Exploring patient-, provider-, and health facility-level determinants of blood pressure among patients with hypertension: A multicenter study in Ghana

Abstract

Optimal blood pressure (BP) control is essential in averting cardiovascular disease and associated complications. Multi-level factors influence the achievement of BP targets in hypertension management. We explored patient-, provider-, and health facility-level factors of systolic and diastolic BP and controlled BP status among patients with hypertension in Ghana, where the burden of hypertension and cardiovascular disease is rising. Using a cross-sectional design, we recruited 15 health facilities, and from each facility, four healthcare professionals who managed patients with hypertension and 15 patients diagnosed with hypertension. The primary outcome of interest was systolic and diastolic BP; the secondary outcome was BP control (<140/90 mmHg) in compliance with Ghana's national standard treatment guidelines. We used mixed-effects regression models to explore the patient- and facility-level predictors of the outcomes. From the 15 health facilities, we recruited 67 healthcare providers with a mean (SD) age of 32 (7) and 224 patients with a mean (SD) age of 60.5 (12.7). Most (182 [81%]) of the patient participants were female, and almost half (109 [49%]) had controlled BP. At the patient level, secondary school education (Coeff.:-7.69, 95% CI: -15.13, -0.26) was associated with lower systolic BP than a lower level of education; and traveling for 30 minutes to 1 hour to the health facility was associated with higher diastolic BP (Coeff.:3.75, 95% CI: 0.12, 7.38) and lower odds of BP control (OR: 0.51, 95% CI: 0.28, 0.92) than traveling less than 30 minutes. Receiving care at government health facilities was associated with less systolic BP (Coeff.: -19.4; 95% CI: -33.58, -5.22) than private health facilities. A higher patient-to-physician or physician assistant ratio was associated with more elevated systolic BP (Coeff.: 23.06, 95% CI: 10.06, 36.05) and lower odds of controlled BP (OR: 0.18, 95% CI: 0.05, 0.74). Further research is warranted to identify effective strategies to address the multi-level factors influencing hypertension control and to mitigate the rising burden of hypertension in Ghana.