Factors associated with uncontrolled hypertension in patients attending a medical clinic of a tertiary care hospital in Sri Lanka

C N Wijekoon,J K P Wanigasuriya,M T Samarawickrama,G S C Mendis,P W M C S B Wijekoon Wijekoon

doi:10.4038/jccp.v51i2.7903

Abstract

Objectives: Uncontrolled hypertension is common. Objective of this study was to describe factors associated with uncontrolled hypertension in a group of patients on treatment for hypertension. Method: A cross-sectional descriptive study was conducted in a medical clinic of a tertiary care hospital in Sri Lanka. Consecutive patients on treatment for hypertension had two readings of blood pressure (BP) 1-2 minutes apart and lower of the two was taken, as the current BP. All patients not achieving a systolic BP of Results: 260 patients were studied (women: 61.2%; mean age: 64.9±9.5years). Mean systolic and diastolic BP were 160.5±16.3mmHg and 91±11.1mmHg, respectively. Mean duration of treatment was 8.5±7.2years. Mean number of anti-hypertensive medications per patient was 2.1±0.8. 70.4% were non-adherent to medications. 13.5% were on concomitant medications known to increase BP. 89.2% had one or more non-medication related factor contributing to uncontrolled BP. 64.6% lacked adequate physical activity. 45% had BMI ≥25kg/m2. Self-reported salt consumption was high among 13.1%. 38.5% admitted adding salt to rice cooked at home. 31.5% had inadequate sleep duration. 43.8% reported snoring during sleep. 8.9% of menreported excess and/or binge consumption of alcohol. 6.9% had chronic kidney disease. Clinician inertia was identified as the cause in 4.6%. True resistant hypertension was observed only in 2.7%. Conclusion: In the study population, majority had correctable factors associated with uncontrolled hypertension. Non-adherence to medications was a major problem. Among the others the main contributing factors were inadequate physical activity, obesity, inadequate sleep and excess salt consumption. True resistant hypertension was seen only in a small proportion.

Highlights

Hypertension is the main preventable cause for cardiovascular disease and all-cause-death worldwide.[1,2] It is defined as having a systolic blood pressure (SBP) of ≥ 140mmHg and/or diastolic blood pressure (DBP) of ≥ 90mmHg.[1,2] Recent trends show that the estimated prevalence of hypertension is higher in lowand middle-income countries (LMIC) than in highincome countries (HIC) with an estimated 349 million with hypertension in HIC and 1.04 billion in LMICs.[3]
Mean number of anti-hypertensive medications per patient was 2.1±0.8. 70.4% were non-adherent to medications. 13.5% were on concomitant medications known to increase BP. 89.2% had one or more non-medication related factor contributing to uncontrolled BP. 64.6% lacked adequate physical activity. 45% had body mass index (BMI) ≥25kg/m2
Self-reported salt consumption was high among 13.1%. 38.5% admitted adding salt to rice cooked at home. 31.5% had inadequate sleep duration. 43.8% reported snoring during sleep. 8.9% of men reported excess and/or binge consumption of alcohol. 6.9% had chronic kidney disease

Summary

Introduction

Hypertension is the main preventable cause for cardiovascular disease and all-cause-death worldwide.[1,2] It is defined as having a systolic blood pressure (SBP) of ≥ 140mmHg and/or diastolic blood pressure (DBP) of ≥ 90mmHg.[1,2] Recent trends show that the estimated prevalence of hypertension is higher in lowand middle-income countries (LMIC) than in highincome countries (HIC) with an estimated 349 million with hypertension in HIC and 1.04 billion in LMICs.[3]. Prevalence of hypertension in Sri Lanka is reported to be 24%-30%4-6 and it is more than 50% among those who are aged 60 years or more.[4]

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Conclusion