Abstract： Objective To analyze the effectiveness of chronic disease management among suburb residents to secure an optimal health management model. Methods Since 2002, physical examinations had been conducted for rural residents aged≥40. Hypertensive patients detected on health check received medical evaluation and risk factor intervention. Results The incidence of high blood pressure decreased from 26.57% in 2002 to 11.99% in 2007-2008. The mortality of cerebrovascular disease declined from 68.00% to 5.26%. The incidence, disability rate, and death rate of hypertension related-stroke were also significantly reduced. Conclusion Primary healthcare center-based chronic disease screening, along with the health management network, can largely decrease the incidence, disability rate, and mortality of stroke associated with high blood pressure.