Good knowledge about hypertension is linked to better control of hypertension; a multicentre cross sectional study in Karachi, Pakistan

Aysha Almas, Saniya Siraj Godil, Saima Lalani, Zahra Aziz Samani, Aamir Hameed Khan, Aysha Almas, Saniya Siraj Godil, Saima Lalani, Zahra Aziz Samani, Aamir Hameed Khan

Abstract

Background: According to the National Health survey only 3% of the population has controlled hypertension. This study was designed to elucidate the knowledge about hypertension in hypertensive patients at three tertiary care centers in Karachi. Secondly we sought to compare the knowledge of those with uncontrolled hypertension and controlled hypertension.

Methods: It was a cross-sectional study conducted at The Aga Khan University hospital (AKUH), Ziauddin Hospital (ZH) and Civil hospital, Karachi (CHK. All diagnosed Hypertensive patients (both inpatients and outpatients) coming to a tertiary care hospital in Pakistan aged > 18 years were included. Patients were categorized into 2 groups: controlled and uncontrolled hypertension based on their initial BP readings on presentation Uncontrolled Hypertension was defined as average BP ≥ 140/90 mm Hg in patients on treatment. Controlled Hypertension (HTN) was defined as average BP <140/90 mm Hg in patients on treatment. Standardized methods were used to record BP in the sitting position. Knowledge was recorded as a15 item question. Primary outcome was knowledge about hypertension.

Results: A total of 650 participants were approached and consented 447 were found eligible. 284(63.5%) were from Aga Khan University, 101(22.6) from Dow University of health sciences and 62(13.9) were from Ziauddin University. Mean (SD) age of participants was 57.7(12) years, 50.1(224) were men. Controlled hypertension was present in 323(72.3) and uncontrolled hypertension was present in 124(27.4). The total mean (SD) Knowledge score was 20.97(4.93) out of a maximum score of 38. On comparison of questions related to knowledge between uncontrolled and controlled hypertension, there was statistically significant different in; meaning of hypertension (p <0.001), target SBP(p0.001), target DBP(p 0.001), importance of SBP versus DBP, improvement of health with lowering of blood pressure (p 0.002), high blood pressure being asymptomatic (p <0.001), changing lifestyle improves blood pressure(p 0.003),hypertension being a lifelong disease (<0.001), lifelong treatment with antihypertensives(<0.001) and high blood pressure being part of aging(<0.001). On comparison of knowledge as a composite score between uncontrolled and controlled hypertensive; Mean (SD) score was 21.85(4.74) v18.67 (4.70) (p value: < 0.001). On multivariate analysis; gender β (95% CI) 1.67(0.75, 2.59) p <0.001, uncontrolled blood pressure; -2.70(-3.76,-1.67) p <0.001, Sindhi ethnicity; -1.79(-3.25,-3.27) p 0.01 and pukhtoon ethnicity; -2.72(-4.13,-1.32) p <0.001 were significantly associated with knowledge score.

Conclusion: Knowledge about hypertension in hypertensive patients is not adequate and is alarmingly poor in patients with uncontrolled hypertension. More emphasis needs to be made on target blood pressure and need for taking antihypertensives for life to patients by physicians.

