Hinneh Thomas, Mensah Bernard, Ogungbe Oluwabunmi, Bayuo Jonathan, Donkoh Emmanuel Timmy, Commodore-Mensah Yvonne
Johns Hopkins School of Nursing, Baltimore, MD, USA.
Yale University, New Haven, CT, USA.
BMC Prim Care. 2025 May 29;26(1):189. doi: 10.1186/s12875-025-02775-4.
Hypertension and type 2 diabetes mellitus are major risk factors for cardiovascular disease and are common indications for adult in-patient admissions in Ghana. Primary health facility data on blood pressure (BP) and glycemic control are needed to model the impact of strategies to reduce the high burden of cardiovascular disease risk in Africa.
This retrospective cross-sectional study was conducted at four primary healthcare facilities in Ghana, from January 2023 to December 2023. Glycemic control was defined as fasting blood glucose < 7.0 mm/L, and BP control as < 140/90 mmHg for patients with only hypertension and < 130/80 mm/Hg for those with diabetes or both, per the Ministry of Health standard treatment guideline. Multivariate logistic regression analyses were conducted to assess associations between patient or facility-level factors and BP and glycemic control.
Among the 1,503 adults, the mean age was 63 years (± 13.1). Participants were mostly females (1194; 79.4%) and had at least primary-level education (324; 32.7%). Most participants (866; 57.6%) had hypertension, less than half (506; 33.6%) had both hypertension and type 2 diabetes mellitus, and (131; 8.8%) had only type 2 diabetes mellitus. Median systolic blood pressure was 136.7 mmHg (IQR; 126.7 -149.7), and median diastolic blood pressure was 79.7 mmHg (IQR: (73.2-86.4), both higher in patients with hypertension and type 2 diabetes. Suboptimal BP and glycemic control were found in 58.3% (95% CI: 55.6-60.7%) and 72.6% (95% CI: 68.4-75.6%) of patients respectively. Complications affected 14.5% (n = 218) of patients, with peripheral neuropathy in 9.0%(n = 135) and 4.3% (n = 65) for retinopathy. In an adjusted multivariate analysis, education (AOR = 1.5, 95% CI: 1.1-2.0, p = 0.02), glycemic control status (AOR = 2.6, 95% CI: 2.0-3.5, P < 0.001) and facility ownership (AOR = 2.45, 95% CI: 1.91-3.101, p < 0.01) were associated with suboptimal BP control. For suboptimal glycemic control, associated factors included the presence of complications (AOR = 1.7, 95% CI: 1.0-2.9, p = 0.004), educational status (AOR = 1.9, 95% CI: 1.1-3.3, p = 0.01), and advanced age (> 60 years) (AOR = 1.5, 95% CI: 1.0-2.1, p = 0.04).
The prevalence of suboptimal blood pressure and glycemic control was high for patients accessing primary level healthcare. Age, education, and complications were associated with suboptimal blood pressure and glycemic control. Strategies to reduce the high burden of suboptimal blood pressure and glycemic control should address patient- and facility-level factors to improve treatment outcomes.
Not applicable.
高血压和2型糖尿病是心血管疾病的主要危险因素，也是加纳成人住院的常见原因。需要初级卫生机构关于血压（BP）和血糖控制的数据，以模拟降低非洲心血管疾病高负担策略的影响。
这项回顾性横断面研究于2023年1月至2023年12月在加纳的四个初级卫生保健机构进行。根据卫生部标准治疗指南，血糖控制定义为空腹血糖<7.0 mmol/L，血压控制定义为仅患有高血压的患者血压<140/90 mmHg，患有糖尿病或两者皆有的患者血压<130/80 mmHg。进行多变量逻辑回归分析，以评估患者或机构层面因素与血压和血糖控制之间的关联。
在1503名成年人中，平均年龄为63岁（±13.1）。参与者大多为女性（1194名；79.4%），至少接受过小学教育（324名；32.7%）。大多数参与者（866名；57.6%）患有高血压，不到一半（506名；33.6%）患有高血压和2型糖尿病，（131名；8.8%）仅患有2型糖尿病。收缩压中位数为136.7 mmHg（四分位间距；126.7 - 149.7），舒张压中位数为79.7 mmHg（四分位间距：73.2 - 86.4），高血压和2型糖尿病患者的这两个数值均较高。分别在58.3%（95%置信区间：55.6 - 60.7%）和72.6%（95%置信区间：68.4 - 75.6%）的患者中发现血压和血糖控制不佳。14.5%（n = 218）的患者出现并发症，其中9.0%（n = 135）患有周围神经病变，4.3%（n = 65）患有视网膜病变。在调整后的多变量分析中，教育程度（调整后比值比[AOR]=1.5，95%置信区间：1.1 - 2.0，p = 0.02）、血糖控制状况（AOR = 2.6，95%置信区间：2.0 - 3.5，P < 0.001）和机构所有权（AOR = 2.45，95%置信区间：1.91 - 3.101，p < 0.01）与血压控制不佳有关。对于血糖控制不佳，相关因素包括并发症的存在（AOR = 1.7，95%置信区间：1.0 - 2.9，p = 0.004）、教育状况（AOR = 1.9，95%置信区间：1.1 - 3.3，p = 0.01）和高龄（>60岁）（AOR = 1.5，95%置信区间：1.0 - 2.1，p = 0.04）。
在接受初级卫生保健的患者中，血压和血糖控制不佳的患病率很高。年龄、教育程度和并发症与血压和血糖控制不佳有关。降低血压和血糖控制不佳高负担的策略应解决患者和机构层面的因素，以改善治疗效果。
不适用。
