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Hypertension Related Knowledge and Its Relationship with Control of High Blood Pressure in Pakistan
Abstract
Introduction: High blood pressure (HBP) is a leading major risk factor for chronic diseases such as CKD, CADx, and deaths. The prevalence of patients with hypertension (HT) has risen from 600 million in 1980 to one billion in 2008. Aims and Objectives: The basic aim of the study is to find the relationship of knowledge about hypertension with the control of blood pressure. Methodology of the Study: This cross sectional study was conducted in Mayo hospital Lahore from January 2021 to July 2021. The data was collected from 100 patients with high blood pressure who visited the OPD of our hospital. A questionnaire was prepared by the researchers in accordance with the literature to measure the level of knowledge about HT. Results: The data was collected from 100 patients of both genders. On comparison of questions related to knowledge, there was a statistically significant difference 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 anti-hypertensives (<0.001) and high blood pressure being part of aging (<0.001). Conclusion: It is concluded that patients who were aware that elevated BP levels lead to reductions in life expectancy had a higher compliance level with medication use and follow-up visits than patients without this awareness.
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Data from the Health Promotion/Disease Prevention Supplement to the 1985 National Health Interview Survey provide an indication of progress made toward achieving the 1990 objectives for the nation. Survey results showed remarkably high levels of knowledge concerning the increased risks associated with uncontrolled high blood pressure. Nine of 10 adults in the United States knew that high blood pressure increases the risk of heart disease, and 3 of 4 knew that high blood pressure is the most significant risk factor for stroke. The majority of both the general public and the subgroup of the population identified as hypertensives reported knowing the results of their last blood pressure measurement; and, most importantly, almost two-thirds of the identified hypertensives reported that their pressures were under control at last measurement. Data examining professional advice, given and acted upon to achieve blood pressure goals, show that almost two-thirds of the hypertensives currently report taking antihypertensive medication. Results also suggest a degree of willingness by both professionals and hypertensives to attempt nondrug approaches to controlling pressures. The large majority of hypertensives who were advised by a health professional to cut down on sodium, lose weight, and exercise reported they were following this advice. These findings will be used to further refine high blood pressure education strategies and advance the progress toward meeting the 1990 hypertension objectives.
The National High Blood Pressure Education Program has been designed to translate the results of basic and clinical research to medical practice through a program of education for the public, patients, and health professionals. It has continuously used health-education principals of media development, patient education, social networking, community organizations, theories of social change, and program evaluation and measurement to reach its objectives. After 15 years, public knowledge regarding blood pressure and its sequelae has improved dramatically.
Key words: education, hypertension, hypertension prevalence, hypertension control, hypertension awareness
To investigate hypertensive patients' understanding of the circulatory system, in particular high blood pressure.
Semi-structured audio-taped interviews of patients immediately after a regular follow-up appointment with their physician.
A primary health care centre and a specialist clinic (hypertension unit) in southern Sweden.
33 hypertensive patients, consecutively selected.
Focus was set on the exploration of patients' understanding/knowledge.
In spite of a long history of hypertensive care, on average ten years, patients had a less than satisfactory understanding of their condition. Most patients knew their blood pressure values, but very few were able to give an account of what high blood pressure implies in functional terms. Knowledge of high blood pressure seems mainly to be derived from sources other than the health care system, in particular from the mass media. Knowledge of the risks associated with hypertension was quite good, as was the insight into how these risks could be managed.
An assessment of patient knowledge of high blood pressure ought to be a starting point for educational strategies that aim to deepen patients' understanding of their state of health.
Objective:
To identify correlates of controlled hypertension in a largely minority population of treated hypertensive patients.
Design:
Case-control study.
Setting:
Urban, public hospital.
Patients:
A consecutive sample of patients who were aware of their diagnosis of hypertension for at least 1 month and had previously filled an antihypertensive prescription. Control patients had a systolic blood pressure (SBP) < or = 140 mm Hg and diastolic blood pressure (DBP) < or = 90 mm Hg, and case patients had a SBP > or = 180 mm Hg or DBP > or = 110 mm Hg.
