Patients Factors and Medication Use Practices Affecting Blood Pressure Control Among Hypertensive Patients Attending a Secondary Health Facility in Ilorin, North Central Nigeria
,
Abstract
Background: The increase in the prevalence and economic burden of hypertension has been attributable to the poor knowledge of disease management and practices. The proper practices would enhance adequate control of blood pressure. This study aimed to determine patients’ characteristics and medication use practices that influence their blood pressure control. Methods: The study was conducted on 202 hypertensive patients attending a Civil Service Hospital, Ilorin, Nigeria. A validated interviewer-administered questionnaire was used for patients’ data collection. The collected data were analyzed in SPSS v. 20. Descriptive statistics were used to analyze numerical and categorical variables, and the results are presented in text, percentages, and charts. The Chi-square and logistic regression tests were used as inferential analysis to determine the relationship between categorical variables. P values less than 0.05 were considered significant. Results: The Mean±SD age of the patients was 59.1±13 years, with the highest frequency of hypertension occurring among patients aged 46-60 years (44.6%). Women were more affected (120; 69.4%) than men (82; 40.6%). The majority of the patients (132; 65.3%) were low- to moderate-income earners. Educational status, frequency of missed doses, and presence of comorbidity significantly influenced blood pressure control (P= 0.017, P= 0.039, and P= 0.019, respectively). Knowledge of the timely use of drugs and regular clinic visits significantly affected blood pressure control, too (P=0.014, and P=0.043, respectively). The blood pressure control among patients was fair despite the poor level of medication use knowledge/practices. Conclusion: Blood pressure control is influenced by educational status and the presence of comorbid conditions. Timely medication use and regular clinic visits were strong predictors of blood pressure control. Multiple drug use was the most common hindrance to the timely use of medication. Background: The increase in the prevalence and economic burden of hypertension has been attributable to the poor knowledge of disease management and practices. The proper practices would enhance adequate control of blood pressure. This study aimed to determine patients’ characteristics and medication use practices that influence their blood pressure control. Methods: The study was conducted on 202 hypertensive patients attending a Civil Service Hospital, Ilorin, Nigeria. A validated interviewer-administered questionnaire was used for patients’ data collection. The collected data were analyzed in SPSS v. 20. Descriptive statistics were used to analyze numerical and categorical variables, and the results are presented in text, percentages, and charts. The Chi-square and logistic regression tests were used as inferential analysis to determine the relationship between categorical variables. P values less than 0.05 were considered significant. Results: The Mean±SD age of the patients was 59.1±13 years, with the highest frequency of hypertension occurring among patients aged 46-60 years (44.6%). Women were more affected (120; 69.4%) than men (82; 40.6%). The majority of the patients (132; 65.3%) were low- to moderate income earners. Educational status, frequency of missed doses, and presence of comorbidity significantly influenced blood pressure control (P= 0.017, P= 0.039, and P= 0.019, respectively). Knowledge of the timely use of drugs and regular clinic visits significantly affected blood pressure control, too (P=0.014, and P=0.043, respectively). The blood pressure control among patients was fair despite the poor level of medication use knowledge/practices. Conclusion: Blood pressure control is influenced by educational status and the presence of comorbid conditions. Timely medication use and regular clinic visits were strong predictors of blood pressure control. Multiple drug use was the most common hindrance to the timely use of medication.
[1] Gupta R, Xavier D. Hypertension: The most important non communicable disease risk factor in India. Indian Heart J. 2018; 70(4):565-72. [DOI:10.1016/j.ihj.2018.02.003] [PMID] [PMCID]
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[5] United Nations Department of Economic and Social Affairs, Population Division (2017). World Population Prospects: The 2017 Revision, (I): Comprehensive Tables (ST/ESA/SER.A/399). Available at: https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2020/Ja/un_2017_world_population_prospects-2017_revision_databooklet.pdf.
