Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
PLoS One. 2018 Mar 19;13(3):e0193494. doi: 10.1371/journal.pone.0193494. eCollection 2018.
The 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.
To 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.
A 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.
The 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).
We 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.
中低收入国家（LMICs）的未控制高血压负担沉重，这些地区心血管疾病和慢性肾衰竭的风险增加。
评估与加纳正在进行的多中心流行病学研究中涉及的高血压患者的未控制血压控制相关的因素，该研究旨在改善高血压治疗的可及性。
横断面研究涉及 2870 名患有高血压或糖尿病的参与者，这些参与者在加纳的 5 家医院（2 家三级医院、2 家地区医院和 1 家农村医院）就诊。收集人口统计学、病史、生活方式因素、抗高血压药物和治疗依从性的数据。使用 Hill-Bone 高血压治疗依从性量表的 14 项版本评估 3 个领域的治疗依从性，即药物治疗、盐摄入量和诊所预约。还进行了高血压知识、态度和实践、抗高血压药物来源以及获取这些药物的挑战的问卷调查。在入组时为每位患者测量血压、体重和身高。使用多变量逻辑回归模型评估与未控制血压（>140/90mmHg）相关的因素。
研究参与者的平均年龄±标准差为 58.9±16.6 岁，女性占优势（76.8%）。在研究参与者中，有 1213 名（42.3%）研究参与者的血压测量值得到控制。调整后的比值比（95%CI）与未控制血压相关的因素包括在三级医疗机构接受治疗：2.47（1.57-3.87）、高血压诊断时间较长：1.01（1.00-1.03）、治疗依从性差：1.21（1.09-1.35），Hill-Bone 量表每增加 5 分、报告获取抗高血压药物困难：1.24（1.02-1.49）和开处的抗高血压药物数量：1.32（1.21-1.44）。
我们发现，在加纳公共医疗机构就诊的高血压患者中，血压控制不佳的比例很高。应解决与血压控制不佳相关的系统和个体层面的因素，以改善加纳人的高血压管理。
