Assessment of Blood Pressure Control among Hypertensive Patients in Southwest Ethiopia

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Abstract

Background

The rate of blood pressure control among hypertensive patients is poor and the reasons for poor control of blood pressure remain poorly understood globally.

Objective

To assess the rate of blood pressure control among adult hypertensive patients at Jimma University Specialized Hospital.

Materials and Methods

We conducted a hospital based cross sectional study among adult hypertensive patients at Jimma University Specialized Hospital hypertension clinic from March 4, 2015 to April 3, 2015. Data on sociodemographic characteristics of the participants and adherence to antihypertensive medication(s) were collected from patients by face to face interview using a pretested structured questionnaire. Comorbidities, antihypertensive medication(s) and blood pressure measurements were collected retrospectively from medical records. Medication adherence was assessed using Morisky’s Medication Adherence Scale-8 score. We did the statistical analysis using chi-square test and binary logistic regression with level of α set at 0.05. Statistical significance was considered for variables with p<0.05.

Results

Out of 311 participants, 286 patients were eligible and were studied. More than half, 154 (53.8%), of the participants were males. The mean age of the participants was 54.8± 12.6 years (range 26 to 94). The majority, 196 (68.53%), of the participants were taking more than one antihypertensive medication. More than one third (39.5%) of the participants were non adherent to their medication(s). The rate of blood pressure control was 50.3%. In a univariate logistic regression analyses, age ≥65 years old (P = 0.008), physical inactivity (p<0.001), chat chewing (P<0.001), adding salt to food (P<0.001), and coffee use (P<0.001) are significantly associated with uncontrolled blood pressure

Conclusion

Almost half of the hypertensive patients on follow up had uncontrolled blood pressure. We recommend better health education and care of patients to improve the rate of blood pressure control at the hospital.

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Most cited references 14

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Concurrent and predictive validity of a self-reported measure of medication adherence.

D E Morisky, L Green, D Levine (1986)

Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structured four-item self-reported adherence measure (alpha reliability = 0.61), which can be easily integrated into the medical visit. Items in the scale address barriers to medication-taking and permit the health care provider to reinforce positive adherence behaviors. Data on patient adherence to the medical regimen were collected at the end of a formalized 18-month educational program. Blood pressure measurements were recorded throughout a 3-year follow-up period. Results showed the scale to demonstrate both concurrent and predictive validity with regard to blood pressure control at 2 years and 5 years, respectively. Seventy-five percent of the patients who scored high on the four-item scale at year 2 had their blood pressure under adequate control at year 5, compared with 47% under control at year 5 for those patients scoring low (P less than 0.01).

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National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants.

Goodarz Danaei, Mariel Finucane, John K Lin … (2011)

Data for trends in blood pressure are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. However, few worldwide analyses of trends in blood pressure have been done. We estimated worldwide trends in population mean systolic blood pressure (SBP). We estimated trends and their uncertainties in mean SBP for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (786 country-years and 5·4 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean SBP by age, country, and year, accounting for whether a study was nationally representative. In 2008, age-standardised mean SBP worldwide was 128·1 mm Hg (95% uncertainty interval 126·7-129·4) in men and 124·4 mm Hg (123·0-125·9) in women. Globally, between 1980 and 2008, SBP decreased by 0·8 mm Hg per decade (-0·4 to 2·2, posterior probability of being a true decline=0·90) in men and 1·0 mm Hg per decade (-0·3 to 2·3, posterior probability=0·93) in women. Female SBP decreased by 3·5 mm Hg or more per decade in western Europe and Australasia (posterior probabilities ≥0·999). Male SBP fell most in high-income North America, by 2·8 mm Hg per decade (1·3-4·5, posterior probability >0·999), followed by Australasia and western Europe where it decreased by more than 2·0 mm Hg per decade (posterior probabilities >0·98). SBP rose in Oceania, east Africa, and south and southeast Asia for both sexes, and in west Africa for women, with the increases ranging 0·8-1·6 mm Hg per decade in men (posterior probabilities 0·72-0·91) and 1·0-2·7 mm Hg per decade for women (posterior probabilities 0·75-0·98). Female SBP was highest in some east and west African countries, with means of 135 mm Hg or greater. Male SBP was highest in Baltic and east and west African countries, where mean SBP reached 138 mm Hg or more. Men and women in western Europe had the highest SBP in high-income regions. On average, global population SBP decreased slightly since 1980, but trends varied significantly across regions and countries. SBP is currently highest in low-income and middle-income countries. Effective population-based and personal interventions should be targeted towards low-income and middle-income countries. Funding Bill & Melinda Gates Foundation and WHO. Copyright © 2011 Elsevier Ltd. All rights reserved.