[6] Ogah OS, Okpechi I, Chukwuonye II, Akinyemi JO, Onwubere BJ, Falase AO, et al. Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review. World J Cardiol. 2012; 4(12):327-40.[DOI:10.4330/wjc.v4.i12.327][PMID] [PMCID]
[7] Adeloye D, Basquill C, Aderemi AV, Thompson JY, Obi FA. An estimate of the prevalence of hypertension in Nigeria: A systematic review and meta-analysis. J Hypertens. 2015; 33(2):230-42.[DOI:10.1097/HJH.0000000000000413] [PMID]
[8] Gupta S, Dhamija JP, Mohan I, Gupta R. Qualitative study of barriers to adherence to antihypertensive medication among rural women in India. Int J Hypertens. 2019; 2019. [DOI:10.1155/2019/5749648] [PMID] [PMCID]
[9] Gakidou E, Afshin A, Abajobir AA, Abate KH, Abbafati C, Abbas KM, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390(10100):1345-422. https://www.sciencedirect.com/science/article/pii/S0140673617323668
[10] Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and lowincome countries. JAMA. 2013; 310(9):959-68. [DOI:10.1001/jama.2013.184182] [PMID]
[11] Adebolu FA, Naidoo M. Blood pressure control amongst patients living with hypertension presenting to an urban district hospital outpatient clinic in Kwazulu-Natal. Afr J Prim Health Care Fam Med. 2014; 6(1):1-6. [DOI:10.4102/phcfm.v6i1.572] [PMID] [PMCID]
[12] Britten N. Patients' ideas about medicines: a qualitative study in a general practice population. Br J Gen Pract. 1994; 44(387):465-8. https://bjgp.org/content/44/387/465.short
[13] Steiner A, Vetter W. Patient compliance-possibilities for improvement. Praxis. 1995; 84(3):58-62. [PMID]
[14] Roter DL, Hall JA, Merisca R, Nordstrom B, Cretin D, Svarstad B. Effectiveness of interventions to improve patient compliance: A meta-analysis. Med Care. 1998:1138-61.[DOI:10.1097/00005650-199808000-00004] [PMID]
[15] Chua SS, Kok LC, Yusof FA, Tang GH, Lee SW, Efendie B, et al. Pharmaceutical care issues identified by pharmacists in patients with diabetes, hypertension or hyperlipidaemia in primary care settings. BMC Health Serv Res. 2012; 12(1):1-0. [DOI:10.1186] [PMID] [PMCID]
[16] The PCNE Classification Pharmaceutical. Care Network Europe (PCNE) Foundation: PCNE classification for drug related problems; 2006. https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf
[17] Cuschieri S, Vassallo J, Calleja N, Pace N, Mamo J. The effects of socioeconomic determinants on hypertension in a cardiometabolic at-risk European country. Int J Hypertens. 2017; 2017. [DOI:10.1155/2017/7107385] [PMID] [PMCID]
[18] Araoye MO. Research methodology with statistics for health and social sciences. Ilorin: Nathadex Publisher. 2004; 115(9):25-120. https://www.scienceopen.com/document?vid=1a3f0be5-5f8d-47e4-8037-83d25e-
109ca7
[19] Ajayi IO, Sowemimo IO, Akpa OM, Ossai NE. Prevalence of hypertension and associated factors among residents of Ibadan-North Local Government Area of Nigeria. Nig J Cardiol. 2016; 13(1):67-75. [DOI:10.4103/0189-7969.165168]
[20] James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311(5):507-20. [DOI:10.1001/jama.2013.284427] [PMID]
[21] Chimberengwa PT, Naidoo M, cooperative inquiry group. Knowledge, attitudes and practices related to hypertension among residents of a disadvantaged rural community in southern Zimbabwe. PloS One. 2019; 14(6):e0215500. [DOI:10.1371/journa] [PMID] [PMCID]
[22] Himmelfarb CR, Commodore-Mensah Y, Hill MN. Expanding the role of nurses to improve hypertension care and control globally. Ann Glob Health. 2016; 82(2):243-53. [DOI:10.1016/j.aogh.2016.02.003] [PMID]
[23] Oliveros E, Patel H, Kyung S, Fugar S, Goldberg A, Madan N, et al. Hypertension in older adults: Assessment, management, and challenges. Clin Cardiol. 2020; 43(2):99-107. [DOI:10.1002/clc.23303] [PMID] [PMCID]
