Assessment of hypertension control and factors associated with the control among hypertensive patients attending at Zewditu Memorial Hospital: a cross sectional study

Prevalence of uncontrolled hypertension and contributing factors in Ethiopia: a systematic review and meta-analysis

Background

Uncontrolled hypertension (HTN) is a major risk factor for cardiovascular and cerebrovascular disease. The prevalence of HTN in the Ethiopian adult population is almost 20%.This study aimed to determine the prevalence of uncontrolled HTN and its contributing factors among patients with HTN in Ethiopia undergoing treatment.

Methods

Electronic bibliographic databases such as PubMed, Google Scholar, Hinari (Research4Life), Embase, and Scopus were searched for original records in the English language that assessed HTN control in Ethiopia and were available before 29 June 2023. The data were extracted using a format prepared in Microsoft Excel and exported to the software STATA 17.0 for analysis. The study protocol was registered at PROSPERO with the reference number CRD42023440121.

Results

A total of 26 studies with 9,046 patients with HTN were included in the systematic review and meta-analysis, of which 11 studies were used to assess factors contributing to uncontrolled blood pressure (BP) in patients in Ethiopia. The estimated prevalence of uncontrolled HTN in the population of Ethiopia is 51% [95% confidence interval (CI), 42%-60%]. The subgroup analysis, based on the assessment tools, region, and follow-up period, revealed that the prevalence of uncontrolled BP was highest following the guidelines of the American Heart Association/American College of Cardiology (AHA/ACC) (89%; 95% CI: 87%-91%) and in Addis Ababa (58%; 95% CI: 40%-76%), and the lowest proportion of uncontrolled BP was in the 3-month follow-up period (34%; 95% CI: 29%-39%). The presence of diabetes mellitus showed the highest impact (pooled odds ratio: 5.19; CI: 1.41-19.11) for uncontrolled HTN. The univariate meta-regression method confirmed that the sample size, year of publication, and subgroups were not sources of heterogeneity in the pooled estimates. Egger's regression test did not indicate the presence of publication bias.

Conclusion

More than half of the hypertensive patients in Ethiopia have uncontrolled BP. Diabetes mellitus, advanced age, male sex, and the presence of comorbidities are among the factors contributing to uncontrolled HTN in Ethiopia. The concerned bodies working in this area should implement interventional strategies and recommendations that might be helpful in achieving optimal BP in hypertensive patients.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023440121, PROSPERO (CRD42023440121).

Uncontrolled blood pressure and associated factors in adult hypertensive patients undergoing follow-up at public health facility ambulatory clinics in Bishoftu town, Ethiopia: a multi-center study

BACKGROUND

Uncontrolled blood pressure is an important medical and public health problem in developing countries like Ethiopia. Improving the management of hypertension requires a better comprehension of the factors influencing blood pressure control and the application of interventions. But in clinical practice, blood pressure is still not adequately controlled. Thus, this study aimed to assess uncontrolled blood pressure and associated among adult hypertensive patients on follow-up at public health facility ambulatory clinics in Bishoftu, Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted among 398 adult hypertensive patients who were on treatment and follow-up from April to May 31, 2022. Systematic random sampling was used to select study participants. Data were collected using an interviewer-administered, semi-structured questionnaire and chart review. The Eighth Joint National Committee (JNC 8) criteria was applied to define blood pressure control status. Binary logistic regression analysis was used to model the association between dependent and independent variables. An adjusted odds ratio and 95% confidence interval were used to measure the strength of the association. Finally, at a p-value < 0.05, statistical significance was proclaimed.

RESULT

Of the total study participants, 249(62.6%) were male. The mean age was 62.26 ± 11.55 years. The overall proportion of uncontrolled blood pressure was 58.8% (95% CI: 54-64). Salt intake (AOR = 2.51; 95% CI: 1.49-4.24), lack of physical activity (AOR = 1.40; 95% CI: 1.10-2.62), habitual coffee consumption (AOR = 4.52; 95% CI: 2.67-7.64), higher BMI (AOR = 2.08; 95% CI: 1.24-3.49), and non-adherence to antihypertensive medications (AOR = 2.31; 95% CI: 1.3-3.89) were independent predictors of uncontrolled blood pressure.

CONCLUSION

More than half of the hypertensive patients in this study had uncontrolled blood pressure. Healthcare providers and other accountable stakeholders should urge patients to follow salt restriction, physical activity, and antihypertensive medication regimes. Reduced coffee consumption and weight maintenance are other crucial blood pressure control measures.

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.

Blood pressure control status of patients with hypertension on treatment in Dessie City Northeast Ethiopia

INTRODUCTION

Uncontrolled blood pressure contributes a huge contribution to many hypertension-related complications and it is one of the unbeaten problems for patients taking antihypertensive drugs. The association of social support and other factors with uncontrolled blood pressure during the covid-19 pandemic is not well investigated. Therefore, this study explored the determinants of blood pressure control status during the COVID-19 pandemic among patients with hypertension who were on an antihypertensive treatment.

