摘要Objective To investigate hypertension(HTN)trends,key risk factors,and gender disparities in rural China,and to propose targeted strategies for improving HTN control in resource-limited settings.Methods This longitudinal study used data from the Henan Rural Cohort Study,including baseline(2015-2017;n=39,224)and follow-up(2018-2022;n=28,621)participants.HTN was defined as systolic/diastolic blood pressure≥140/90 mmHg,self-reported diagnosis,or use of antihypertensive medication.Severity was classified using a 7-tier blood pressure(BP)staging system(optimal,normal,high normal,and HTN stages 1-4).A generalized linear mixed-effects model(GLMM)identified associated risk factors.Results HTN prevalence increased modestly from 32.7%(95%CI:32.2-33.2)to 33.9%(95%CI:33.3%-34.4%).Awareness and treatment improved from 20.1%to 25.3%,and from 18.8%to 24.4%,respectively,but control rates remained low(6.2%to 12.3%).After adjustment,women had a 1.53-fold higher HTN risk than men(OR=1.53,95%CI:1.43-1.63),revealing gender-specific trends.Key risk factors included alcohol use(OR=1.37,95%CI:1.27-1.47)and overweight status(OR=1.76,95%CI:1.66-1.86).BP staging showed an increase in optimal BP(42.3%to 45.8%),but stagnant management of advanced HTN stages.Conclusion Hypertension in rural China is shaped by behavioral risk factors and healthcare access gaps.Gender-sensitive,community-based interventions,including task-shifting models,are necessary to mitigate the growing burden of hypertension.