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Prevalence and factors associated with uncontrolled hypertension among adult hypertensive patients on follow-up at Northern Ethiopia, 2019: cross-sectional study

Prevalence and factors associated with uncontrolled hypertension among adult hypertensive patients on follow-up at Northern Ethiopia, 2019: cross-sectional study

Woldu Aberhe1,&, Teklewoini Mariye1, Degena Bahrey1, Kidane Zereabruk1, Abrha Hailay1, Guesh Mebrahtom1, Kibrom Gemechu2, Brhanu Medhin3

 

1School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia, 2College of Health Sciences and School of Nursing, Adigrat University, Tigray, Ethiopia, 3College of Health Sciences and School of Nursing, Samara University, Samara, Afar, Ethiopia

 

 

&Corresponding author
Woldu Aberhe, School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia

 

 

Abstract

Introduction: uncontrolled hypertension is a major risk factor for cardiovascular, renal, and cerebrovascular morbidities and mortalities. This study aims to assess the prevalence and factors associated with uncontrolled hypertension among adult hypertensive patients.

 

Methods: hospital-based cross-sectional study was conducted. Systematic random sampling technique was used to select 396 hypertensive patients. Respondents were interviewed and their medical charts were reviewed using pretested structured questionnaire. Bivariable logistic regression was employed to examine the crude associations between the outcome variable and determinant variables. This was followed by multivariable logistic regression analysis using those variables with P-value ≤ 0.25 in the bivariable analysis.

 

Results: of the total 396 hypertensive patients the prevalence of uncontrolled hypertension was found to be 48.6%. One fourth (26.1%), 231(59.1%), 289(73.9%), and 151(38.6%) hypertensive respondents were non adherent to anti-hypertensive medication, physical exercise, low salt diet, and weight management respectively. Age ≥50 years old (AOR = 2.33, 95%CI: 1.25, 4.35), non-adherence to anti-hypertensive medication, (AOR = 1.82 95%CI: 1.08, 3.04), non-adherence to physical exercise (AOR = 1.79 95%CI: 1.13, 2.83), non-adherence to low-salt diet (AOR = 1.98 95%CI: 1.18,3.31), and non-adherence to weight management (AOR = 2.06, 95%CI: 1.31, 3.23) were significantly associated with uncontrolled hypertension.

 

Conclusion: the prevalence of uncontrolled hypertension was high. Older hypertensive patients, non-adherent to their medications, physical inactivity, non-adherent to low salt diet and non-adherent to weight management were more likely to have uncontrolled hypertension. Therefore, more effort should be dedicated to those identified modifiable risk factors to maximize blood pressure control.

 

 

Introduction    Down

Uncontrolled hypertension is a major public health challenge among hypertensive patients both in high and low-income countries [1-4]. Globally, nearly 1 billion individuals are living with uncontrolled hypertension [5] with a proportion of 66.8% and 61.6%, in developed and developing countries respectively [6]. In SSA, hypertension affects about 25% of the adult population and the prevalence of uncontrolled hypertension is around 70% [7]. Despite Ethiopia was signed to achieve sustainable development goal to reduce the premature death from non-communicable diseases by one third from 2016 to 2030 but the annual death of Ethiopia population due to non-communicable disease such as uncontrolled hypertension was still high (39%) [8, 9]. Few studies in Ethiopia reported that the prevalence of uncontrolled hypertension ranges from 37-63% [10-13]. Uncontrolled hypertension is a major risk factor for cardiovascular, renal, and cerebrovascular morbidities and mortalities [14-16]. Cardiovascular-related morbidity and mortality is the most common adverse outcome of uncontrolled hypertension, which is responsible for occurrence of stroke, ischemic heart disease, peripheral arterial disease, aortic aneurysm and congestive heart failure [17, 18]. Like many other chronic non-communicable diseases, the prevalence of uncontrolled hypertension in Ethiopia is rising due to increased risk factors [19]. Evidence had shown that age, sex, non-adherence to antihypertensive medications, non-adherence to low salt intake, physical inactivity, and the number of medications and presence of comorbid disease are among the major contributing factors to uncontrolled hypertension [20-23]. Identifying these determinant factors are important to reduce uncontrolled hypertension among hypertensive patients. Therefore, this study aims to assess the prevalence of uncontrolled hypertension and its associated factors among hypertensive patients on treatment follow-up at Mekelle public hospitals.