[24] Rahman M, Williams G, Al Mamun A. Gender differences in hypertension awareness, anti hypertensive use and blood pressure control in Bangladeshi adults: findings from a national cross-sectional survey. J
Health Popul Nutr. 2017; 36(1):1-3. [DOI:10.1186/s41043-017-0101-5] [PMID] [PMCID]
[25] Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019; 74(10):1376-414. https://www.jacc.org/doi/abs/10.1016/j.jacc.2019.03.009
[26] Thinyane KH, Mothebe T, Sooro M, Namole LD, Cooper V. An observational study of hypertension treatment and patient outcomes in a primary care setting. Pan Afr Med J. 2015; 20:424 [DOI:10.11604/pamj.2015.20.424.5040] [PMID] [PMCID]
[27] Kazzam E, Ghurbana BA, Obineche EN, Nicholls MG. Hypertension: Still an important cause of heart failure? J Hum Hypertens. 2005; 19(4):267-75. [DOI:10.1038/sj.jhh.1001820] [PMID]
[28] Choi HY, Im Jung Oh JA, Lim J, Kim YS, Jeon TH, Cheong YS, et al. Factors affecting adherence to antihypertensive medication. Korean J Fam Med. 2018; 39(6):325-32. [DOI:10.4082/kjfm.17.0041] [PMID] [PMCID]
[29] Fenerty SD, West C, Davis SA, Kaplan SG, Feldman SR. The effect of reminder systems on patients’ adherence to treatment. Patient Prefer Adherence. 2012; 6:127-35. [DOI:10.2147/PPA.S26314] [PMID] [PMCID]
[30] McNaughton CD, Self WH, Zhu Y, Janke AT, Storrow AB, Levy P. Incidence of hypertension-related emergency department visits in the United States, 2006 to 2012. Am J Cardiol. 2015; 116(11):1717-23. [DOI:10.1016/j.amjcard.2015.09.007] [PMID] [PMCID]
[31] Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. NEJM. 2008; 358(18):1887-98. [DOI:10.1056/NEJMoa0801369] [PMID]
[32] Zhang K, Eastwood D, Ertl K, Whittle J. Educational attainment does not modify the effect of educational interventions on blood pressure control: A secondary analysis of data from a randomised trial. JRSM Open.2016; 7(8):2054270416654359.[DOI:10.1177/2054270416654359] [PMID] [PMCID]
[33] National Population Commission (2006). [Internet] 2006 [Updated 16 Feb 2020]. Available from: https://nationalpopulation.gov.ng/
[34] Kayima J, Wanyenze RK, Katamba A, Leontsini E, Nuwaha F. Hypertension awareness, treatment and control in Africa: a systematic review. BMC Cardiovasc Disord. 2013; 13(1):1-1.[DOI:10.1186/1471-2261-13-54] [PMID] [PMCID]
[35] Anstey DE, Christian J, Shimbo D. Income inequality and hypertension control. J Am Heart Assoc. 2019; 8(15):e013636 . [DOI:10.1161/JAHA.119.013636]
[36] Lee HY, Shin J, Kim GH, Park S, Ihm SH, Kim HC, et al. 2018 Korean Society of Hypertension Guidelines for the management of hypertension: Part II-diagnosis and treatment of hypertension. Clin Hypertens. 2019; 25(1):1-24. [DOI:10.1186/s40885-019-0124-x] [PMID] [PMCID]
[37] Okai DE, Manu A, Amoah EM, Laar A, Akamah J, Torpey K. Patient-level factors influencing hypertension control in adults in Accra, Ghana. BMC Cardiovasc Disord. 2020; 20(1):1-7. [DOI:10.1186/s12872-020-01370-y] [PMID] [PMCID]
[2] Rani R, Mengi V, Gupta RK, Sharma HK. Hypertension and its risk factors–a cross sectional study in an urban population of a north Indian District. PJ Public Health Res. 2015; 5(3):67-72. [Doi:10.5923/j.phr.20150503.01]
[3] World Health Organization (WHO). Bulletin of the World Health Organization. Geneva: World Health Organization; 2013. [DOI:10.2471/BLT.13.020413] [PMID] [PMCID]
[4] Akinlua JT, Meakin R, Umar AM, Freemantle N. Current prevalence pattern of hypertension in Nigeria: A systematic review. PloS One. 2015; 10(10):e0140021. [DOI:10.1371/journal.pone.0140021] [PMID] [PMCID]
[5] United Nations Department of Economic and Social Affairs, Population Division (2017). World Population Prospects: The 2017 Revision, (I): Comprehensive Tables (ST/ESA/SER.A/399). Available at: https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2020/Ja/un_2017_world_population_prospects-2017_revision_databooklet.pdf.