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Uncontrolled and apparent treatment resistant hypertension in the United States, 1988 to 2008.

Keith Ferdinand, R. Axon, Brent M Egan … (2011)

Despite progress, many hypertensive patients remain uncontrolled. Defining characteristics of uncontrolled hypertensives may facilitate efforts to improve blood pressure control. Subjects included 13,375 hypertensive adults from National Health and Nutrition Examination Surveys (NHANESs) subdivided into 1988 to 1994, 1999 to 2004, and 2005 to 2008. Uncontrolled hypertension was defined as blood pressure ≥140/≥90 mm Hg and apparent treatment-resistant hypertension (aTRH) when subjects reported taking ≥3 antihypertensive medications. Framingham 10-year coronary risk was calculated. Multivariable logistic regression was used to identify clinical characteristics associated with untreated, treated uncontrolled on 1 to 2 blood pressure medications, and aTRH across all 3 survey periods. More than half of uncontrolled hypertensives were untreated across surveys, including 52.2% in 2005 to 2008. Clinical factors linked with untreated hypertension included male sex, infrequent healthcare visits (0 to 1 per year), body mass index 20% (P<0.01). Untreated, undertreated, and aTRH patients have consistent characteristics that could inform strategies to improve blood pressure control by decreasing untreated hypertension, reducing therapeutic inertia in undertreated patients, and enhancing therapeutic efficiency in aTRH.

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Author and article information

Contributors

Johannes Boltze: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 23 November 2016

Publication date Collection: 2016

Volume: 11

Issue: 11

Electronic Location Identifier: e0166432

Affiliations

[1 ]Department of Pharmacy, Clinical Pharmacy Unit, College of Health Sciences, Mekelle University, Mekelle, Ethiopia

[2 ]Department of Internal Medicine, School of Medicine, Jimma University, Jimma, Ethiopia

[3 ]Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia

Fraunhofer Research Institution of Marine Biotechnology, GERMANY

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceptualization: TA SW EK.
Data curation: TA SW EK.
Formal analysis: TA SW.
Investigation: TA SW EK.
Methodology: TA SW EK.
Project administration: TA EK.
Resources: TA SW EK.
Software: TA SW.
Supervision: TA SW EK.
Validation: TA SW EK.
Visualization: TA SW EK.
Writing – original draft: TA SW.
Writing – review & editing: TA.

* E-mail: tgfrekidan16@ 123456gmail.com

Article

Publisher ID: PONE-D-16-00738

DOI: 10.1371/journal.pone.0166432

PMC ID: 5120816

PubMed ID: 27880781

SO-VID: 1b838c92-e8e1-4f78-86ac-f43be2adb7c3

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 9 January 2016

Date accepted : 28 October 2016

Page count

Figures: 0, Tables: 5, Pages: 12

Funding

The authors received no specific funding for this work.

Custom metadata

Data Availability All relevant data are within the paper and its Supporting Information files.

Assessment of Blood Pressure Control among Hypertensive Patients in Southwest Ethiopia

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Abstract

Background

Objective

Materials and Methods

Results

Conclusion

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PLOS Climate

Most cited references 14

Concurrent and predictive validity of a self-reported measure of medication adherence.

National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants.

Uncontrolled and apparent treatment resistant hypertension in the United States, 1988 to 2008.

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