Awareness, treatment and control of hypertension among hypertensive patients aged 18 to 59 years old in the northeast of China

Trend, burden and determinants of undiagnosed hypertension in the Horn of Africa: A systematic review and meta-analysis

BACKGROUND

Hypertension is a silent killer disease and the global report revealed that half of the world's population lives with undiagnosed hypertension. The problem is expected to be worse in low-income countries such as in Horn of Africa countries. Thus, we planned to determine the trend, burden, and determinates of undiagnosed hypertension in this region and provide conclusive and tangible evidence for interventions.

METHOD

Articles were searched on Google, Google Scholar, PubMed/Medline, EMBASE, SCOPUS, and the published articles' reference list. The JBI critical appraisal checklist was used for quality assessment. A sensitivity test and I2 statistics were conducted to evaluate the heterogeneity. The Begg's statistics in the random effect model were done to evaluate the publication bias.

RESULT

The pooled prevalence of undiagnosed hypertension in the Horn of Africa was 17% (95% CI: 15%-20%) and it ranges from from 13% in 2006 to 20% in 2023. A trip time to a medical institution of less than 35 minutes (OR = 0.52, 95%CI: 0.35-0.79), no regular exercise (OR = 2.26, 95% CI: 1.54-3.32), age > = 45 years (OR = 2.51, 95% CI: 1.66-3.8), age 35-44 years (OR = 1.88, 95% CI: 1.5-2.37), male (OR = 1.72, 95% CI: 1.34-2.2), poor knowledge (OR = 3.29, 95%CI: 2.39,4.53), normal BMI (OR = 3.84, 95% CI: 2.96-4.98), Overweight (OR = 1.97, 95% CI: 2.96-4.98), poor health seeking (OR = 2.79, 95%CI: 2.01-3.86), low vegetable consumers (OR = 1.99, 95%CI:1.36-2.91), smoking (OR = 1.47, 95%CI: 1.13-1.93), high triglyceride (OR = 1.83, 95%CI:1.33-2.52), chat chewing (OR = 2.18, 95%CI: 1.54-3.09), and alcohol drinking (OR = 1.75, 95%CI: 1.32-2.33) were the determinats of undiagnosed hypertension.

CONCLUSION AND RECOMMENDATION

The pooled prevalence of undiagnosed hypertension was low in the Horn of Africa but its trend was increased over time. Individual level variables were identified that affect the undiagnosed hypertension. Therefore, healthy lifestyle is recommended.

Prevalence and Awareness of Hypertension among a Rural Jazan Population

BACKGROUND

Hypertension (HTN) is a major global public health problem. Knowledge of the risk factors and repercussions of HTN is crucial to preventing the disease. Rural populations have lower levels of knowledge of the disease than urban populations. However, no studies have assessed the levels of awareness of HTN and their determinants in rural regions of Saudi Arabia.

OBJECTIVES

This study aimed to assess the awareness of HTN and its determinants among a rural population of Jazan region, Saudi Arabia.

METHODOLOGY

We conducted a cross-sectional analytical study among six primary healthcare centers selected randomly from the rural areas of Jazan region. We targeted all Saudi adults visiting these centers. Information was gathered using interview questionnaires completed by 607 people. SPSS was utilized to analyze the collected data.

RESULTS

In all population groups, the prevalence of diagnosed HTN increased with age, particularly gradually increasing in those aged younger than 40 years and then rapidly and sharply increasing in those aged 40 years and over. The women (43.3%) had a higher prevalence of HTN than the men (34.6%), which is comparable with findings in other areas in Saudi Arabia and the Middle East. Approximately 65.6% of the participants without HTN and 34.4% of the participants with HTN did not know their normal blood pressure. Approximately 61.7% of the participants without HTN and 59.0% of the participants with HTN felt that pharmaceuticals are insufficient in curing HTN, while 60.7% and 64.7% believed that HTN can be cured.

CONCLUSIONS

The global prevalence of HTN is increasing annually owing to rapid changes in lifestyle and dietary habits. Furthermore, because adherence to antihypertensives is poor in rural Jazan, the Ministry of Health and researchers advocate implementing a program to increase awareness and assess patient adherence to prescribed medication for the control of HTN.

Awareness, Treatment, and Control of Hypertension among 10663 Adults Based on the Baseline Data of the Kherameh Cohort Study

Background

A comprehensive strategy to reduce the complications of hypertension (HTN) should include prevention approaches, such as increasing awareness, early diagnosis, and adequate treatment. The present study aimed to assess awareness, treatment, and control of HTN and their related factors in Kherameh, Iran.

Methods

This cross-sectional study was performed on 10 663 individuals aged between 40 and 70 years using the Kherameh cohort data. HTN was defined as either systolic/diastolic blood pressure ≥140/90 mmHg or taking medications. Logistic regression was used to investigate the relationship between awareness, treatment, and control of HTN and demographic factors, comorbidities, and a family history of diseases.

