The results of the EQ-5D-5L scale showed that the pain/discomfort dimension was the most common source of problems, with 63.23% of the total population reporting issues associated with this dimension. Older adults are a special group, especially in an increasingly aging China. As older people begin to physically weaken, they become more sensitive to certain aches and pains or psychological ailments they accumulated in their younger years, which can explain the high rate of self-reported problems in the pain/discomfort dimension. In terms of the low number of participants with problems associated with the self-care dimension (25.31%), this can be explained by the fact that pain and discomfort generally do not have a serious impact on self-care. Similar to the results of the present study, studies conducted in the Hubei and Sichuan provinces in China have also shown pain/discomfort to be the most prominent health problem among older adults[25, 26].
Overall, 34.75% of the participants reported problems regarding the anxiety/depression dimension, and the results of the PHQ-9 scale showed that 353 (31.13%) participants had depressive symptoms. These two results confirm that the proportion of participants with problems associated with the psychological dimension was 31–35%, a higher rate than that reported by Dong and Liu[27, 28]. This discrepancy in results may be related to differences in survey tools; however, it cannot be discounted that our study sample indeed featured a higher proportion of individuals with depression symptoms when compared to other studies’ samples. However, the scale used in this research paper is a tool for screening depressive symptoms and does not have a diagnostic function; this represents a limitation to our approach.
Of the seven factors found to impact HRQOL, depression had the strongest effect, and had a direct impact on HRQOL. Similarly, a previous study that used the Tobit regression model to analyze factors affecting HRQOL reported that depression and hypertension are both important factors in this regard[29]. The incidence of depression in older patients with hypertension is approximately 21%, and older patients with hypertension and depressive symptoms have been found to have relatively low HRQOL and poor mental health[27]. Further, a systematic review of factors affecting HRQOL in patients with hypertension reported that mental-health factors (anxiety, depression, stress) have a significant impact on such individuals’ HRQOL[30]. Returning to our findings, the factor found to have the second-strongest effect on HRQOL was exercise, which had a positive impact on HRQOL, and its indirect effect was stronger than its direct effect. Similar to these findings, a study on the HRQOL of low-income patients with hypertension in South Korea reported that exercise and subjective health are the two most significant factors for HRQOL[31]. Evidence regarding the mechanism of action by which exercise influences hypertension suggests that exercise is a very promising non-drug treatment for hypertension, mainly because it can help reduce heart rate, sympathetic activity, and peripheral vascular resistance. Moreover, exercise training has been found to be the best tool for the treatment and prevention of hypertension and related diseases and disorders[32]. Finally, we found that experience of complications and hypertension severity had effect coefficients of 0.086 and 0.081, respectively. Similarly, a 2019 study of chronic diseases among the Iranian population found hypertension and diabetes to be the two diseases with the greatest impact on HRQOL scores[33]. Experience of complications and hypertension severity directly reflect patients’ hypertension condition. More frequent visits to the emergency room may be due to more severe illness, which in turn leads to a poorer quality of life. Using path analysis, depression and disease severity were found to contribute to HRQoL both directly and indirectly through other factors.
In this study, the factors affecting the HRQoL in older patients with hypertension were investigated by questionnaire. Then, in order to identify the mechanism of these factors on HRQoL, path analysis was used to explore the mediating effect of depression and disease severity. However, the results of this study, concerning only the older hypertensive patients in a certain region of Xinjiang, cannot be considered representative of the situation in other provinces and cities in China. Therefore, nationally representative research conclusions should be further determined on the basis of a large sample range in the future.The relationship between factors influencing health related QOL and hypertension is complex and interdependent, with several sharing mechanisms of action and pathophysiology. The cross sectional nature of this study could limit the assessment of temporality and therefore sociodemographic characteristics in older patients with hypertension in China.
In conclusion, the present results suggest that age, average annual income, physical exercise, experience of hypertension complications, severity of hypertension, number of emergency room visits in the past year, and depression factors that influence the HRQOL of older patients with hypertension. Two mediating variables were found: severity of hypertension and depression. These results are consistent with previous evidence obtained in different can guide the development of interventions and health policies for mitigating the negative impacts of hypertension on HRQOL.