[6] Ogah OS, Okpechi I, Chukwuonye II, Akinyemi JO, Onwubere BJ, Falase AO, et al. Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review. World J Cardiol. 2012; 4(12):327-40.[DOI:10.4330/wjc.v4.i12.327][PMID] [PMCID]
[7] Adeloye D, Basquill C, Aderemi AV, Thompson JY, Obi FA. An estimate of the prevalence of hypertension in Nigeria: A systematic review and meta-analysis. J Hypertens. 2015; 33(2):230-42.[DOI:10.1097/HJH.0000000000000413] [PMID]
[8] Gupta S, Dhamija JP, Mohan I, Gupta R. Qualitative study of barriers to adherence to antihypertensive medication among rural women in India. Int J Hypertens. 2019; 2019. [DOI:10.1155/2019/5749648] [PMID] [PMCID]
[9] Gakidou E, Afshin A, Abajobir AA, Abate KH, Abbafati C, Abbas KM, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390(10100):1345-422. https://www.sciencedirect.com/science/article/pii/S0140673617323668
[10] Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and lowincome countries. JAMA. 2013; 310(9):959-68. [DOI:10.1001/jama.2013.184182] [PMID]
[11] Adebolu FA, Naidoo M. Blood pressure control amongst patients living with hypertension presenting to an urban district hospital outpatient clinic in Kwazulu-Natal. Afr J Prim Health Care Fam Med. 2014; 6(1):1-6. [DOI:10.4102/phcfm.v6i1.572] [PMID] [PMCID]
[12] Britten N. Patients' ideas about medicines: a qualitative study in a general practice population. Br J Gen Pract. 1994; 44(387):465-8. https://bjgp.org/content/44/387/465.short
[13] Steiner A, Vetter W. Patient compliance-possibilities for improvement. Praxis. 1995; 84(3):58-62. [PMID]
[14] Roter DL, Hall JA, Merisca R, Nordstrom B, Cretin D, Svarstad B. Effectiveness of interventions to improve patient compliance: A meta-analysis. Med Care. 1998:1138-61.[DOI:10.1097/00005650-199808000-00004] [PMID]
[15] Chua SS, Kok LC, Yusof FA, Tang GH, Lee SW, Efendie B, et al. Pharmaceutical care issues identified by pharmacists in patients with diabetes, hypertension or hyperlipidaemia in primary care settings. BMC Health Serv Res. 2012; 12(1):1-0. [DOI:10.1186] [PMID] [PMCID]
[16] The PCNE Classification Pharmaceutical. Care Network Europe (PCNE) Foundation: PCNE classification for drug related problems; 2006. https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf
[17] Cuschieri S, Vassallo J, Calleja N, Pace N, Mamo J. The effects of socioeconomic determinants on hypertension in a cardiometabolic at-risk European country. Int J Hypertens. 2017; 2017. [DOI:10.1155/2017/7107385] [PMID] [PMCID]
[18] Araoye MO. Research methodology with statistics for health and social sciences. Ilorin: Nathadex Publisher. 2004; 115(9):25-120. https://www.scienceopen.com/document?vid=1a3f0be5-5f8d-47e4-8037-83d25e-
109ca7
[19] Ajayi IO, Sowemimo IO, Akpa OM, Ossai NE. Prevalence of hypertension and associated factors among residents of Ibadan-North Local Government Area of Nigeria. Nig J Cardiol. 2016; 13(1):67-75. [DOI:10.4103/0189-7969.165168]
[20] James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311(5):507-20. [DOI:10.1001/jama.2013.284427] [PMID]
[21] Chimberengwa PT, Naidoo M, cooperative inquiry group. Knowledge, attitudes and practices related to hypertension among residents of a disadvantaged rural community in southern Zimbabwe. PloS One. 2019; 14(6):e0215500. [DOI:10.1371/journa] [PMID] [PMCID]
[22] Himmelfarb CR, Commodore-Mensah Y, Hill MN. Expanding the role of nurses to improve hypertension care and control globally. Ann Glob Health. 2016; 82(2):243-53. [DOI:10.1016/j.aogh.2016.02.003] [PMID]