Measurements and main results:
Control subjects had a mean blood pressure (BP) of 130/80 mm Hg and case subjects had a mean BP of 193/106 mm Hg. Baseline demographic characteristics between the 88 case and the 133 control subjects were not significantly different. In a logistic regression model, after adjusting for age, gender, race, education, owning a telephone, and family income, controlled hypertension was associated with having a regular source of care (odds ratio [OR] 7.93; 95% confidence interval [CI] 3.86, 16.29), having been to a doctor in the previous 6 months (OR 4.81; 1.14, 20.31), reporting that cost was not a deterrent to buying their antihypertensive medication (OR 3.63; 1.59, 8.28), and having insurance (OR 2.15; 1.02, 4.52). Being compliant with antihypertensive medication regimens was of borderline significance (OR 1.96; 0.99, 3.88). A secondary analysis found that patients with Medicaid coverage were significantly less likely than the uninsured to report cost as a barrier to purchasing antihypertensive medications and seeing a physician.
Conclusions:
The absence of out-of-pocket expenditures under Medicaid for medications and physician care may contribute significantly to BP control. Improved access to a regular source of care and increased sensitivity to medication costs for all patients may lead to improved BP control in an indigent, inner-city population.
The survey was conducted to assess knowledge and attitudes of a population in Southern Germany towards hypertension and hypercholesterolemia. A questionnaire, mailed to a random sample of 2000 citizens of the Augsburg area between 25 and 74 years of age, was responded by 67%. Knowledge about determinants and complications of hypertension or hypercholesterolemia was considerably high. Major deficiencies were found in knowledge about personal values and recommended definitions of the two risk factors. Fifty eight percent claimed, to know their personal blood pressure value, but merely 14% reported to know their personal blood cholesterol value. Just 21% were able to give the correct definition of hypertension and 10% defined hypercholesterolemia correctly. People had more trust in the effect of lowering high blood pressure (54%) to prevent heart disease than in the effect of lowering high blood cholesterol (43%). Sixty percent claimed to take some kind of actions to control their blood pressure and blood cholesterol.
J Clin Hypertens (Greenwich). 2011;13:750–757. ©2011 Wiley Periodicals, Inc.
Patients’ knowledge concerning high blood pressure (HBP) is a useful outcome measure in HBP education programs. However, valid and easy-to-use HBP knowledge assessment tools are scarce. The purpose of the study was to validate the HBP Knowledge Test (HKT) in two independent samples of Korean Americans with HBP (N=885). A total of 61% of the sample were women with a mean age of about 61 years (standard deviation=11.0) and 44% reported some college education or greater. Psychometric and item response theory analyses identified 21 items that fit a unidimensional model to form the HKT. Internal consistency was acceptable, with Cronbach’s α=0.70. Construct validity testing revealed that patients with controlled BP had significantly higher HKT scores than those with uncontrolled BP (P=.012). The HKT is a simple questionnaire for assessing and monitoring HBP knowledge. It is sensitive to differences in blood pressure control status and should provide a valid, reliable, and standardized measure of HBP knowledge with wide relevance.
To examine whether secular trends in risk factor levels and improvements in treatment can account for the observed decline in coronary heart disease mortality in the United States from 1980 to 1990 and to analyze the proportional contribution of these changes.
Literature review, US statistics, health surveys, and ongoing clinical trials.
Data representative of the US situation nationwide reported in adequate detail.
A computer-simulation state-transition model of the US population between the ages of 35 and 84 years was developed to forecast coronary mortality. The input variables were estimated such that the combination of values led to an adequate agreement with reported coronary mortality figures. Subsequently, secular trends were modeled.
Actual coronary mortality in 1990 was 34% (127,000 deaths) lower than would be predicted if risk factor levels, case-fatality rates, and event rates in those with and without coronary disease remained the same as in 1980. When secular changes in these factors were included in the model, predicted coronary mortality in 1990 was within 3% (10,000 deaths) of the observed mortality and explained 92% of the decline; only 25% of the decline was explained by primary prevention, while 29% was explained by secondary reduction in risk factors in patients with coronary disease and 43% by other improvements in treatment in patients with coronary disease.
