may lead to decreased attention and memory loss. Insufficient sleep time or long-term low-quality sleep can affect the body's immunity, making people prone to illness and leading to a decline in quality of life. Middle-aged and elderly hypertensive patients are prone to insomnia due to their age, and improve the quality of sleep in the elderly by incense and foot bathing. A high global PSQI score is associated with increased odds of hypertension in a rural Chinese population[32]. In addition, the study found that patients with hypertension who exercised more than 4 times a week had higher PCS scores than those who did not exercise, while patients who exercised 1–4 times a week had no significant difference. Regular physical activity (PA) prevents hypertension and is also a basic part of the treatment of hypertension[33]. This suggests that middle-aged and elderly patients with hypertension should exercise more, and the frequency of exercises should be more than four times a week, which can effectively improve their quality of life.
Despite these interesting findings, there are some limitations that need to consider. Firstly, as the sample of this study is limited to the Xuan’en County area of Enshi City, Hubei Province, it cannot fully represent the situation in all regions of the country. Xuan'en County is a poverty-stricken county with relatively poor educational resources. More than 70% of the participants only had a primary school level and below, and the family monthly income is less than 3,000 yuan. Secondly, the study is a population-based survey where socio-demographic and lifestyle behaviors were self-reported, though all of the data was collected by face-to-face interviews, recall bias should not be ignored. Thirdly, the blood pressure of the study subjects was not graded. Lastly, this study is a cross-sectional survey, which could not draw causal inferences concerning the relationship between targeting variables and HRQoL, but bidirectional effects are likely. Further longitudinal studies are needed to examine the causation of observed association and tailor better intervention for middle-aged and elderly hypertensive patients.