Evaluating whether health management indicators deteriorate and become problematic in individuals with a long history of hypertension is essential for reducing hypertension-related complications and mortality, as well as for enhancing their quality of life. In this context, the present study aimed to assess the need for developing targeted hypertension management strategies based on the duration of the condition by examining variations in health management indicators among hypertensive patients aged 40 to 79 in South Korea. Utilizing raw data from the 2022 Community Health Survey, the study investigated differences in health management indicators and health behaviors according to hypertension duration, along with associated factors. The findings are presented below.

A prolonged duration of hypertension was linked to a significantly higher average age among affected patients, along with notable shifts in sociodemographic characteristics, including a greater proportion of individuals living in rural areas and those who were widowed. Lee et al. [8] reported that sociodemographic factors—such as educational level, income, and age—were significantly associated with the frequency of tooth brushing and the use of auxiliary oral care products. These findings suggest that patients with long-term hypertension tend to be older and may experience disparities in access to health information, healthcare services, health literacy, and educational resources. Moreover, these socioeconomic and environmental vulnerabilities may exacerbate declines in oral health behaviors and disease management outcomes, underscoring the importance of developing region-specific, tailored hypertension management programs that address these contextual factors.

A prolonged duration of hypertension is linked to a significant decrease in smoking and alcohol consumption. This indicates that extended experience with the condition enhances health awareness and encourages the voluntary adoption of healthier behaviors. Consistent with previous research, a longer duration of chronic illness tends to promote the habitual integration of disease management practices, resulting in better treatment adherence and a reduced likelihood of engaging in risky behaviors [9]. Furthermore, patients often make healthier lifestyle choices to minimize the risk of complications [10]. Importantly, quitting smoking and moderating alcohol intake are crucial for controlling blood pressure and preventing cardiovascular disease in individuals with hypertension, reflecting positive management outcomes. Over time, as hypertension persists, patients demonstrate complex changes in health behaviors and management indicators, highlighting the beneficial impact of long-term disease experience in reducing key risk factors such as smoking and drinking. These findings also suggest that patients’ health awareness gradually improves throughout the course of disease management.

Conversely, the frequency of using nutrition labels and maintaining regular tooth brushing habits decreased as the duration of illness increased. This finding aligns with An and Kim [4], who reported that individuals with hypertension often neglect oral health care. It also supports research [11] showing that stroke patients with longer hospital stays experience a decline in oral health-related quality of life, which negatively impacts their oral health status. Additionally, this trend is consistent with the study by Choi et al. [12], which found that individuals who brush their teeth once daily or less have a higher prevalence of hypertension compared to those who brush regularly after meals, suggesting a potential link between oral hygiene practices and hypertension. Periodontal disease and the number of remaining teeth have both been associated with an increased risk of long-term hypertension [13]. Moreover, antihypertensive medications can cause side effects such as xerostomia (dry mouth) [14] and gingival enlargement [6]. Individuals who brush their teeth less frequently are 1.53 times more likely to have fewer than 20 teeth remaining [15]. Additionally, as tooth loss increases [16], reduced adherence to regular tooth brushing may contribute to a decline in the overall effectiveness of hypertension management [17]. Brushing teeth two or more times daily reduces the prevalence of periodontal disease [18]. Moreover, frequent tooth brushing is associated with improvements in blood pressure, non-HDL cholesterol, triglyceride levels, and fasting blood glucose, as well as reductions in inflammatory markers such as high-sensitivity C-reactive protein (hsCRP) and white blood cell count (WBC) [19]. Therefore, regular tooth brushing extends beyond oral hygiene, playing a beneficial role in regulating systemic inflammation and preventing cardiovascular disease [17]. Since blood pressure control significantly affects both oral and overall systemic health [13], maintaining oral health—particularly through basic practices like tooth brushing—should be regarded as an essential component of systemic health management and disease prevention. Additionally, individuals with long-term hypertension often adopt behaviors directly related to managing their condition, such as quitting smoking and reducing alcohol consumption, but may overlook health behaviors indirectly related to their illness, including diet and oral care. Consequently, it is vital to develop programs for patients with chronic hypertension that promote proactive oral health management alongside regular dental care to support sustained oral health.

This study confirmed that a longer duration of hypertension is significantly associated with higher levels of perceived subjective stress and an increased prevalence of depressive symptoms. These findings suggest that the chronic nature of hypertension may lead to neglect of routine health management behaviors and the development of psychological difficulties over time, resulting in an accumulated mental burden. Prolonged exposure to the disease may also cause emotional exhaustion and a decline in quality of life [20]. Additionally, previous research has shown that individuals with hypertension have more than an elevenfold increase in depressive symptoms [21], that perceived stress significantly raises the incidence of depression among hypertensive patients [22], and that psychosocial stress increases the risk of developing hypertension by 2.4 times, with hypertensive individuals experiencing 2.7 times greater psychosocial stress compared to control groups [23]. These findings support the results of the present study. Since mental stress and depression often contribute to lapses in health management and neglect of oral health care, hypertension management programs should include mental health assessments and interventions as essential components. Such programs must take a holistic approach that addresses not only physical factors, such as blood pressure control, but also the psychological well-being of patients.

The influenza vaccination rate appeared to rise with the longer duration of hypertension, although the findings were not entirely consistent. This suggests that individuals with chronic hypertension may have better access to and utilization of healthcare services. However, because accessibility can vary depending on factors such as educational level or geographic location, further analyses adjusting for these variables are needed.

Awareness of blood pressure levels and participation in hypertension management education generally increase with the duration of the illness. This trend suggests that patients with chronic hypertension gradually acquire knowledge and practical experience in managing their condition, leading to improved awareness and a greater willingness to engage in educational programs. In contrast, recognition rates of early symptoms related to myocardial infarction and stroke tend to decline or vary inconsistently as the illness progresses. This indicates that, despite having basic knowledge and experience in hypertension management, patients may become less vigilant about their condition and less able to promptly identify and respond to cardiovascular disease symptoms. Indeed, previous studies have shown that individuals with hypertension often have limited awareness of cardiovascular emergency symptoms, which can contribute to delays or failures in early intervention [24].

This study utilizes a cross-sectional design based on raw data from the 2022 Community Health Survey, which inherently limits the ability to establish definitive causal relationships between the duration of hypertension and related health management indicators. Nevertheless, the findings are noteworthy: although patients’ knowledge about hypertension tends to improve with longer disease duration, adherence to routine and fundamental health behaviors—especially oral health care—declines. These results highlight the need for integrated hypertension management strategies that go beyond blood pressure control to address broader aspects such as mental health, oral health, and general health behaviors. Additionally, longitudinal studies using panel data are essential to clarify temporal changes in health behaviors and to incorporate objective oral health measures, including periodontal disease diagnosis and tooth loss assessment. Since prolonged hypertension duration is associated with increased health management fatigue, reduced attention to oral health, and potential mental health challenges, there is a critical need for targeted, ongoing educational programs and phased management approaches that integrate oral health, nutrition, and mental health support for patients with long-standing hypertension. Such comprehensive interventions are expected to reduce disease burden and improve patients’ quality of life.