METHOD

A cross-sectional study was done from March to May 2021 among adults aged 18 or more patients with hypertension for three months or more on treatment in Dessie City. An interview-administered questionnaire was done using simple random sampling from hypertension follow-up register for 380 patients with hypertension. Blood pressure measurement was taken from their arm using a stethoscope and mercury sphygmomanometer at a sitting position with 90-degree back support. Uncontrolled blood pressure was also computed either the systolic or diastolic blood pressure greater than or less than the limit of uncontrolled blood pressure with regarding the age and diabetic status of patients. The perceived social support-related questionnaire was adopted from the Multidimensional Scale of Perceived Social Support (MSPSS) -12 item checklist. It was sum-up and transformed into three categories using tertile of their computed raw scores. The adjusted prevalence ratio with a 95 percent confidence interval (CI) was used to calculate the strength of the association between uncontrolled blood pressure and independent predictors using log-binomial regression analysis. A P-value less than 0.05 was declared as statistically significant in multivariable log-binomial regression analysis.

RESULT

A total of 360 study participants were included in this study. The prevalence of uncontrolled blood measures in patients with hypertension with a 95% CI was 55.8(50.7, 61.0). In a multivariable analysis adjusted prevalence ratio with 95% CI for poor medication adherence 1.86(1.59,2.19), being male 1.35(1.11,1.64), secondary education 0.52(0.35,0.77), and low social support 1.24(1.01, 1.54) were the predictors of uncontrolled blood pressure.

CONCLUSION

Uncontrolled blood pressure for patients with hypertension on treatment is higher during the COVID-19 pandemic. Being male, poor medication adherence, educational status and low social support are factors that contribute to uncontrolled blood pressure.

Blood Pressure Control with Reference to Intensive Blood Pressure Targets Among Hypertension Patients on Chronic Follow-Up at Dessie Referral Hospital, Northeast Ethiopia

Background

Hypertension is a risk factor for heart, brain, kidney, and other diseases. It is also the major cause of premature death. Thus, it is important to prevent, treat, and control hypertension and to reduce the risk of cardiovascular disease.

Objective

To determine the level of blood pressure control and associated factors based on the new intensive blood pressure goals (<130/80 mmHg).

Methods

A cross-sectional study design was used to assess the level of blood pressure control and associated factors from February 15 to April 15, 2019. Two hundred and sixteen patients were selected through a systematic sampling technique.

Results

From 203 hypertension patients incorporated in the study, 102 (50.2%) were females. The mean age of patients documented during the last date of follow-up was 55.2 (SD=±14.47). About 51.2% of patients were less than 5 years from the day of diagnosis of hypertension. The majority of the study participants (111, 54.7%) were using two antihypertensives. The most common anti-hypertensive medication was hydrochlorothiazide (HCT), at 25 (12.3%). The most common combination drug therapy used was the combination of HCT and calcium channel blockers, at 62 (30.5%). Heart failure (22, 20.8%), stroke (18, 16.98%), and dyslipidemia (17, 16.04%) were the top three comorbidities. Based on the new intensive targets of blood pressure control (<130/80 mmHg), the blood pressure was controlled for only 25 (12%) patients.

Conclusion

The level of blood pressure control for hypertensive patients on chronic follow-up at Dessie Referral Hospital was very poor.

Implementation of a non-communicable disease clinic in rural Sierra Leone: early experiences and lessons learned

This study is an evaluation of the first cohort of patients enrolled in an outpatient non-communicable disease clinic in Kono, Sierra Leone. In the first year, the clinic enrolled 916 patients. Eight months after the enrollment of the last patient, 53% were still active in care, 43% had been lost to follow-up (LTFU) and 4% had defaulted. Of the LTFU patients, 47% only came for the initial enrollment visit and never returned. Treatment outcomes of three patient groups [HTN only (n = 720), DM only (n = 51), and HTN/DM (n = 96)] were analyzed through a retrospective chart review. On average, all groups experienced reductions in blood pressure and/or blood glucose of approximately 10% and 20%, respectively. The proportions of patients with their condition controlled also increased. As NCDs remain underfunded and under-prioritized in low-income countries, the integrated program in Kono demonstrates the possibility of improving outpatient NCD care in Sierra Leone and similar settings.

Prevalence of hypertension and its risk factors among cotton textile workers in low- and middle-income countries: a protocol for a systematic review

BACKGROUND

Cotton workers are exposed to various hazards in the textile industry that might result in different ailments including hypertension (HTN). However, few attempts have been made to systematically review the prevalence of hypertension and its risk factor among cotton textile workers in low-and middle-income countries (LMICs). The objective of this study will be to evaluate the prevalence of hypertension and its risk factors among adult cotton textile workers in low- and middle-income countries.

