Objective This study aimed to analyze the trends in blood pressure control rates among hypertensive patients managed under the National Basic Public Health Service from 2012 to 2022 and to explore the factors influencing these rates. The study provides a scientific basis for optimizing resource allocation and policy formulation.Methods TUtilizing data collected by the Chinese Center for Disease Control and Prevention from 16 counties across 8 provinces (autonomous regions), this study employed trajectory models and generalized linear mixed-effects models (GLMMs) to analyze blood pressure control rates and their associated factors.Results Most blood pressure control rates fluctuated between 59% and 72%, divided into three trajectory groups: the Low-Level Decline group (18.75%), all rural, with declining control rates; the Low-Level Increase group (29.17%), mostly rural, with increasing control rates; and the High-Level Maintenance group (52.08%), primarily urban, with control rates maintained above 75%. Individual behavioral protective factors varied significantly across groups, with the best protective indicators in the High-Level Maintenance group. Community physician service levels were high and relatively uniform across all groups. Blood pressure control rates in the Low-Level Decline group were associated with Dietary Diversity Score (DDS) and weight measurements; in the Low-Level Increase group, they were associated with gender and physical activity; and in the High-Level Maintenance group, they were associated with medication adherence and awareness of blood pressure knowledge.Conclusion The quality of community physician services requires further enhancement. It is recommended to strengthen the training of primary healthcare personnel, improve service quality, and intensify health education and lifestyle interventions to improve the management outcomes of hypertension.