 

 

Methods Up    Down

Study area and period: the study was conducted at Mekelle public hospitals of the Tigray region, Northern Ethiopia. Mekelle is found at 783 Km away to the north from the capital city of Addis Ababa. In Mekelle city, there are two general public hospitals (Mekelle and Quiha hospital), one comprehensive specialized hospital Ayder comprehensive specialized hospital that provides service for more than 9 million populations in its catchment areas. The study was conducted from March to May 2019 at Mekelle public hospitals.

Study design: a hospital-based cross-sectional study was conducted.

Study population: the study population was all adult hypertensive patients who were under treatment follow-up at Mekelle public hospitals during the data collection period.

Inclusion and exclusion criteria: all adult (≥ 18 years old) hypertensive patients who were on anti-hypertensive treatment follow up for at least 6 months duration at the time of data collection were included in this study. However, unconscious hypertensive patients and pregnant mothers were excluded from this study.

Sample size determination: the sample size was calculated using a single population proportion formula by considering the following assumptions:

n = minimum sample size, P= estimated proportion of uncontrolled hypertension (57.1%) [24], d = the margin of sampling error (5%), and Za/2 = is the standard normal variable at 1-a% confidence level (95%=1.96) n = ((1.96)2 x 0.571(1-0.571)) / (0.05)2 = 377. By adding 5% of none response rate the final sample size was 396.

Sampling technique and procedure: from the two month report of 842 hypertensive patients who had attended follow up at Mekelle city public hospitals, the sample size was proportionally allocated to the three public hospitals. The first study subjects were randomly selected using the lottery method from each hypertension follow up unit of the three public hospitals. Finally, 396 hypertensive patients were selected using a systematic random sampling technique (K=2).

Data collection tools and instrument: a structured questionnaire was used to collect data from the selected study participants. Weight and height were measured to determine anthropometric data using the Seca weighing scale and stadiometer respectively. The tool contains four sections (socio-demographic, knowledge, behavioral and clinical) characteristics. The first part (socio-demographic) and the third (clinical characteristics) part of the tool were developed based on a review of different literatures Whereas Adherence to self-care activities (medication adherence, low salt diet, alcohol, and smoking) were measured using the H-SCALE [25].

Data collection procedure: five BSc nurses as data collectors and one senior BSc nurse as supervisor were recruited. The data were collected through face-to-face interviews and document reviews. Weight and height were measured with participants standing without shoes and wearing light clothing. Participants were standing upright with the head in the Frankfort plane for height measurement. Bodyweight (kg) was measured using an electronic scale to the nearest 10g, and standing height was measured using a wall stadiometer to the nearest 0.1cm. BMI was calculated as body weight (kg)/height (m2). The subjects were then classified into four WHO BMI cut-offs points. Underweight < 18.50, normal range 18.5-24.9, overweight 25-30, and obese ≥ 30s.

Study variables: the dependent variable is uncontrolled hypertension. The independent variables were socio-demographic characteristic (age, sex, marital status, religion, ethnicity, occupation, educational status, and residence), knowledge, behavioral characteristics (anti-hypertension medication adherence, low salt diet adherence, physical activity status, alcohol status, smoking status) and clinical characteristics (duration of hypertension, family history of hypertension, availability of BP cuff at home, BP monitoring at home or any else, co-morbidity, BMI status, number of anti-HTN drugs).

Operational definition

Adherent to low salt diet: twelve items were assessed practices related to eating a healthy diet, avoiding salt while cooking and eating, and avoiding foods high in salt content. Scores of 6 or better were considered adherent [25].

Diabetic mellitus: was defined as self-reported diabetes or the use of hypoglycemic agents or both.

