Continuity of care combined with TCM acupoint application improves blood pressure control and quality of life in elderly hypertensive patients: a retrospective study with bootstrap mediation analysis.

Abstract

Objective: To evaluate the effects of continuity of care combined with Traditional Chinese Medicine (TCM) acupoint application on blood pressure control, metabolic parameters, psychological status, treatment adherence, and quality of life in elderly patients with essential hypertension, and to explore potential mediation pathways using Bootstrap-based multiple mediation analysis.

Methods: This retrospective study included 393 elderly patients with essential hypertension (experimental group, n = 209; control group, n = 184) treated between January 2022 and January 2025. The experimental group received a 12-week integrated intervention combining TCM acupoint application and continuity of care in addition to standard antihypertensive therapy. The control group received standard antihypertensive therapy and routine nursing only. Primary outcomes were post-intervention systolic blood pressure (SBP) and SF-36 total score. Secondary outcomes included diastolic blood pressure (DBP), laboratory indices, Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Adherence to Refills and Medications Scale (ARMS), and self-management behavior scores.

Results: Compared with the control group, the experimental group showed significantly lower post-intervention SBP, DBP, TC, TG, FBG, and CRP (all P < 0.05), as well as significantly lower SAS and SDS scores, lower ARMS scores, and higher SF-36 total scores (all P < 0.001). Consistent intervention effects were observed across age subgroups. Mediation analysis identified self-management behavior, anxiety status, and treatment adherence as candidate mediators; however, none reached statistical significance.

Conclusion: The integrated intervention significantly improved multidimensional outcomes in elderly hypertensive patients. The identified mediation pathways are hypothesis-generating and require confirmation in future prospective studies.