Agreement between self-reported and objectively measured hypertension diagnosis and control: evidence from a nationally representative sample of community-dwelling middle‐aged and older adults in China

Background: As the population ages, hypertension has become the leading risk factor for cardiovascular diseases (CVDs) and premature deaths worldwide. Accurate monitoring of CVD risks and planning community-based public health interventions require reliable estimates of hypertension prevalence and management. While the validity of self-reporting in assessing hypertension prevalence has been debated, the concordance between self-reports and clinical measurements of hypertension control remains underexplored, particularly in large, community-based older populations. This study aims to examine the agreement between self-reported and objectively measured data on both hypertension diagnosis and control, as well as the associated factors, among community-dwelling middle-aged and older Chinese adults. Methods: Data from the China Health and Retirement Longitudinal Study were utilized, with household survey responses combined with biomedical data. Sensitivity, specificity, and kappa coefficients were used to assess the agreement between self-reported and objectively measured hypertension diagnosis in the general sample, and the agreement on hypertension control among individuals who reported having hypertension. Binary and multinomial logistic regression analyses were conducted to identify individual, household, and community-level factors associated with the agreement. Results: Self-reports exhibited substantial sensitivity, excellent specificity, and moderate agreement with objective measurements for hypertension diagnosis, while demonstrating fair sensitivity, excellent specificity, but low agreement for hypertension control. The odds of agreement on hypertension diagnosis were negatively associated with older age and heavy drinking, but positively related to marital status, higher education, chronic kidney disease, recent healthcare service utilization, and higher household economic levels. Meanwhile, the likelihood of agreement on hypertension control was negatively associated with older age, comorbid diabetes or cardiovascular disease, heavy drinking, BMI over 25, and antihypertensive medication adherence, but positively associated with recently healthcare service utilization. Conclusions: Self-reporting underestimated hypertension prevalence but significantly overestimated the hypertension control rates. For middle-aged and older Chinese adults, individual-level factors including age, multimorbidity, behavioural risks, and healthcare-seeking behaviours were identified as significant predictors of agreement between self-reported and objectively measured hypertension data. Recognizing these factors is essential for improving the accuracy of chronic condition estimates and facilitating targeted chronic disease management programs for China’s aging population and other developing countries with similar demographic and health challenges.