Evaluation of a mobile health-enabled hierarchical care model for hypertension management and health-related quality of life among older adults: a prospective pre-post intervention study.
Ma X, Li K, et al. • Frontiers in public health • 2026
A mHealth-enabled hierarchical care model integrated within regional healthcare networks was associated with improvements in blood pressure indicators and HRQoL among older adults with hypertension, though the single-arm design means controlled studies are still required.
Key Findings
Results
Systolic blood pressure fell significantly from baseline to 12 months in older adults with hypertension enrolled in the mHealth-HDTEP program.
Mean SBP decreased from 145.35 ± 4.18 mmHg to 130.64 ± 5.62 mmHg.
Mean difference was 14.71 mmHg (95% CI: 13.68 to 15.74; p < 0.001; Cohen's d = 2.043).
Of 225 enrolled participants, 210 completed the 12-month follow-up.
Design was a prospective, single-arm, pre-post study in Shenzhen, China (January to December 2025), analyzed with paired t-tests.
Results
Diastolic blood pressure also decreased significantly over the 12-month program.
Mean DBP decreased from 68.93 ± 4.85 mmHg to 60.73 ± 4.31 mmHg.
Mean difference was 8.20 mmHg (95% CI: 7.28 to 9.12; p < 0.001; Cohen's d = 1.262).
Results
Health-related quality of life, the primary outcome, improved significantly as measured by EQ-5D-5L utility values.
Utility values increased from 0.82 ± 0.13 to 0.94 ± 0.06.
Mean difference was 0.12 (95% CI, 0.10 to 0.14; p < 0.001; Cohen's d = 0.850).
Results
Self-rated health on the EQ-VAS increased significantly after 12 months.
EQ-VAS scores rose from 74.16 ± 11.07 to 80.93 ± 8.03.
Mean difference was 6.77 (95% CI, 6.18 to 7.36; p < 0.001; Cohen's d = 1.536).
Results
Among the five EQ-5D-5L dimensions, anxiety/depression showed the most pronounced improvement.
Dimension-level changes were tested with Wilcoxon signed-rank tests with FDR correction for multiple comparisons.
The anxiety/depression dimension had an FDR-adjusted p < 0.001.
Results
Reductions in blood pressure were positively correlated with improvements in HRQoL measures.
Pearson correlations ranged from r = 0.22 to 0.32, all p < 0.001.
These are modest correlations between changes in blood pressure indicators and changes in HRQoL parameters.
Methods
The intervention integrated digital self-management with hierarchical care pathways delivered through a WeChat mini program.
The 12-month program ran via the Shekangtong WeChat mini program.
Components were blood pressure self-monitoring, health education, family doctor follow-up, and specialist consultation pathways.
Participants were recruited from regional medical consortia in Shenzhen, China.
Conclusions
The authors conclude the model may be a feasible chronic disease management strategy but that controlled studies are needed to establish effectiveness, sustainability and scalability.
Findings are described as associations, from a single-arm pre-post design without a control group.
Combining digital self-management support with primary care coordination is suggested as feasible.
Further work is needed across diverse healthcare settings.
What This Means
This study followed 225 older adults with high blood pressure in Shenzhen, China, for 12 months while they used a program delivered through a WeChat mini program. The program combined home blood pressure monitoring, health education, follow-up with a family doctor, and routes to specialist care. A total of 210 people completed the year. There was no comparison group; everyone received the program and their results were compared with their own starting values.
By the end of the year, average blood pressure had dropped by about 15 points for the top number (systolic, 145 to 131 mmHg) and about 8 points for the bottom number (diastolic, 69 to 61 mmHg). Participants also reported better quality of life on a standard questionnaire, with the biggest gain in the anxiety/depression area. People whose blood pressure fell more tended to report larger quality-of-life gains, although the link was modest.
This research suggests that pairing a smartphone-based tool with coordinated care between primary and specialist doctors may be a workable way to support older adults with hypertension. Because there was no control group, the study cannot show that the program itself caused the improvements; other factors such as extra attention or natural changes over time could contribute. The authors call for controlled studies to confirm whether the approach works, lasts, and can be expanded to other settings.
Ma X, Li K, Zheng D, Song Y, Lin J, Chen L. (2026). Evaluation of a mobile health-enabled hierarchical care model for hypertension management and health-related quality of life among older adults: a prospective pre-post intervention study.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1964536