METHODS

We designed and registered a study protocol for a systematic review of descriptive epidemiology data. We will include observational studies (e.g., cross-sectional, cohort, surveys) on the epidemiology of hypertension among adult cotton textile workers in low- and middle-income countries. The primary outcome will be the prevalence of hypertension. Secondary outcomes will be the prevalence of risk factors of hypertension. Literature searches will be conducted in multiple electronic databases (from January 2000 onwards), including PubMed/MEDLINE, CINAHL, Science Direct, and Cochrane Library. Gray literature will be identified through searching conference abstracts, thesis dissertations, and public repositories. Two investigators will independently screen all citations, full-text articles, and abstract data. The study methodological quality (or bias) will be appraised using an appropriate tool. If feasible, we will conduct random effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., age, gender, years of service, textile department).

DISCUSSION

This systematic review will identify, evaluate, and integrate evidence on the prevalence and risk factors of hypertension among adult cotton textile workers in low- and middle-income countries. Our findings will be made publicly available in a repository and published in a peer-reviewed journal.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020167175.

Cost of Hypertension Illness and Associated Factors Among Patients Attending Hospitals in Southwest Shewa Zone, Oromia Regional State, Ethiopia

Background

Hypertension is a common vascular disease and the main risk factor for cardiovascular diseases. Since the incidence of hypertension is rising in Ethiopia, one may expect that the household’s cost of healthcare services related to the disease will increase in the near future. Yet the cost associated with the disease is not known. We aimed to estimate the total cost of hypertension illness and identify associated factors among patients attending hospitals in Southwest Shewa zone, Oromia regional state, Ethiopia.

Patients and Methods

An institution-based cross-sectional study design was employed to conduct the study from 13 August to 2 September 2018. All hypertensive patients aged 18 years and older who were on follow-up were eligible for this study. The total cost of hypertension illness was estimated by summing the direct and indirect costs. Bivariate and multivariate linear regression analyses were performed to identify factors associated with hypertension costs of illnesses.

Results

A total of 349 patients participated in the study. The mean monthly total cost of hypertension illness was US$ 22.3 (95% CI, 21.3–23.3). Direct and indirect costs constitute 51% and 49% of the total cost, respectively. The mean direct cost of hypertension illness per patient per month was US$ 11.39 (95% CI, 10.6–12.1). Out of these, drugs comprised higher cost (31%), followed by food (25%). The mean indirect cost per patient per month was US$ 10.89 (95% CI, 10.4–11.4). In this study, the primary educational status, family size (4–6 and >6), distance from hospital (≥10 km), the presence of a companion and stage of hypertension (stage two) of patients were identified as the predictors of the cost of hypertension illnesses.

Conclusion

The cost of hypertension illness was very high when compared to the monthly income of households, exposing patients to catastrophic costs. Hence, the government should give due attention to protect patients from catastrophic health expenditures.

Magnitude and Determinants of Uncontrolled Blood Pressure Among Adult Hypertensive Patients on Follow-Up at Nekemte Referral Hospital, Western Ethiopia

Background

Hypertension is the leading cause of morbidity and mortality among non-communicable diseases. The rate of blood pressure (BP) control among hypertensive patients is poor and the reasons for poor control of BP remain poorly understood globally. Therefore, this study aimed to assess the magnitude and determinants of uncontrolled blood pressure among adult hypertensive patients on follow-up at Nekemte referral hospital (NRH).

Methods

A hospital-based cross-sectional study was conducted from February to April 2018 at NRH. BP control status was determined by the average consecutive BP recordings across the 3 months. The data was entered and analyzed using SPSS version 20.0 and p-value <0.05 was considered statistically significant.

Results

Out of 297 study participants included, the majority were females, 181 (60.9%), and the mean age of the patients was 59.4 ±10.4 years. About half, 137 (46.12%), of the patients had at least one comorbidity and the most common class of anti-hypertensive medication was angiotensin-converting enzyme inhibitors (88.2%). The mean of systolic blood pressure was 132.41± 15.61mmHg, while the mean of diastolic blood pressure was 84.37± 9.32 mmHg. The proportion of participants with optimally controlled BP was 63.6% and 36% were adherent to their medications. Male sex (Adjusted Odd Ratio [AOR]: 1.89, 95% CI: 1.09-4.84), illiteracy (AOR= 1.56, 95% CI: 1.22-6.78), duration of hypertension diagnosis > 10 years (AOR= 2.01, 95% CI: 1.04-16.11), non-adherence (AOR= 3.14, 95% CI: 1.35-10.76) and lack of physical exercise (AOR= 2.8, 95% CI: 1.16-6.74) were positively associated with uncontrolled BP status. Whereas age older than 55 years (AOR= 0.38, 95% CI: 0.11-0.92) was negatively associated with uncontrolled BP.

Conclusion

BP control was relatively achieved in about two-third of pharmacologically treated patients. We recommend better health education and care of patients to improve the rate of BP control status.