References

    1. Kaplan RC, Heckbert SR, Furberg CD, Psaty BM. Predictors of subsequent coronary events, stroke, and death among survivors of first hospitalized myocardial infarction. J Clin Epidemiol. 2002;55(7):654–664. doi: 10.1016/S0895-4356(02)00405-5.
    1. Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371(9623):1513–1518. doi: 10.1016/S0140-6736(08)60655-8.
    1. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217–223.
    1. Bramlage P, Bohm M, Volpe M, Khan BV, Paar WD, Tebbe U. et al.A global perspective on blood pressure treatment and control in a referred cohort of hypertensive patients. J Clin Hypertens (Greenwich) 2010;12(9):666–677. doi: 10.1111/j.1751-7176.2010.00322.x.
    1. Tocci G, Rosei EA, Ambrosioni E, Borghi C, Ferri C, Ferrucci A. et al.Blood pressure control in Italy: analysis of clinical data from 2005–2011 surveys on hypertension. J Hypertens. 2012;30(6):1065–1074. doi: 10.1097/HJH.0b013e3283535993.
    1. Leenen FH, Dumais J, McInnis NH, Turton P, Stratychuk L, Nemeth K. et al.Results of the Ontario survey on the prevalence and control of hypertension. CMAJ. 2008;178(11):1441–1449. doi: 10.1503/cmaj.071340.
    1. Rayner B, Schoeman HS. A cross-sectional study of blood pressure control in hypertensive patients in general practice (the I-TARGET study) Cardiovasc J Afr. 2009;20(4):224–227.
    1. Saleheen D, Hashmi SK, Zaidi M, Rasheed A, Murtaza M, Abbas A. et al.Evaluation of therapeutic control in a Pakistani population with hypertension. J Eval Clin Pract. 2010;16(6):1081–1084. doi: 10.1111/j.1365-2753.2009.01256.x.
    1. Health Profile of the People of Pakistan 1990–94. Islamabad: Pakistan: Pakistan Medical Research Council; 1998.
    1. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA. 2003;290(2):199–206. doi: 10.1001/jama.290.2.199.
    1. Wang TJ, Vasan RS. Epidemiology of uncontrolled hypertension in the United States. Circulation. 2005;112(11):1651–1662. doi: 10.1161/CIRCULATIONAHA.104.490599.
    1. Shaikh RB, Mathew E, Sreedharan J, Muttappallymyalil J, Sharbatti SA, Basha SA. Knowledge regarding risk factors of hypertension among entry year students of a medical university. J Family Community Med. 2011;18(3):124–129. doi: 10.4103/2230-8229.90011.
    1. Ashfaq T, Anjum Q, Siddiqui H, Shaikh S, Vohra EA. Awareness of hypertension among patients attending primary health care centre and outpatient department of tertiary care hospital of Karachi. J Pak Med Assoc. 2007;57(8):396–399.
    1. Zafar SN, Gowani SA, Irani FA, Ishaq M. Awareness of the risk factors, presenting features and complications of hypertension amongst hypertensives and normotensives. J Pak Med Assoc. 2008;58(12):711–715.
    1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr. et al.The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560–2572. doi: 10.1001/jama.289.19.2560.
    1. Standards of medical care in diabetes--2010. Diabetes Care. 2010;33(Suppl 1):S11–S61.
    1. Stroke--1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke. 1989;20(10):1407–1431.
    1. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994;90(1):583–612. doi: 10.1161/01.CIR.90.1.583.
    1. Ahmad K, Jafary F, Jehan I, Hatcher J, Khan AQ, Chaturvedi N. et al.Prevalence and predictors of smoking in Pakistan: results of the National Health Survey of Pakistan. Eur J Cardiovasc Prev Rehabil. 2005;12(3):203–208.
    1. Kim EY, Han HR, Jeong S, Kim KB, Park H, Kang E. et al.Does knowledge matter?: intentional medication nonadherence among middle-aged Korean Americans with high blood pressure. J Cardiovasc Nurs. 2007;22(5):397–404.
    1. Han HR, Chan K, Song H, Nguyen T, Lee JE, Kim MT. Development and evaluation of a hypertension knowledge test for Korean hypertensive patients. J Clin Hypertens (Greenwich) 2011;13(10):750–757. doi: 10.1111/j.1751-7176.2011.00497.x.
    1. Ailinger RL. Hypertension knowledge in a Hispanic community. Nurs Res. 1982;31(4):207–210.
    1. Shirani S, Gharipour M, Khosravi A, Kelishadi R, Habibi HR, Abdalvand A. et al.Gender differences in the prevalence of hypertension in a representative sample of Iranian population: the Isfahan Healthy Heart Program. Acta Biomed. 2011;82(3):223–229.
    1. Guessous I, Bochud M, Theler JM, Gaspoz JM, Pechere-Bertschi A. 1999–2009 Trends in prevalence, unawareness, treatment and control of hypertension in Geneva. Switzerland. 2012;7(6):e39877. doi: 10.1371/journal.pone.0039877.
    1. Bramlage P, Thoenes M, Kirch W, Lenfant C. Clinical practice and recent recommendations in hypertension management–reporting a gap in a global survey of 1259 primary care physicians in 17 countries. Curr Med Res Opin. 2007;23(4):783–791. doi: 10.1185/030079907X182077.
    1. Almas A, Hameed A, Ahmed B, Islam M. Compliance to antihypertensive therapy. J Coll Physicians Surg Pak. 2006;16(1):23–26.
    1. Heisler M, Hogan MM, Hofer TP, Schmittdiel JA, Pladevall M, Kerr EA. When more is not better: treatment intensification among hypertensive patients with poor medication adherence. Circulation. 2008;117(22):2884–2892. doi: 10.1161/CIRCULATIONAHA.107.724104.
    1. Prugger C, Keil U, Wellmann J, de Bacquer D, de Backer G, Ambrosio GB. et al.Blood pressure control and knowledge of target blood pressure in coronary patients across Europe: results from the EUROASPIRE III survey. J Hypertens. 2011;29(8):1641–1648. doi: 10.1097/HJH.0b013e328348efa7.
    1. Subramanian U, Hofer TP, Klamerus ML, Zikmund-Fisher BJ, Heisler M, Kerr EA. Knowledge of blood pressure targets among patients with diabetes. Prim Care Diabetes. 2007;1(4):195–198. doi: 10.1016/j.pcd.2007.09.001.
    1. Abolfotouh MA, Soliman LA, Abolfotouh SM, Raafat M. Knowledge and Practice of PHC Physicians toward the Detection and Management of Hypertension and Other CVD Risk Factors in Egypt. Int J Hypertens. 2011;2011:983869.
    1. Jafar TH, Jessani S, Jafary FH, Ishaq M, Orakzai R, Orakzai S. et al.General practitioners’ approach to hypertension in urban Pakistan: disturbing trends in practice. Circulation. 2005;111(10):1278–1283. doi: 10.1161/01.CIR.0000157698.78949.D7.
    1. Oliveria SA, Lapuerta P, McCarthy BD, L’Italien GJ, Berlowitz DR, Asch SM. Physician-related barriers to the effective management of uncontrolled hypertension. Arch Intern Med. 2002;162(4):413–420. doi: 10.1001/archinte.162.4.413.
    1. Qadir F, Khan MM, Medhin G, Prince M. Male gender preference, female gender disadvantage as risk factors for psychological morbidity in Pakistani women of childbearing age - a life course perspective. BMC Public Health. 2011;11(1):745. doi: 10.1186/1471-2458-11-745.

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