Background In rural areas of China, hypertension is on the rise and it is drawing the Chinese government’s attention. The health outcomes of hypertension management can be positively impacted by patient satisfaction with primary care physicians (PCPs), and the influence of patient trust on satisfaction cannot be ignored. This study aimed to analyze the effect of trust in PCPs on patient satisfaction among patients with hypertension in rural China, and the influence of patients’ socio-demographic characteristics and hypertension-management-related factors. Methods A multi-stage stratified random sampling method was adopted to investigate 2665 patients with hypertension in rural China. Patient trust and satisfaction were measured using the Chinese version of the Wake Forest Physician Trust Scale and the European Task Force on Patient Evaluation of General Practice. Multiple linear regression was used to analyze the factors influencing patient satisfaction, and structural equation modeling was conducted to clarify the relationships among patient trust and patient satisfaction with PCPs. Results Patients’ trust in their PCPs’ benevolence had a positive main effect on all three satisfaction dimensions (clinical behavior: β = 0.940, p <  0.01; continuity and cooperation: β = 0.910, p <  0.01; and organization of care: β = 0.879, p <  0.01). Patients’ trust in their PCPs’ technical competence had a small negative effect on all three satisfaction dimensions (clinical behavior: β = − 0.077, p <  0.01; continuity and cooperation: β = − 0.136, p <  0.01; and organization of care: β = − 0.064, p <  0.01). Patient satisfaction was also associated with region, gender, insurance status, distance from the nearest medical/health-service institution, and number of visits to PCPs in the past year. Conclusions Patients focused more on physicians’ benevolence than on their technical competence. Hence, medical humanities and communication skills education should be emphasized for PCPs. Regarding region-based and health-insurance-based differences, the inequities between eastern, central, and western provinces, as well as between urban and rural areas, must also be addressed.

In rural China, treatment adherence of patients with hypertension remains a challenge. Although early research on patient adherence has confirmed the importance of trust in doctors, the relative contribution and influence of the two-dimensional structure of trust on adherence has not been explored. Thus, this study examined the effects of patient trust in primary care physicians' (PCPs) benevolence and ability on medication adherence, dietary management, and physical activity. The data were derived from 2,533 patients at 54 primary health institutions in China (village level) from February 2017 to May 2018. Participants were assessed using the Chinese version of the Wake Forest Physician Trust Scale and the Therapeutic Adherence Subscale for Hypertensive Patients. Other information included region, gender, age, and self-rated health status. The results of multiple linear regression and structural equation modeling confirmed that patient trust in PCPs' benevolence was positively correlated with patient adherence to medication, diet management, and physical activity. Patient trust in PCPs' ability was negatively correlated with adherence to dietary management and physical activity. We concluded that interventions aimed at increasing PCP benevolence have the greatest potential to improve patient adherence to hypertension treatment. Under the country's policy of advocating to improve PCPs' diagnoses and treatment technology, it may be important to cultivate doctors' communication skills, medical ethics, and other benevolent qualities to improve patients' adherence with drug and Non-drug treatments.