Abstract
BackgroundThe use of antihypertensive medications is critical for controlling high blood pressure. We aimed to investigate associations between socio-demographic factors and antihypertensive medications use, and antihypertensive medications use with different types of drugs use with levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP).MethodsFor the present report we derived data from the baseline measurements of a cluster randomised control trial on 307 participants with previously diagnosed hypertension from the rural district of Narial in Bangladesh. We measured the participant’s current blood pressure levels and recorded antihypertensive medications uses. Associated factors included socio-economic status, diabetes, antihypertensive medications use, and types of drugs and doses used for controlling blood pressure. We applied analysis of variance and logistic regression techniques to identify factors associated with blood pressure.ResultsOf the total participants, 144 (46.9%) were on antihypertensive medications. After multivariate adjustment, binary logistic regression revealed that employees (odds ratio, (95% confidence interval (CI)) (OR 3.58, 95%CI 1.38-9.28) compared to farmers, and people with diabetes (OR 2.43, 95%CI 1.13-5.26) compared to people without diabetes were associated with a higher proportion of antihypertensive medications use. Of 144 participants on antihypertensive medications, 7 (5%) had taken two doses, 114 (79%) had taken one dose per day and the rest were irregular in medication use. The mean (standard deviation) [min, max] SBP and DBP were 149 (19) mmHg [114, 217] and 90 (10) mmHg [75, 126], respectively. Overall, there was no significant difference in SBP (p = 0.10) or DBP (p = 0.67) between participants with or without antihypertensive medications or using any type of medications (p = 0.54 for SBP and 0.76 for DBP). There was no significant association between antihypertensive medications use and elevated BP levels SBP/DBP≥140/90 mmHg (p = 0.42)ConclusionLess than half of the people with hypertension were on medication. Irrespective of the antihypertensive medications use, most of the participant’s blood pressure was high. Further study is needed with a large sample to understand the factors and aetiology of unmanaged hypertension in rural areas of Bangladesh where the prevalence of hypertension is very high.
Highlights
The use of antihypertensive medications is critical for controlling high blood pressure
The cohort comprised an almost equal number of men and women, one-third of the participants were over 60 years of age and 15% were between 30- 39 years of age, one-third of the participants had no schooling, half of the participants were homemakers, about one-fifth of the participants were farmers and another one-fifth were employees, one-fifth of the participants were current smokers (Table 1)
The proportion of people on antihypertensive medications was 46.9% (n = 144), which was significantly higher in people of age 50-59 years (odds ratio (OR) (95% Confidence Interval (CI): 2.11 (1.01, 4.41)) and 60-69 years (OR: 2.88 (1.35, 6.17)) compared to age 30-39 years
Summary
The use of antihypertensive medications is critical for controlling high blood pressure. A significant population with hypertension are unaware of their disease condition, among those with known hypertension, it was estimated that only 18 to 42% of people in high-income countries (HICs) and 8 to 20% in lowincome countries were able to control their hypertension [2, 6,7,8,9,10] Those figures are expected to be disproportionately larger in rural areas where the case fatality due to CVD was reported to be higher [11]. Previous studies have suggested the prevention and control of hypertension may be improved by the application of targeted and/or population-based strategies These include interventions to increase awareness in maintaining recommended healthy lifestyle and adherence to antihypertensive medications [10, 12,13,14], nonadherence to antihypertensive therapy and lifestyle modification are major barriers in managing hypertension [15,16,17]. Managing blood pressure at the targeted level is more challenging in low-middle income countries where almost three-quarters of the total hypertensive cases reside, and treatment facilities are insufficient [9]
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