Mokwena Kebogile, Modutoane Margaret
Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
J Family Med Prim Care. 2022 Nov;11(11):7048-7054. doi: 10.4103/jfmpc.jfmpc_740_22. Epub 2022 Dec 16.
Adequate control of hypertension (HTN) is essential to prevent complications such as cardiovascular and kidney diseases. Despite the use of established clinical protocols on the treatment of HTN in primary health facilities in South Africa, the HTN of many patients remains poorly controlled. The objectives of this study were to determine the prevalence of poorly controlled HTN as well as identify related associated risk factors in a sample of adult attendees in primary health care facilities.
A cross-sectional study was conducted among adult hypertension clinic attendees at primary health care facilities in Tshwane District, South Africa. Data were collected using the WHO Stepwise instrument on chronic disease risk factor surveillance and anthropometric and blood pressure (BP) measurements. Stata Version 13 was used for data analysis.
Of the 327 patients who participated in the study, 72.2% were female and 27.8% were male. Their mean age was 56 years (SD 10.8 years). The prevalence of uncontrolled HTN was 58%, with the mean systolic BP and diastolic BP of 142.18 and 87.43, respectively. The prevalence of poorly controlled HTN increased with age. Factors associated with poorly controlled HTN were age, gender, being unemployed, source of income, smoking, alcohol use, lack of physical activity, and skipping of medication. By multi-variate analysis, both the mean systolic and diastolic blood pressures were found to be significantly associated with poorly controlled BP.
The high prevalence of poorly controlled BP among patients who are on treatment suggests the need to re-consider the appropriateness of the current integrated management and treatment of HTN used in primary health care facilities in South Africa. The results suggest that the established clinical protocols and standard treatment for HTN are not beneficial for all patients and that physicians should use the treatment response of individual patients to make clinical decisions.
充分控制高血压对于预防心血管疾病和肾脏疾病等并发症至关重要。尽管南非初级卫生保健机构采用了既定的高血压临床治疗方案，但许多患者的高血压仍控制不佳。本研究的目的是确定初级卫生保健机构成年就诊者样本中血压控制不佳的患病率，并识别相关的危险因素。
在南非茨瓦内区初级卫生保健机构的成年高血压门诊就诊者中进行了一项横断面研究。使用世界卫生组织慢性病危险因素监测逐步调查工具以及人体测量和血压测量收集数据。数据分析采用Stata 13版。
参与研究的327名患者中，72.2%为女性，27.8%为男性。他们的平均年龄为56岁（标准差10.8岁）。血压未得到控制的患病率为58%，平均收缩压和舒张压分别为142.18和87.43。血压控制不佳的患病率随年龄增加而上升。与血压控制不佳相关的因素包括年龄、性别、失业、收入来源、吸烟、饮酒、缺乏体育活动和漏服药物。通过多变量分析，发现平均收缩压和舒张压均与血压控制不佳显著相关。
接受治疗的患者中血压控制不佳的高患病率表明，需要重新考虑南非初级卫生保健机构目前用于高血压综合管理和治疗的方法是否合适。结果表明，既定的高血压临床方案和标准治疗并非对所有患者都有益，医生应根据个体患者的治疗反应做出临床决策。