Results

Out of 10 663 participants, 4719 (44.3%) were men, and the average age of the participants was 51.94±8.27 years. The rates of the prevalence, awareness, treatment, and control of HTN were 27.7% (95% CI, 26.86 to 28.54), 80.3% (95% CI, 79.56 to 81.04), 78% (95% CI, 77.22 to 78.78), and 53.6% (95% CI, 52.66 to 54.54), respectively. Age, gender, body mass index, and cardiovascular disease were associated with all the dependent variables in the regression model. Additionally, occupation, diabetes, chronic diseases, a history of cardiovascular disease in first and second-degree relatives and a history of chronic diseases in second-degree relatives were related to all the dependent variables except for treatment.

Conclusion

A high percentage of the patients were aware of their disease, but a smaller proportion were on medication. Consequently, about half the patients had blood pressure below 140/90 mmHg.

Undiagnosed hypertension and its determinants among hypertensive patients in rural districts of northwest Ethiopia: a mediation analysis

BACKGROUND

Early detection of hypertension is associated with improved blood pressure control and a reduced risk of cardiovascular diseases. However, in rural areas of Ethiopia, evidence is scarce where access to healthcare services is low. This study aimed to estimate the proportion of undiagnosed hypertension and identify its determinants and mediators among patients with hypertension in rural northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted from September to November 2020. A three-stage sampling technique was used to select a total of 2436 study participants. Blood pressure was measured using an aneroid sphygmomanometer two times, 30 min apart. A validated tool was used to assess participants' beliefs and knowledge of hypertension. The proportion, determinants, and mediators of undiagnosed hypertension were determined among patients with hypertension. The regression-based approach used to calculate the direct and indirect effects of determinants of undiagnosed hypertension. Joint significance testing was used to determine the significance of the indirect effect.

RESULTS

The proportion of undiagnosed hypertension was 84.0% (95% CI: 81.4-86.7%). Participants aged 25-34 years (AOR = 6.03; 95% CI: 2.11, 17.29), who drank alcohol (AOR = 2.40; 95% CI: 1.37, 4.20), were overweight (AOR = 0.41; 95% CI: 0.18, 0.98), had a family history of hypertension (AOR = 0.32; 95% CI: 0.20, 0.53), and had comorbidities (AOR = 0.28; 95% CI: 0.15, 0.54) were significantly associated with undiagnosed hypertension. The mediation analysis revealed that hypertension health information mediated 64.1% and 68.2% of the effect of family history of hypertension and comorbidities on undiagnosed hypertension, respectively. Perceived susceptibility to hypertensive disease mediated 33.3% of the total effect of age on undiagnosed hypertension. Health facility visits also mediated the effect of alcohol drinking (14.2%) and comorbidities (12.3%) on undiagnosed hypertension.

CONCLUSION

A higher proportion of hypertensive patients remain undiagnosed. Being young, drinking alcohol, being overweight, having a family history of hypertension, and having comorbidities were significant factors. Hypertension health information, knowledge of hypertensive symptoms, and perceived susceptibility to hypertension were identified as important mediators. Public health interventions aimed at providing adequate hypertension health information, particularly to young adults and drinkers, could improve knowledge and perceived susceptibility to hypertensive disease and reduce the burden of undiagnosed hypertension.

Medication Adherence and Blood Pressure Control Among Hypertensive Outpatients Attending a Tertiary Cardiovascular Hospital in Tanzania: A Cross-Sectional Study

Background

Notwithstanding the availability of effective treatments, asymptomatic nature and the interminable treatment length, adherence to medication remains a substantial challenge among patients with hypertension. Suboptimal adherence to BP-lowering agents is a growing global concern that is associated with the substantial worsening of disease, increased service utilization and health-care cost escalation. This study aimed to explore medication adherence and its associated factors among hypertension outpatients attending a tertiary-level cardiovascular hospital in Tanzania.

Methods

The pill count adherence ratio (PCAR) was used to compute adherence rate. In descriptive analyses, adherence was dichotomized and consumption of less than 80% of the prescribed medications was used to denote poor adherence. Logistic regression analyses was used to determine factors associated with adherence.

Results

A total of 849 outpatients taking antihypertensive drugs for ≥1 month prior to recruitment were randomly enrolled in this study. The mean age was 59.9 years and about two-thirds were females. Overall, a total of 653 (76.9%) participants had good adherence and 367 (43.2%) had their blood pressure controlled. Multivariate logistic regression analysis showed; lack of a health insurance (OR 0.5, 95% CI 0.3-0.7, p<0.01), last BP measurement >1 week (OR 0.6, 95% CI 0.4-0.8, p<0.01), last clinic attendance >1 month (OR 0.4, 95% CI 0.3-0.6, p<0.001), frequent unavailability of drugs (OR 0.6, 95% CI 0.3-0.9, p = 0.03), running out of medication before the next appointment (OR 0.6, 95% CI 0.4-0.9, p = 0.01) and stopping medications when asymptomatic (OR 0.6, 95% CI 0.4-0.8, p<0.001) to be independent associated factors for poor adherence.

Conclusion

A substantial proportion of hypertensive outpatients in this tertiary-level setting had good medication adherence. Nonetheless, observed suboptimal blood pressure control regardless of a fairly satisfactory adherence rate suggests that lifestyle modification plays a central role in hypertension management.