Hypertension: was defined as those who had a documented diagnosis of hypertension (i.e. BP ≥ 140/90 mmHg) or those on anti-hypertensive agents.

Uncontrolled hypertension: is BP ≥ 140/90 mmHg using digital sphygmomanometer for adult hypertensive clients without diabetes mellitus and chronic kidney disease for at least three consecutive follow-up measurements and blood pressure ≥ 130/80 mmHg using digital sphygmomanometer for adult hypertensive clients with diabetes mellitus and chronic kidney disease for at least three consecutive follow-up measurements.

Physical activity: was assessed by 2 items. How many of the past 7 days did you do at least 30 minutes total physical activity? and how many of the past 7 days did you do a specific exercise activity (such as swimming, walking or biking) other than what you do around the house or as part of your work? Responses were summed (range, 0-14). Participants who scored ≥ 8 were coded as adhering to physical activity recommendations [25].

Weight management: ten items were used to assess activities undertaken in the past 30 days to manage weight through dietary practices and physical exercise. Response categories ranged from strongly disagree to strongly agree. Participants who agree or strongly agree with all 10 items (score ≥ 40) were considered to be following good weight management practices [25].

Data quality assurance: to assure the data quality training was given for the data collectors and supervisor. The weight measured by the digital scale was checked that it was at zero before each measurement. The questionnaire was translated into the local language (Tigrigna) and back to English. Five percent of the questionnaire was pre-tested before data collection to check logical sequence and consistency with desired objectives at Adigrat general hospital. After completing the pre-test they were asked about the clarity and relevance of each item and then based on comments and responses collected during the pre-test, adjustments were made to the questionnaire. The supervisor and principal investigator supervised the correct implementation of the data collection procedure, checked the completeness and logical consistency of the study tool daily. Besides this, the principal investigator carefully checked the entered data and thoroughly cleaned it before the start of the analysis.

Data processing and analysis: the data were checked for completeness, the response was coded and entered into Epi-data manager version 4.4.3.1 for windows and exported to SPSS version 23 for analysis. Descriptive statistics were computed and the result was summarized and presented by texts, tables, percentage, and frequency. Mean and the standard deviation were used for normally distributed data. Analysis using bivariable logistic regression model was made to see the association between the explanatory variables and the outcome variable. This was followed by multivariable logistic regression analysis using those variables with P-value ≤ 0.25 in the bivariable analysis and statistical significance was declared at P < 0.05. The Magnitude of the association was measured by using the adjusted odds ratio at a 95% confidence interval. Hosmer - Lemeshow test (0.741) was used to check the fitness model. Multi-Collinearity was checked using the variance inflation factor (< 1.16) and tolerance test (> 0.86).

 

 

Results Up    Down

Socio-demographic characteristics: in the study, 391 hypertensive respondents had participated with a response rate of 98.7%. The mean age of the study participants was 52.5 years (± 12.6) years which range from 24-89 years. Two hundred nineteen (56%) of the respondents were females, 215 (55%) were currently married, and two third (66.2%) of the respondents were orthodox Christian followers. One fourth (25.8%) were Colleague/university, and 316(80.8%) of the respondents were urban dwellers (Table 1). About half (47.3%) of the respondents had poor knowledge on hypertension.

Behavioral characteristics of respondents: of all respondents, one fourth (26.1%), 231(59.1%), 289(73.9%), and 151(38.6%) were non adherent to anti-hypertensive medication, physical exercise, low salt diet, and weight management respectively. About three fourth (76%) of the participants were adherent to alcohol abstinence (Table 2).

Health profile characteristics: the mean duration of hypertension was 5.39 years (± 3.76) years with a minimum of 1 year and a maximum of 25 years. Of all respondents, 75(19.2%) had comorbid disease. From those who had comorbid disease, 64(85.3%), and 10(13.3%) had DM and CVD respectively. Among the respondents, 52(13.3%) of the participants reported as they had family history of hypertension, and 318(81.3%) of the study subjects had been taking one type of drugs per day (Table 3).

