Department of Public Health, Faculty of Health Science, University of Liverpool, Liverpool, United Kingdom; and, Department of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
S Afr Fam Pract (2004). 2022 Mar 28;64(1):e1-e9. doi: 10.4102/safp.v64i1.5403.
Hypertension is a major cause of morbidity and mortality and its control has important clinical and socio-economic benefits to the family and community. Unfortunately, the extent of blood pressure (BP) control and its potential predictors in hypertensive patients in many rural communities in low-resource settings are largely unknown. This study assessed the extent of uncontrolled BP and its predictors amongst hypertensive patients accessing primary health care in a rural community in South Africa.
This cross-sectional study included 422 randomly selected hypertensive patients. Demographic and clinical data were collected using structured face-to-face questionnaire supplemented by respondents' clinical records.
Obesity plus overweight (n = 286, 67.8%) and diabetes (n = 228, 54.0%) were the most common comorbidities. Treatment adherence was achieved in only 36.3% and BP was controlled to target in 50.2% of the respondents. Significant predictors of uncontrolled BP were poor treatment adherence (odds ratio [OR] = 15.88, 95% confidence interval [CI] = 8.96, 28.14, p 0.001), obesity compared with normal weight and overweight (OR = 3.75, 95% CI = 2.17, 6.46, p 0.001) and being a diabetic (OR = 2.83, 95% CI = 1.74, 4.61, p 0.001).
Poor adherence to treatment was the major predictor of uncontrolled BP. The increase in uncontrolled BP in the presence of diabetes and/or obesity as risk predictors, indicates the need for appropriate behaviour change/interventions and management of these conditions in line with the health belief model (HBM). We also propose the use of Community-Based Physical and Electronic Reminding and Tracking System (CB-PERTS) to address poor treatment adherence.
高血压是发病率和死亡率的主要原因，控制高血压对家庭和社区具有重要的临床和社会经济效益。不幸的是，在许多资源匮乏的农村社区，高血压患者的血压控制程度及其潜在预测因素在很大程度上尚不清楚。本研究评估了南非农村社区中接受初级卫生保健的高血压患者中血压控制不佳的程度及其预测因素。
本横断面研究纳入了 422 名随机选择的高血压患者。使用结构化的面对面问卷收集人口统计学和临床数据，并通过受访者的临床记录进行补充。
肥胖加超重（n=286，67.8%）和糖尿病（n=228，54.0%）是最常见的合并症。仅 36.3%的患者达到了治疗依从性，50.2%的患者血压得到了控制。血压控制不佳的显著预测因素是治疗依从性差（比值比[OR] = 15.88，95%置信区间[CI] = 8.96，28.14，p<0.001），与正常体重和超重相比，肥胖（OR = 3.75，95%CI = 2.17，6.46，p<0.001）和糖尿病（OR = 2.83，95%CI = 1.74，4.61，p<0.001）。
治疗依从性差是血压控制不佳的主要预测因素。在存在糖尿病和/或肥胖作为风险预测因素的情况下，血压控制不佳的情况增加，表明需要根据健康信念模型（HBM）进行适当的行为改变/干预和这些疾病的管理。我们还建议使用基于社区的物理和电子提醒和跟踪系统（CB-PERTS）来解决治疗依从性差的问题。
