Department of Biotechnology, University of the Western Cape, 7535, Bellville, Cape Town, South Africa.
Department of Family Medicine, Center for Teaching and Learning, Piet Retief Hospital, Mkhondo, South Africa.
BMC Public Health. 2020 Jul 6;20(1):1069. doi: 10.1186/s12889-020-09174-7.
Achieving the blood pressure treatment target in individuals with hypertension is a serious global health challenge. Furthermore, the actual burden of uncontrolled hypertension is poorly understood, especially in the developing countries. Therefore, this study comprehensively examined the prevalence and factors associated with uncontrolled hypertension in individuals receiving care at the primary healthcare facilities in the rural areas of Mkhondo Municipality in the Mpumalanga Province, South Africa.
In this cross-sectional study, 329 individuals attending care for hypertension were recruited from January 2019 to June 2019 at three primary healthcare centres, namely, Piet Retief hospital, Mkhondo town clinic and Thandukukhanya community health centre. Uncontrolled hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg in accordance with the South African Hypertension Society guideline (2014). Multiple logistic regression (Forward LR method) analysis was used to identify the significant determinants of uncontrolled hypertension.
The majority of the participants were 55 years old and above (69.0%), Zulus (81.2%), non-smokers (84.19%) and had been diagnosed with hypertension for more than a year prior to the study (72.64%). The overall prevalence of uncontrolled hypertension was 56.83% (n = 187) with no significant difference between sexes, 57.38% male versus 56.88% female, respectively. In the multiple logistic regression model analysis after adjusting for confounding variables, obesity (AOR = 2.90; 95% CI 1.66-5.05), physical activity (AOR = 4.79; 95% CI 2.15-10.65) and HDL-C (AOR = 5.66; 95% CI 3.33-9.60) were the significant and independent determinants of uncontrolled hypertension in the cohort.
The high prevalence of uncontrolled hypertension in the study setting can be largely attributed to obesity, physical activity and dyslipidaemia. Treatment will require the collaborative efforts of individuals, clinicians and health authorities. All these determinants should be addressed decisively so as to achieve the treatment blood pressure targets in the study population.
在高血压患者中实现降压治疗目标是一项严峻的全球健康挑战。此外，人们对未得到控制的高血压的实际负担知之甚少，特别是在发展中国家。因此，本研究全面调查了南非姆普马兰加省姆赫龙多市农村初级保健设施接受治疗的个体中未得到控制的高血压的流行情况及其相关因素。
在这项横断面研究中，于 2019 年 1 月至 6 月期间，在三个初级保健中心（皮埃特罗特夫医院、姆赫龙多镇诊所和坦杜库库尼亚社区卫生中心）招募了 329 名高血压就诊者。根据南非高血压学会指南（2014 年），将收缩压≥140mmHg 和/或舒张压≥90mmHg 定义为未得到控制的高血压。采用多变量逻辑回归（向前 LR 法）分析确定未得到控制的高血压的显著决定因素。
大多数参与者年龄在 55 岁及以上（69.0%），祖鲁人（81.2%），不吸烟者（84.19%），并且在研究前被诊断患有高血压超过一年（72.64%）。未得到控制的高血压的总体患病率为 56.83%（n=187），男女性别之间无显著差异，分别为 57.38%男性和 56.88%女性。在调整混杂因素后的多变量逻辑回归模型分析中，肥胖（AOR=2.90；95%CI 1.66-5.05）、身体活动（AOR=4.79；95%CI 2.15-10.65）和高密度脂蛋白胆固醇（AOR=5.66；95%CI 3.33-9.60）是队列中未得到控制的高血压的显著独立决定因素。
在研究环境中，未得到控制的高血压的高患病率主要归因于肥胖、身体活动和血脂异常。治疗需要个人、临床医生和卫生当局的共同努力。应该果断地解决所有这些决定因素，以实现研究人群的治疗血压目标。