Uncontrolled hypertension and associated factors: the magnitude of uncontrolled hypertension was found to 48.6 % (95%CI: 43.5-53.2%).In the bivariate logistic regression analysis, uncontrolled hypertension was significantly associated with nine variables. After adjustment for potential confounders older age, non-adherence to antihypertensive medication, non-adherence to physical exercise, non-adherence to dietary management and non-adherence to weight management were significantly and positively associated with uncontrolled hypertension among hypertensive patients. The odds of having uncontrolled hypertension was 2.3 times higher among the age of ≥ 50 years old compared to the age of < 50 years old (AOR = 2.33, 95%CI: 1.25, 4.35). Patients who were non-adherent to their prescribed antihypertensive drugs were two times (AOR = 1.82 95%CI: 1.08, 3.04) more likely to have uncontrolled hypertension as compared to those who were adherent to their antihypertensive drugs. Patients who didn´t adhere to physical exercise were 1.8 times more likely to have uncontrolled hypertension compared to those who adhered to physical exercise (AOR = 1.79 95%CI: 1.13, 2.83). Hypertensive patients who were non-adherent to Low-salt diet were two times more likely to develop uncontrolled hypertension compared to counterparts (AOR = 1.98 95%CI: 1.18, 3.31). Similarly, the odds of having uncontrolled hypertension were two times higher among non-adherent to weight management respondents compared to adherent respondents (AOR = 2.06, 95%CI: 1.31, 3.23) (Table 4).

 

 

Discussion Up    Down

This study revealed that 48.6% (95% CI: 43.5-53.2%) of hypertensive patients had uncontrolled hypertension. This finding is in line with studies done Lebanon (51.1%) [17], Malaysia (51.7%) [26], in Kwazulu-Natal (51%) [27], Jimma hospital Ethiopia (52.7%) [13], and Ayder comprehensive specialized hospital Ethiopia (51.2%) [20]. It was lower than studies done in Southern China (55.4%), Western India 63.6% [28], Panama (66.7%) [29], South Africa (75.5%) [30], Kinshasa (77.5%) [31], Cameroon (63.2%) [32], Zimbabwe (67.2%) [33], Ethiopia (63%) [12] and Zewditu Ethiopia (69.9%) [11], and Debre Tabor, Northwest Ethiopia (57.1%) [24]. However, the magnitude of uncontrolled hypertension in this study was higher than the finding of previous studies done in Israel (35.9%) [34], Sudan (36%) [35], and university of Gondar hospital Ethiopia (37%) [10]. This discrepancy could be due to the difference in drug adherence level, study population, degree of urbanization, differences in lifestyle behaviors, dietary habits, and environmental factors. In this study, age ≥ 50 years old was significantly and positively associated with uncontrolled hypertension compared to age < 50 years old. This finding also agrees with studies done in India [21], Morocco [36], Uganda [23], Angola [37], and Jimma Ethiopia [13]. This is due to aging causes loss of elasticity of vasculature, arterial stiffening, which in turn leads to peripheral vascular resistance and uncontrolled hypertension [38, 39]. Antihypertensive medication non-adherence was another factor significantly associated with uncontrolled hypertension. Hypertensive patients who were non-adherent to their prescribed antihypertensive drugs were nearly two times more likely to have uncontrolled hypertension as compared to those who were adherent to their prescribed antihypertensive drugs. This finding is supported by studies done in Ghana, University of Gondar hospital Ethiopia, and Ayder comprehensive specialized hospital Ethiopia [10, 20, 40]. Other studies done in Malaysia [41], Southern California [42], South Asia [43], Cameron [32], and South Africa [44] revealed that good adherence to antihypertensive medication was found a preventive factor to uncontrolled hypertension. This might be due to good adherence to antihypertensive medications is crucial to lower high blood pressure through vasodilatation, increase urination which reduces sodium and fluid in the body and blocking of the sympathetic activation of the heart [45]. Non-adherence to physical activity and non-adherent to weight management were statistically and positively associated with uncontrolled hypertension. Hypertensive patients who didn´t adhere to physical exercise were 1.8 times more likely to have uncontrolled hypertension compared to those who adhered to physical exercise. This finding is supported by the previous studies done in China, sub-Saharan countries, Debre Tabor Ethiopia and Ayder Ethiopia [1, 20, 22, 24]. This may be due to adherence to physical activity controls high blood pressure through enhancement of renal function (decreasing of cardiometabolic risk factors), and preventing weight gain [46, 47]. Similarly, Non-adherence to a low-salt diet was found significantly associated with uncontrolled hypertension. This is consistent with studies done in Macau China, Southern China, and Ethiopia [22, 24, 48]. This may be due to the effect of high-salt diets on the function of the renin-angiotensin system that causes fluid retention which increases the cardiac burden and uncontrolled hypertension [49].

