Uncontrolled hypertension: Evidence pointing towards inadequate health systems and unhealthy life style

Objective:

1)                          To determine the frequency of uncontrolled hypertension among the hypertensive patients attending a tertiary health care facility.2)                          To investigate the factors affecting uncontrolled hypertension among the hypertensive patients.
Methods:

Cross Sectional study on 217 participants was done between January 2007 and September 2008 in a tertiary health care facility in the private sector in Islamabad, Pakistan. IRB approval was obtained and written informed consent was obtained. All data was entered and analyzed using SPSS version 10.0 . The level of statistical significance was p<0.05.

Results:  Age distribution of the sample of 217 participants was 53 ± 11 years. 99(46%) were males while 118(54%) were females. 119 (54%) participants were found to have blood pressure equal to or more than 140/90 mm Hg. Among those who knew they were hypertensive 82 (51%) had uncontrolled blood pressure (BP≥140/90). Among the participants taking antihypertensive medications 67% of the patients were taking them regularly. In multivariate logistic regression analysis factors which were significantly associated with uncontrolled blood pressure were male sex  (O.R 2.4; 95% CI 1.2 to 5, p=0.01), Government health facility accessed vs Private health facility for usual care (O.R 2.9; 95% CI 1.5 to 6, p= 0.002), last blood pressure checked less than 1 month vs more than 1 month (O.R 0.12, 95% CI 0.05 to 0.28, p=0.001),smoking (O.R 2.4; 95% CI 1.2 to5, p=0.01) and regular exercise vs no-exercise (O.R 0.38, 95% CI 0.17 to 0.83, p=0.016).
Conclusion:
Uncontrolled blood pressure was statistically significantly associated with patients getting usual care from government health facilities, last blood pressure checked more than 1 month ago, male gender, smoking and lack of exercise.  Patient education in terms of drug compliance, regular blood pressure monitoring and advocating exercise and quitting smoking could go a long way in controlling hypertension.