Determinants of poor blood pressure control in urban hypertensives of central India.

OBJECTIVES

To determine the factors responsible for poor blood pressure (BP) control among patients started on treatment for hypertension, with the hypothesis that patient non-compliance would be an important determinant.

DESIGN

Patients attending the Cardiology Clinic of the Government Medical College, Nagpur with hypertension for the first time were followed for 3 months and labelled as uncontrolled, if at end of this time the mean of two measures of diastolic blood pressure (DBP) was > 95 mm Hg, despite apparently adequate anti-hypertensive drugs.

STUDY FACTORS

Compliance (measured by pill count), life stress (measured by life event score), smoking and alcohol intake and demographic variables (measured by an interviewer-administered questionnaire), and body mass index (BMI).

RESULTS

Of 156 subjects recruited, 139 (89%) completed follow-up of 3 months, of whom 45 (32%) had uncontrolled hypertension (DBP > 95 mm Hg) at the end of follow-up. There was no statistically significant difference in the baseline characteristics of subjects who completed follow-up as compared with those lost to follow-up. The mean age of the patients was 55 years and male to female ratio was 1.5:1. Sixty-one per cent of the uncontrolled hypertensives were non-compliant by pill count (taking < 80% of drugs) as compared to 21% of the controlled hypertensives (odds ratio, OR = 6.1, 95% Cl = 3.9-12.6; P < 0.0001). There was no statistically significant difference in the mean age, mean BMI, sex distribution, alcohol intake, cigarette smoking rates, educational level, occupational or marital status between controlled and uncontrolled hypertensives. The median life event score (LES) was significantly higher in uncontrolled than in controlled hypertensives 4 vs 1.5 (P < 0.00001). Multiple logistic regression analysis found non-compliance and LES to be statistically significant independent predictors of uncontrolled hypertension.

CONCLUSION

Patient non-compliance with drugs and life stress may help explain poor BP control in patients on treatment for hypertension in this setting.