 

 

Conclusion Up    Down

The prevalence of uncontrolled hypertension among adult hypertensive patients was high. This study revealed that nearly one out of two hypertensive patients had uncontrolled hypertension. Older age, non-adherence to antihypertensive medication, non-adherence to physical exercise, non-adherence to low salt diet and non-adherence to weight management were significantly associated with uncontrolled hypertension. Therefore, more effort should be dedicated to those identified modifiable risk factors to maximize blood pressure control.

What is known about this topic

  • Uncontrolled hypertension has become the commonest cause of cardiovascular, renal, and cerebrovascular morbidities and mortalities on the continent;
  • The prevalence of uncontrolled hypertension among adult hypertensive patients in Africa is a major public health problem;
  • The annual death of Ethiopia population due to non-communicable disease such as uncontrolled hypertension is still high (39%).

What this study adds

  • The prevalence of uncontrolled hypertension among adult hypertensive patients was considerably high;
  • Older age, non-adherence to antihypertensive medication, physical inactivity, non-adherence to low salt diet and non-adherence to weight management were significantly associated with uncontrolled hypertension;
  • Health care personnel should be concerned to those identified modifiable risk factors to maximize blood pressure control.

 

 

Competing interests Up    Down

The authors declare no competing interests.

 

 

Authors' contributions Up    Down

WA made substantial contributions to the conception, design of the work, methodology, analysis, data interpretation and wrote the final manuscript. BM, KG and TM, had equally contributed to the analysis and interpretation of the data. KZ, AH, DB and GM have made substantial contribution in reviewing overall the study in analysis, interpretation of data, have drafted the manuscript and substantively revised the work. All authors read and approved the final manuscript.

 

 

Acknowledgments Up    Down

We would like to thank all study participants and data collectors for their contribution to the success of this work.

 

 

Tables Up    Down

Table 1: socio-demographic characteristics of uncontrolled hypertension among adult hypertensive patients on follow up at Mekelle city public hospitals, Tigray, Northern Ethiopia, 2019

Table 2: behavioral characteristics of uncontrolled hypertension among adult hypertensive patients on follow up at Mekelle city public hospitals, Tigray, Northern Ethiopia, 2019

Table 3: health profile related characteristics of uncontrolled hypertension among adult hypertensive patients on follow up at Mekelle public hospitals, Tigray, Ethiopia, 2019

Table 4: logistic regression analysis of factors associated with uncontrolled hypertension among adult hypertensive patients on follow up at Mekelle city public hospitals, Tigray, Ethiopia, 2019

 

 

References Up    Down

  1. Dzudie A, Kengne AP, Muna WF, Ba H, Menanga A, Kouam CK et al. Prevalence, awareness, treatment and control of hypertension in a self-selected sub-Saharan African urban population: a cross-sectional study. BMJ open. 2012;2(4):e001217. PubMed | Google Scholar

  2. Iloh GU, Ofoedu JN, Njoku PU, Amadi AN, Godswill-Uko EU. Medication adherence and blood pressure control amongst adults with primary hypertension attending a tertiary hospital primary care clinic in Eastern Nigeria. African journal of primary health care & family medicine. 2013;5(1). Google Scholar

  3. Maryon-Davis A, Press V. Easing the pressure: tackling hypertension, a toolkit for developing a local strategy to tackle high blood pressure. Easing the pressure: tackling hypertension, a toolkit for developing a local strategy to tackle high blood pressure. 2005. Google Scholar

