Factors associated with uncontrolled blood pressure among Ghanaians: Evidence from a multicenter hospital-based study

Abstract

BackgroundThe burden of uncontrolled hypertension in Low-and-Middle Income Countries (LMICs) is high, with an increased risk of cardiovascular diseases and chronic renal failure in these settings.ObjectiveTo assess the factors associated with uncontrolled blood pressure control in a cross-section of Ghanaian hypertensive subjects involved in an on-going multicenter epidemiological study aimed at improving access to hypertension treatment.MethodsA cross-sectional study involving 2,870 participants with hypertension with or without diabetes who were enrolled at 5 hospitals in Ghana (2 tertiary, 2 district and 1 rural hospital). Data on demographics, medical history, lifestyle factors, anti-hypertensive medications and treatment adherence were collected. The 14-item version of the Hill-Bone compliance to high blood pressure therapy scale was used to assess adherence to treatment in 3 domains namely adherence to medications, salt intake and clinic appointments. Questionnaires on knowledge, attitudes and practices on hypertension, sources of antihypertensive medications and challenges with accessing these medications were also administered. Blood pressure, weight and height were measured for each subject at enrollment. Factors associated with uncontrolled blood pressure (>140/90mmHg) were assessed using a multivariate logistic regression model.ResultsThe mean ± SD age of study participants was 58.9 ± 16.6 years, with a female preponderance (76.8%). Among study participants, 1,213 (42.3%) study participants had blood pressure measurements under control. Factors that remained significantly associated with uncontrolled blood pressure with adjusted OR (95% CI) included receiving therapy at a tertiary level of care: 2.47 (1.57–3.87), longer duration of hypertension diagnosis: 1.01 (1.00–1.03), poor adherence to therapy: 1.21 (1.09–1.35) for each 5 points higher score on the Hill-Bone scale, reported difficulties in obtaining antihypertensive medications: 1.24 (1.02–1.49) and number of antihypertensive medications prescribed: 1.32 (1.21–1.44).ConclusionWe have found high rates of uncontrolled blood pressure among Ghanaian patients with hypertension accessing healthcare in public institutions. The system-level and individual-level factors associated with poor blood pressure control should be addressed to improve hypertension management among Ghanaians.

Characteristics of hypertension among people living with HIV in Ghana: Impact of new hypertension guideline

“…On a much broader scale, our previous report shows a highly prevalent but poorly controlled hypertension rate in the general population based on evidence gleaned from our HIV‐negative sample . This may explain why we found that HIV per se was not to be independently associated with stroke occurrence in a low endemic country such as Ghana, although the burden of stroke and poor outcomes continue to rise in the subregion due to a myriad of factors hampering the control of key CVD risk factors …”

“…22 This may explain why we found that HIV per se was not to be independently associated with stroke occurrence in a low endemic country such as Ghana, 44 although the burden of stroke and poor outcomes continue to rise in the subregion [45][46][47][48] due to a myriad of factors hampering the control of key CVD risk factors. 49…”

Prevalence and predictors of chronic kidney disease among Ghanaian patients with hypertension and diabetes mellitus: A multicenter cross‐sectional study

“…Patients should also be advised to avoid herbal medications and ensure blood pressure is controlled to target with antihypertensive medications and adherence to therapeutic lifestyle interventions. We have previously reported that blood pressure 44 and glycemic control are poor among Ghanaians seeking health care in medical facilities. 45 We have also shown earlier that CKD independently predicts incident stroke among Ghanaians with diabetes and hypertension 46 and that this increased risk may have genetic underpinnings.…”

Patient-level factors influencing hypertension control in adults in Accra, Ghana

“…Various studies have reported rates of 32.9%-49%among similar population groups (2,(14)(15)(16). In Ghana, however, control rates reported are relatively lower and range from 24% to 42% (17)(18)(19). The available studies that have established the high prevalence of uncontrolled hypertension in Ghana, but found inconsistent associations between socio-demographic factors and blood pressure control (18,19).…”

“…In Ghana, however, control rates reported are relatively lower and range from 24% to 42% (17)(18)(19). The available studies that have established the high prevalence of uncontrolled hypertension in Ghana, but found inconsistent associations between socio-demographic factors and blood pressure control (18,19). Where client level factors have been assessed, evidence shows poor control associated with the number of hypertensive medications, duration of diagnosis and access to medication (19).…”