Gender heterogeneity in self-reported hypertension

We investigate the gender gap in hypertension misreporting using the French Constances cohort. We show that false negative reporting of hypertension is more frequent among men than among women, even after conditioning on a series of individual characteristics. As a second step, we investigate the causes of the gender gap in hypertension misreporting. We show that women go to the doctor more often than men do and that they have better knowledge of their family medical history. Once these differences are taken into account, the gender gap in false negative reporting of hypertension is reversed. This suggests that information acquisition and healthcare utilisation are crucial ingredients in fighting undiagnosed male hypertension.

Translation and Validation of the Indonesian Version of the Hypertension Self-care Profile

BACKGROUND: High blood pressure self-care profile (HBP-SCP) is one of the instruments that needed to evaluate education program among hypertension patients. AIM: The purpose of the study was to translate and validate HBP-SCP into Indonesian version. METHODS: This study involved translation, content validation, and psychometric testing. The first instrument was conducted forward and backward translation by experts. Seven expert reviewed the contents for consistency, clarity, difficulty, representativeness, and suitability for inclusion. Finally, instrument was tested for reliability and validity on 40 hypertensive patients using Cronbach’s alpha and Pearson’s moment product. RESULTS: The final Indonesian version of HBP-SCP included behavior, motivation, and self-efficacy that each consists of 20 items questions were valid and reliable with positive expert review ratings (content validity index 0.964), internal consistency reliability coefficient ranged from 0.911 to 0.955. Items questionnaire of Indonesian version of HBP-SCP had strong correlation and significant validity (p ≤ 0.05). CONCLUSION: Indonesian version of HBP-SCP is a valid and reliable instrument to assess behavior, motivation, and self-efficacy among hypertension patients and evaluate group based hypertension education programs in Indonesia.

Patient Awareness and Clinical Inertia: Obstacles to Hypertension Control in Rural Communities in the Dominican Republic

BACKGROUND

Many obstacles exist for adequate hypertension control, including low individual awareness and clinical inertia (CI). In this study, we aimed to determine hypertension prevalence, awareness, treatment, and control among community residents of rural areas of Peravia in Dominican Republic (DR), followed by an assessment of CI in their primary care clinics (PCCs).

METHODS

We interviewed 827 adults from 8 rural communities of Peravia. Demographics, medical history, health care information, and blood pressure (BP) were obtained. We reviewed the community PCC visits of patients with known hypertension or a BP ≥140/90, abstracting medical history and the physician's action toward uncontrolled BP.

RESULTS

Of those interviewed, 57% (95% CI: 53%-60%) had hypertension, with 63% (95% CI: 59%-68%) of those aware of their diagnosis. Among individuals with hypertension, 60% (95% CI: 56%-65%) were receiving pharmacological treatment, and only 35% (95% CI: 31%-40%) were controlled. Characteristics associated with awareness were female sex, age >55 years, diabetes, private insurance, and having at least 1 health care visit within the past year. Of the 507 PCC patients reviewed, 340 (67%) had uncontrolled BP. Of these, 220 had no clinical action to address the uncontrolled BP, corresponding to a CI rate of 65%.

CONCLUSIONS

Among rural communities in the DR, undiagnosed hypertension remains common, especially in individuals who are younger, uninsured, or with limited access to health care. For those seen in PCCs, therapeutic intensification to achieve controlled BP is infrequently done. Strategies to address population awareness and CI are needed to improve hypertension control.

READINESS ASSESSMENT OF PATIENTS WITH ARTERIAL HYPERTENSION TO THE APPLICATION OF TELEMEDICAL TECHNOLOGIES

This article presents original data on patients' awareness of arterial hypertension and their readiness to use telemedicine technologies. The aim: to study the factors that may affect the effectiveness of diagnosis and treatment of patients with arterial hypertension (AH) through the use of telemedicine technologies. Materials and methods: this study involves 336 outpatients and indoor patients diagnosed with arterial hypertension. Anonymously, using a questionnaire, were assessed patients' awareness of their diagnosis, access to the Internet, and the ability to remotely control of blood pressure. Results: only about a third of all respondents systematically took the recommended antihypertensive therapy daily. Among them, the vast majority were indoor patients (82 %). We found a direct dependence between the regularity to use the antihypertensive therapy and the interest in the use of telemonitoring of blood pressure (Spearman correlation coefficient +0.59). There is a low awareness of patients about the possibilities of remote monitoring of blood pressure (only 11 %), the vast majority of patients (60 %) for the first time learned about such technologies. Among our respondents, a statistically significant dependence was found between the age of patients and interest in telemonitoring blood pressure at a significance level of p<0.01 (χ2 – 26.119, and the critical value of χ2 significance level p=0.01 is 9.21). Conclusions: the main sources of information for patients with arterial hypertension are primary care physicians (family doctors, therapists) and the Internet. Limited access of patients to the Internet can negatively affect over introduction of telemedicine technologies for the management of arterial hypertension, despite the great interest of patients and society.