  4. Kingue S, Ngoe CN, Menanga AP, Jingi AM, Noubiap JJN, Fesuh B et al. Prevalence and risk factors of hypertension in urban areas of Cameroon: a nationwide population-based cross-sectional study. The Journal of Clinical Hypertension. 2015;17(10):819-2. PubMed | Google Scholar

  5. Mendis S, Puska P, Norrving B, WHO. Global atlas on cardiovascular disease prevention and control. Geneva: World Health Organization. 2011. Google Scholar

  6. Pereira M, Lunet N, Azevedo A, Barros H. Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries. Journal of hypertension. 2009;27(5):963-75. PubMed | Google Scholar

  7. Ataklte F, Erqou S, Kaptoge S, Taye B, Echouffo-Tcheugui JB, Kengne AP. Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis. Hypertension. 2015;65(2):291-8. PubMed | Google Scholar

  8. Assembly G. Sustainable Development goals (SDGs), transforming our world. The general assembly. 2015;2030. Google Scholar

  9. WHO. Noncommunicable diseases (NCD) country profiles. Risk of premature death due to NCDS in Ethiopia. 2018. Google Scholar

  10. Abdu O, Diro E, Abera Balcha MA, Ayanaw D, Getahun S, Mitiku T et al. Blood pressure control among hypertensive patients in University of Gondar Hospital, Northwest Ethiopia: a cross sectional study. Hypertension. 2017;140(1):6. Google Scholar

  11. Yazie D, Shibeshi W, Alebachew M, Berha A. Assessment of Blood Pressure Control among Hypertensive Patients in Zewditu Memorial Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study. J Bioanal Biomed. 2018;10:80-7. Google Scholar

  12. Berhe DF, Taxis K, Haaijer-Ruskamp FM, Mulugeta A, Mengistu YT, Mol PG. Hypertension treatment practices and its determinants among ambulatory patients: retrospective cohort study in Ethiopia. BMJ open. 2017;7(8):e015743. PubMed | Google Scholar

  13. Tesfaye B, Haile D, Lake B, Belachew T, Tesfaye T, Abera H. Uncontrolled hypertension and associated factors among adult hypertensive patients on follow-up at Jimma University Teaching and Specialized Hospital: cross-sectional study. Research Reports in Clinical Cardiology. 2017;8:21. Google Scholar

  14. Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, Jafar TH, Heerspink HJL, Mann JF et al. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. The Lancet. 2013;382(9889):339-52. PubMed | Google Scholar

  15. van de Vijver S, Akinyi H, Oti S, Olajide A, Agyemang C, Aboderin I et al. Status report on hypertension in Africa-Consultative review for the 6th Session of the African Union Conference of Ministers of Health on NCD´s. Pan African Medical Journal. 2014;16(1). PubMed | Google Scholar

  16. Psaty BM, Lumley T, Furberg CD, Schellenbaum G, Pahor M, Alderman MH et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. Jama. 2003;289(19):2534-44. PubMed | Google Scholar

  17. Iyer AS, Ahmed MI, Filippatos GS, Ekundayo OJ, Aban IB, Love TE et al. Uncontrolled hypertension and increased risk for incident heart failure in older adults with hypertension: findings from a propensity-matched prospective population study. Journal of the American Society of Hypertension. 2010;4(1):22-31. PubMed | Google Scholar

  18. Acelajado MC, Calhoun DA. Resistant hypertension, secondary hypertension, and hypertensive crises: diagnostic evaluation and treatment. Cardiology clinics. 2010;28(4):639-54. PubMed | Google Scholar

  19. Organization WH. Global status report on noncommunicable diseases 2014. World Health Organization. 2014. Google Scholar

  20. Gebremichael GB, Berhe KK, Zemichael TM. Uncontrolled hypertension and associated factors among adult hypertensive patients in Ayder comprehensive specialized hospital, Tigray, Ethiopia, 2018. BMC cardiovascular disorders. 2019;19(1):121. PubMed | Google Scholar

