Abstract P363: Risk Factors Associated With Uncontrolled Hypertension in Low Income Jordanians

Abstract

Background: Hypertension (HTN) is one of the most important modifiable and contributing factors to stroke, cardiovascular and renal disease. Globally, HTN control remains inadequate, with about half attaining BP goal. This study evaluated potential risk factors associated with uncontrolled HTN in a low income population managed by the ministry of health (MOH) which provides coverage for the vast majority of Jordan’s population. Methods: All subjects (400) in this multi-center, cross-sectional study, were recruited at MOH primary care clinics, were using the same HTN medication regimen for a minimum of 6 months and were all initiated on HTN therapy under JNC-7 guidelines. BP control was assessed based on JNC 7 and 8 guidelines. In addition, obesity, diabetes, metabolic syndrome (MetS), medication regimens and adherence, fat/salt intake, fasting blood glucose, lipids, leptin, adiponectin, hs-CRP and plasminogen activator inhibitor-1 (PAI-1) were examined for association with HTN control: Results: Less than half (178 of 400) of subjects BP was controlled per JNC 7, whereas 67% (268 of 400) were controlled based on JNC 8. Nearly 60% (238 of 400) were diabetic; a DM diagnosis was significantly (p<0.05) associated (2.5 fold higher vs non-diabetic) with uncontrolled HTN. Most subjects (93%, 371 of 400) were obese and 90% (360 of 400) met the International Diabetes Federation (IDF) and ATP-III criteria for MetS. Of the biomarkers examined, abnormal levels of PAI-1, adiponectine and hs-CRP were significantly associated with presence of MetS. MetS was associated with a 2.5 and 3.5 fold increase in the odds of having uncontrolled BP based on IDF and ATP-III criteria respectively. Elevated fasting blood sugar was also significantly associated with inadequate BP control. Conclusions: While some of this study’s findings such as the association with DM and MetS are in agreement with the literature, often reported patient-behavior risk factors such as medication adherence was not. Although HTN control is suboptimal in this population, it is higher than the previously reported national rate (45% vs 39%). This difference may be explained by the higher medication adherence (64%) observed in this population compared with previous national studies (43%).