Abstract
Nepal has a high prevalence of hypertension. While improving the overall health-related quality of life (HRQOL) is a central tenet to public health plans in developed nations, this focus has yet to be articulated in Nepal. Therefore, this study aims to identify the factors associated with HRQOL among hypertensive patients in Nepal. The EuroQol-5Dimension HRQOL survey was administered to 180 hypertensive patients, attending the outpatient clinic at Shahid Gangalal National Heart Center in Kathmandu, Nepal. Multiple linear regression models, adjusted for age and sex, were used to identify factors associated with HRQOL. The mean age and EuroQol visual analytic scale of the participants were 53.2 years and 63.7, respectively. Age [β = -0.56; 95% confidence interval (CI): -0.75 to -0.37], income (β = 0.02; 95% CI: 0.01, 0.03), family size (β = -0.98; 95% CI: -1.89, -0.07), number of antihypertensive drugs use (β = 4.62; 95% CI: 1.33, 7.90), and compliance to dietary salt advise (β = 4.86; 95% CI: 0.29, 9.43) were significant factors associated with HRQOL among participants. In addition, levels of education and self-perceived health were associated in a positive gradient to HRQOL. In mediation analysis, both, dietary low salt compliance and use of antihypertensive drugs, had a significant direct effect on HRQOL, and the use of antihypertensive drugs did not significantly mediate the relationship between dietary salt compliance and HRQOL. Various factors were found to be associated with HRQOL among hypertensive patients in Kathmandu. Assessing HRQOL is a valuable technique to identify populations in need of services and interventions. This assessment can serve as a baseline, and in conjunction with multiple stakeholders, can guide public health policy, planning, and practices, especially those aimed toward improving the HRQOL of Nepalese with hypertension.
Highlights
Hypertension is a global public health issue and a leading cause of cardiovascular disease [1], accounting for 45% of deaths due to heart disease, and 51% of deaths due to stroke globally [2]
A recent survey done among hypertensive patients in Manmohan Cardiothoracic Vascular and Transplant Centre in Kathmandu Nepal found age, non-formal education, and being single to be associated with lower health-related quality of life (HRQOL) [13]
As reducing dietary salt has been considered as a non-pharmacotherapy for controlling blood pressure, the high HRQOL perceived by the hypertensive patient compliant to low dietary salt may be explained by the same mechanism that explained the difference in HRQOL between adherent and non-adherent patients
Summary
Hypertension is a global public health issue and a leading cause of cardiovascular disease [1], accounting for 45% of deaths due to heart disease, and 51% of deaths due to stroke globally [2]. Owing to the sociodemographic and cultural discrepancies between Nepal and these countries, an inference cannot be made on HRQOL of Nepalese hypertensive patients from these international studies. A recent survey done among hypertensive patients in Manmohan Cardiothoracic Vascular and Transplant Centre in Kathmandu Nepal found age, non-formal education, and being single to be associated with lower HRQOL [13]. For the first time in 2009, Nepal included non-communicable diseases (NCDs) in national health policy [14]. Implementing such policies into practice will require knowledge on various aspects of NCDs, including hypertension. This study aims to identify the factors associated with HRQOL among hypertensive patients in Kathmandu, Nepal
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