  21. Kanungo S, Mahapatra T, Bhowmik K, Saha J, Mahapatra S, Pal D et al. Patterns and predictors of undiagnosed and uncontrolled hypertension: observations from a poor-resource setting. Journal of human hypertension. 2017;31(1):56. PubMed | Google Scholar

  22. Yang L, Xu X, Yan J, Yu W, Tang X, Wu H et al. Analysis on associated factors of uncontrolled hypertension among elderly hypertensive patients in Southern China: a community-based, cross-sectional survey. BMC public health. 2014;14(1):903. PubMed | Google Scholar

  23. Musinguzi G, Van Geertruyden JP, Bastiaens H, Nuwaha F. Uncontrolled hypertension in Uganda: a comparative cross-sectional study. The Journal of Clinical Hypertension. 2015;17(1):63-9. PubMed | Google Scholar

  24. Teshome DF, Demssie AF, Zeleke BM. Determinants of blood pressure control amongst hypertensive patients in Northwest Ethiopia. PloS one. 2018;13(5):e0196535. PubMed | Google Scholar

  25. Warren-Findlow J, Seymour RB. Prevalence rates of hypertension self-care activities among African Americans. Journal of the National Medical Association. 2011;103(6):503-12. PubMed | Google Scholar

  26. Cheong A, Sazlina S-G, Tong S, Azah AS, Salmiah S. Poor blood pressure control and its associated factors among older people with hypertension: a cross-sectional study in six public primary care clinics in Malaysia. Malaysian family physician: the official journal of the Academy of Family Physicians of Malaysia. 2015;10(1):19. PubMed | Google Scholar

  27. Olowe OA, Ross AJ. Knowledge, adherence and control among patients with hypertension attending a peri-urban primary health care clinic, KwaZulu-Natal. African journal of primary health care & family medicine. 2017;9(1):1-5. PubMed | Google Scholar

  28. Choudhary R, Sharma SM, Kumari V, Gautam D. Awareness, treatment adherence and risk predictors of uncontrolled hypertension at a tertiary care teaching hospital in Western India. Indian Heart J. 2016;68(Suppl 2):S251. PubMed | Google Scholar

  29. Chen Camano RR. Uncontrolled Hypertension and Associated Factors in Hypertensive Patients at the Primary Healthcare Center Luis H. Moreno, Panama: A Feasibility Study. 2013. Google Scholar

  30. Adeniyi OV, Yogeswaran P, Longo-Mbenza B, Ter Goon D. Uncontrolled hypertension and its determinants in patients with concomitant type 2 diabetes mellitus (T2DM) in rural South Africa. PLoS One. 2016;11(3):e0150033. PubMed | Google Scholar

  31. Kika T, Kintoki E, M´Buyamba-Kabangu J, Lepira F, Makulo J, Sumaili E et al. Uncontrolled hypertension among patients managed in primary healthcare facilities in Kinshasa, Democratic Republic of the Congo. Cardiovascular journal of Africa. 2016;27(6):361. PubMed | Google Scholar

  32. Menanga A, Edie S, Nkoke C, Boombhi J, Musa AJ, Mfeukeu LK et al. Factors associated with blood pressure control amongst adults with hypertension in Yaounde, Cameroon: a cross-sectional study. Cardiovascular diagnosis and therapy. 2016;6(5):439. PubMed | Google Scholar

  33. Goverwa TP, Masuka N, Tshimanga M, Gombe NT, Takundwa L, Bangure D et al. Uncontrolled hypertension among hypertensive patients on treatment in Lupane District, Zimbabwe, 2012. BMC research notes. 2014;7(1):703. PubMed | Google Scholar

  34. Weitzman D, Chodick G, Shalev V, Grossman C, Grossman E. Prevalence and factors associated with resistant hypertension in a large health maintenance organization in Israel. Hypertension. 2014;64(3):501-7. PubMed | Google Scholar

  35. Babiker FA, Elkhalifa Lamia A, Moukhyer ME. Awareness of hypertension and factors associated with uncontrolled hypertension in Sudanese adults. Cardiovascular journal of Africa. 2013;24(6):208. PubMed | Google Scholar