These results suggest that primary and secondary risk factor reductions explain about 50% of the striking decline in coronary mortality in the United States between 1980 and 1990 but that more than 70% of the overall decline in mortality has occurred among patients with coronary disease.
The Canadian Heart Health Survey, in which all 10 Canadian provinces participated using a standardized protocol, provides data from 23,129 randomly selected participants. The hypertension component of this survey indicates a prevalence of 22%; among these hypertensives, 59% were aware of their elevated blood pressure status. The breakdown of aware hypertensives indicates that 16% of those were treated and controlled, 24% were treated but not controlled, and 19% were neither treated nor controlled. In terms of drug prescription pattern, angiotensin converting enzyme inhibitors, including angiotensin II antagonists, command the maximum market share of 27.7% ($36 million), followed by diuretics, calcium channel blockers, beta3-blockers, and others. Although hypertension awareness and control have improved in the past 25 years, sustained efforts are warranted to control hypertension in Canada.
To evaluate public awareness following a nationwide educational campaign on hypertension.
In 1978 the Austrian Heart Foundation conducted a nationwide educational campaign to increase the awareness of the population regarding the importance of recognizing and treating high blood pressure. Following this campaign, five opinion polls of random and representative samples were conducted to measure the awareness and knowledge of the population relating to issues of high blood pressure. The poll results indicated that during the period immediately following the awareness campaign, knowledge and perception of the dangers of high blood pressure increased. However, this effect dissipated during subsequent years. In 1978, 14% of the population were reported to be hypertensive and 10% had no relevant information about their blood pressure status. In 1998, those who labelled themselves as hypertensive dropped to 12%, while those who did not know their blood pressure values, increased to 14%. The percentage of the population who recalled having their blood pressure measured during the last 3 months dropped from 49% in 1978, to 34% in 1993, and remained at 34% in 1998.
We conclude that the intensive blood pressure education campaign had only a temporary effect on improving blood pressure awareness. Improved strategies are needed to achieve better community control of hypertension.
To examine predictors of intentional and unintentional nonadherence to antihypertensive medication regimens and their relationships to blood pressure outcomes.
Although poor adherence to medical regimens is a major concern in the care of patients with high blood pressure (HBP), our understanding of the complex behavior related to adherence is limited. Moreover, few studies have been devoted to understanding adherence issues in ethnic minority groups, such as the interplay between cultural beliefs and HBP medication-taking behaviors.
A cross-sectional analysis was performed to assess the factors affecting nonadherence to antihypertensive medication regimens.
The data used in this analysis came from an ongoing HBP intervention trial involving middle-aged (40-64 years) Korean Americans with HBP. A total of 445 Korean Americans with HBP was enrolled in the trial at baseline. Of these, 208 participants who were on antihypertensive medication were included in the analysis. Using multivariate logistic regression, we examined theoretically selected variables to assess their relationships to intentional and unintentional nonadherence in this sample.
Approximately 53.8% of the subjects endorsed 1 or more types of nonadherent behaviors. After controlling for demographic variables, multivariate analysis revealed that a greater number of side effects from the medication (adjusted odds ratio [OR], 1.19; 95% confidence interval [CI], 1.07 to 1.33) and a lower level of HBP knowledge (adjusted OR, 0.89; 95% CI, 0.79 to 0.99) were significantly associated with intentional nonadherence. Unintentional nonadherence was less strongly associated with the study variables examined in the analysis.
Our findings indicate that intentional nonadherence to antihypertensive medication that stems from incomplete knowledge of HBP treatment is prevalent among middle-aged Korean Americans with HBP. The results highlight the strong need for an intervention that focuses on increasing patient knowledge about HBP, including the benefits and side effects of antihypertensive medication. This type of focused intervention may help reduce intentional nonadherence to antihypertensive medications and ultimately result in achieving adequate BP control in this high-risk group.