Evaluation of blood pressure control and associated factors among patients with hypertension in Iraq: a prospective cross-sectional study

Abstract

A bstract Background: Uncontrolled blood pressure (BP) is a major contributor to cardiovascular disease–related morbidity and mortality. However, evidence regarding the rate and factors associated with uncontrolled BP in Iraq is scarce. The objectives of this study were a) to assess the magnitude of and factors associated with patient BP control and b) to investigate the patient-level prescribing patterns of antihypertensive medications, in a large Iraqi hospital. Materials and Methods: A prospective, cross-sectional study was conducted in the primary care centers of Al-Yarmouk Hospital in Baghdad, Iraq, between April 2018 and August 2018. Eligible patients answered standard survey questions and had their BP measured. Controlled BP was defined as <130/80mm Hg for patients with diabetes and/or chronic kidney disease and <140/90mm Hg for other populations. Results: During the study period, 300 patients were included; of which, 67.3% were female. The average age was 57.6 (9.2) years (range, 25–79 years). Among the 300 patients included, only 38.7% had controlled BP. In univariate analysis, poorly controlled BP was not associated with education, employment, smoking, comorbid conditions excluding diabetes, and therapeutic regimen used. In contrast, the strongest predictors of uncontrolled BP were age <60 years, male sex, and diabetes mellitus. The majority were prescribed monotherapy (53.0%), followed by dual therapy (38.7%), and triple therapy (8.3%). Angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors were the most commonly prescribed medications at 74.7%, followed by beta-blockers at 29.3%, calcium channel blockers at 28.0%, and diuretics at 23.0%. Conclusion: BP control was suboptimal. Effective feasible strategies should be implemented to increase BP control in Iraq to reduce hypertension-related complications.

Associations between Socio-Demographic Factors and Hypertension Management during the COVID-19 Pandemic: Preliminary Findings from Malaysia

“…We found a significant association between total adherence scores and BP control (U = 1116, p = 0.001). This finding is consistent with the findings from several other studies [27,[32][33][34][35]. For example, an Ethiopian study conducted by Animut et al in 2018 reported that patients who were highly adherent to their antihypertensive medications were two times more likely to have controlled BP than those with low adherence [32].…”

“…However, some studies have suggested that old age is considered as a barrier to optimal BP control and a strong predictor of uncontrolled HTN according to reported data from Singapore and Sweden, respectively [43,44]. In addition, the evidence from an Iraqi study did not support the significant impact of education and employment on the control of BP among hypertensive patients [34].…”

“…Females were more likely to disagree with the increased complexity of hypertension treatment than males. Concerning the gender impact on BP control, several studies reported that male patients were more prone to have poor BP control [34,39,40]. Meanwhile, in 2016, another Brazilian study consistently reported that females were more likely to report uncontrolled BP than males [41].…”

Management of Diabetes and Hypertension within the Gulf Region: Updates on Treatment Practices and Therapies

“…Hypertension is a highly prevalent condition that significantly increases a patient’s risk of developing cardiovascular disease (CVD), the leading cause of death from non-communicable causes globally [ 3 ]. For the treatment of hypertension, renin–angiotensin–aldosterone system inhibitors (RAASis) are the most widely prescribed class of drugs, including angiotensin-converting enzyme inhibitors (ACEis) and angiotensin-receptor blockers (ARBs), the two most clinically relevant anti-hypertensive agents [ 7 – 12 ]. While RAASi are generally prescribed as a first-line therapy, poorly controlled hypertension is often managed with the addition of calcium channel blockers (CCBs) and diuretics [ 13 ].…”

High Mobility Group Box 1 and Dickkopf-Related Protein 1 as New Biomarkers of Type 2 Diabetes Mellitus: Associations with Increased Glucose Toxicity and Atherogenicity and Lower &beta; Cell Function

“…T2DM frequently coincides with hypertension and about 68.4% of T2DM patients have hypertension in the USA [6]. T2DM coupled with age and sex are the strongest predictors of uncontrolled blood pressure (BP) [7]. T2DM is usually associated with chronic inflammation due to metabolic syndrome-related immune system dysregulations [8,9].…”