[23] Oliveros E, Patel H, Kyung S, Fugar S, Goldberg A, Madan N, et al. Hypertension in older adults: Assessment, management, and challenges. Clin Cardiol. 2020; 43(2):99-107. [DOI:10.1002/clc.23303] [PMID] [PMCID]
[24] Rahman M, Williams G, Al Mamun A. Gender differences in hypertension awareness, anti hypertensive use and blood pressure control in Bangladeshi adults: findings from a national cross-sectional survey. J
Health Popul Nutr. 2017; 36(1):1-3. [DOI:10.1186/s41043-017-0101-5] [PMID] [PMCID]
[25] Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019; 74(10):1376-414. https://www.jacc.org/doi/abs/10.1016/j.jacc.2019.03.009
[26] Thinyane KH, Mothebe T, Sooro M, Namole LD, Cooper V. An observational study of hypertension treatment and patient outcomes in a primary care setting. Pan Afr Med J. 2015; 20:424 [DOI:10.11604/pamj.2015.20.424.5040] [PMID] [PMCID]
[27] Kazzam E, Ghurbana BA, Obineche EN, Nicholls MG. Hypertension: Still an important cause of heart failure? J Hum Hypertens. 2005; 19(4):267-75. [DOI:10.1038/sj.jhh.1001820] [PMID]
[28] Choi HY, Im Jung Oh JA, Lim J, Kim YS, Jeon TH, Cheong YS, et al. Factors affecting adherence to antihypertensive medication. Korean J Fam Med. 2018; 39(6):325-32. [DOI:10.4082/kjfm.17.0041] [PMID] [PMCID]
[29] Fenerty SD, West C, Davis SA, Kaplan SG, Feldman SR. The effect of reminder systems on patients’ adherence to treatment. Patient Prefer Adherence. 2012; 6:127-35. [DOI:10.2147/PPA.S26314] [PMID] [PMCID]
[30] McNaughton CD, Self WH, Zhu Y, Janke AT, Storrow AB, Levy P. Incidence of hypertension-related emergency department visits in the United States, 2006 to 2012. Am J Cardiol. 2015; 116(11):1717-23. [DOI:10.1016/j.amjcard.2015.09.007] [PMID] [PMCID]
[31] Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. NEJM. 2008; 358(18):1887-98. [DOI:10.1056/NEJMoa0801369] [PMID]
[32] Zhang K, Eastwood D, Ertl K, Whittle J. Educational attainment does not modify the effect of educational interventions on blood pressure control: A secondary analysis of data from a randomised trial. JRSM Open.2016; 7(8):2054270416654359.[DOI:10.1177/2054270416654359] [PMID] [PMCID]
[33] National Population Commission (2006). [Internet] 2006 [Updated 16 Feb 2020]. Available from: https://nationalpopulation.gov.ng/
[34] Kayima J, Wanyenze RK, Katamba A, Leontsini E, Nuwaha F. Hypertension awareness, treatment and control in Africa: a systematic review. BMC Cardiovasc Disord. 2013; 13(1):1-1.[DOI:10.1186/1471-2261-13-54] [PMID] [PMCID]
[35] Anstey DE, Christian J, Shimbo D. Income inequality and hypertension control. J Am Heart Assoc. 2019; 8(15):e013636 . [DOI:10.1161/JAHA.119.013636]
[36] Lee HY, Shin J, Kim GH, Park S, Ihm SH, Kim HC, et al. 2018 Korean Society of Hypertension Guidelines for the management of hypertension: Part II-diagnosis and treatment of hypertension. Clin Hypertens. 2019; 25(1):1-24. [DOI:10.1186/s40885-019-0124-x] [PMID] [PMCID]
[37] Okai DE, Manu A, Amoah EM, Laar A, Akamah J, Torpey K. Patient-level factors influencing hypertension control in adults in Accra, Ghana. BMC Cardiovasc Disord. 2020; 20(1):1-7. [DOI:10.1186/s12872-020-01370-y] [PMID] [PMCID]
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How to Cite
1.
Giwa A, Jamiu M, Giwa H, Abdulazeez I. Patients Factors and Medication Use Practices Affecting Blood Pressure Control Among Hypertensive Patients Attending a Secondary Health Facility in Ilorin, North Central Nigeria. JPPM. 2021;7(3/4):82-92.