  36. Berraho M, El Achhab Y, Benslimane A, Rhazi KE, Chikri M, Nejjari C. Hypertension and type 2 diabetes: a cross-sectional study in Morocco (EPIDIAM Study). Pan African Medical Journal. 2012;11(1). PubMed | Google Scholar

  37. Pires JE, Sebastião YV, Langa AJ, Nery SV. Hypertension in Northern Angola: prevalence, associated factors, awareness, treatment and control. BMC public health. 2013;13(1):90. PubMed | Google Scholar

  38. Mutua EM, Gitonga MM, Mbuthia B, Muiruri N, Cheptum JJ, Maingi T. Level of blood pressure control among hypertensive patients on follow-up in a Regional Referral Hospital in Central Kenya. The Pan African Medical Journal. 2014;18. PubMed | Google Scholar

  39. Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. The journal of clinical hypertension. 2014;16(1):14-26. PubMed | Google Scholar

  40. Sarfo FS, Mobula LM, Burnham G, Ansong D, Plange-Rhule J, Sarfo-Kantanka O et al. Factors associated with uncontrolled blood pressure among Ghanaians: evidence from a multicenter hospital-based study. PloS one. 2018;13(3):e0193494. PubMed | Google Scholar

  41. Ramli A, Ahmad NS, Paraidathathu T. Medication adherence among hypertensive patients of primary health clinics in Malaysia. Patient preference and adherence. 2012;6:613. PubMed | Google Scholar

  42. Elperin DT, Pelter MA, Deamer RL, Burchette RJ. A large cohort study evaluating risk factors associated with uncontrolled hypertension. The Journal of Clinical Hypertension. 2014;16(2):149-54. PubMed | Google Scholar

  43. Jafar TH, Gandhi M, Jehan I, Naheed A, de Silva HA, Shahab H et al. Determinants of uncontrolled hypertension in rural communities in South Asia-Bangladesh, Pakistan, and Sri Lanka. American journal of hypertension. 2018;31(11):1205-14. PubMed | Google Scholar

  44. Duncan P, Howe L, Manakusa Z, Purdy S. Determinants of blood pressure control in rural KwaZulu-Natal, South Africa. South African Family Practice. 2014;56(6):297-304. PubMed | Google Scholar

  45. Bell K, Twiggs J, Olin BR, Date IR. Hypertension: the silent killer: updated JNC-8 guideline recommendations. Alabama Pharmacy Association. 2015;334:4222. PubMed | Google Scholar

  46. Lee D-c, Sui X, Church TS, Lavie CJ, Jackson AS, Blair SN. Changes in fitness and fatness on the development of cardiovascular disease risk factors: hypertension, metabolic syndrome, and hypercholesterolemia. Journal of the American College of Cardiology. 2012;59(7):665-72. PubMed | Google Scholar

  47. Diaz KM, Shimbo D. Physical activity and the prevention of hypertension. Current hypertension reports. 2013;15(6):659-68. PubMed | Google Scholar

  48. Ke L, Ho J, Feng J, Mpofu E, Dibley MJ, Li Y et al. Prevalence, awareness, treatment and control of hypertension in Macau: results from a cross-sectional epidemiological study in Macau, China. American journal of hypertension. 2014;28(2):159-65. PubMed | Google Scholar

  49. Drenjancevic-Peric I, Jelakovic B, Lombard JH, Kunert MP, Kibel A, Gros M. High-salt diet and hypertension: focus on the renin-angiotensin system. Kidney and blood pressure Research. 2011;34(1):1-11. PubMed | Google Scholar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Adherence to antiretroviral therapy among people living with HIV attending medication-assisted treatment clinics in Dar es Salaam, Tanzania: a cross-sectional study

The need for active and integrated involvement of the community and health professionals in the prevention and control of dengue hemorrhagic fever in Indonesia

Risk factors for breast cancer among women in Freetown, Sierra Leone, 2017: a case-control study

Épidémiologie et facteurs de risque de la prématurité dans le nord-ouest algérien

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