Blood pressure control status of patients with hypertension on treatment in Dessie City Northeast Ethiopia

Predicting factors of blood pressure normalization in hypertensive patients after short-term follow-up

Introduction

Normalization of blood pressure in hypertensive patients is a major challenge for practitioners. Knowledge of the factors associated with normalization of blood pressure could help optimize management of these hypertensive patients. In this study, we analysed the factors predictive of this in a population of hypertensive patients followed as outpatients in a specialised department.

Patients and methods

Retrospective and analytic study (January 2021-May 2022) of adult hypertensive patients over 40 years old who had been receiving antihypertensive treatment as outpatients in the Cardiology Department of the Bouake Teaching Hospital for at least 6 months. We studied the epidemiological and clinical parameters as well as the factors involved in the normalization of blood pressure in this population. Statistical analysis was performed using SPPS version 26 software (SPSS Inc., Chicago, IL, USA).

Results

We collected 194 patients records (57.7% women). The mean age was 59.13 years [extremes: 40-89 years]. One hundred and nine (56.2%) patients had a low socioeconomic status and 151 (77.83%) had at least 2 cardiovascular risk factors. The mean systolic blood pressure on admission was 171.12 ± 22.38 mmHg [extremes: 140-259 mmHg] and the mean diastolic blood pressure was 97.98 ± 17.83 mmHg [extremes: 60-168 mmHg]. First-line treatment consisted of dual anti-hypertensive therapy (n = 133; 68.55%) and fixed combination (n = 152; 78.35%). Only 25.25% (n = 49) of patients achieved normalization of blood pressure with therapeutic adherence estimated at 37.62% (n = 73). In multivariate analysis adjusted for anti-hypertensive treatment adherence, age (OR = 1.03; 95% CI = 1.002-1.059; p = 0.039), absence of alcoholism (OR = 9.48; 95% CI = 2.13-42.11; p = 0.003), number of cardiovascular risk factors <2 (OR = 1.52; 95% CI = 1.06-2.16; p = 0.021), normalization of uricemia (OR = 1.05; 95% CI = 1.00-1.11; p = 0.039) and natraemia (OR = 1.01; 95% CI = 1.00-1.03; p = 0.021), dual therapy (OR = 0.40; 95% CI = 0.18-0.90; p = 0.027), change in treatment for optimization (OR = 4.22; 95% CI = 1.71-10.37; p = 0.002), intellectual education (OR = 10.40; 95% CI = 4.31-25.10; p < 0.001) and health insurance (OR = 0.09; 95% CI = 0.04-0.21; p < 0.001) were the main factors predicting normalization of blood pressure.

Conclusion

Control of cardiovascular risk factors and compliance with treatment are the main factors in normalizing blood pressure.

The impact of COVID-19 on non-communicable disease patients in sub-Saharan African countries: A systematic review

BACKGROUND

COVID-19 and its prevention measures have had a significant impact on patients with non-communicable diseases (NCDs) by disrupting routine healthcare service and increasing risk factors. These challenges were expected to be more severe in sub-Saharan Africa due to the lack of physical infrastructure and inadequate resources. The quantity of studies conducted was limited, and there was a lack of published systematic reviews in the specified region. This systematic review aimed to assess the indirect impacts of the COVID-19 pandemic and associated lockdown measures on individuals with non-communicable diseases (NCDs) in sub-Saharan African countries.

METHOD

This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and is registered with PROSPERO (ID CRD42023387755). Extensive searches were conducted in MEDLINE, EMBASE, and CINAHL databases in December 2023, supplemented by a manual search of references, grey literature, and the WHO COVID-19 database. Inclusion criteria encompassed studies that reported on the impact of COVID-19 on NCD patients in sub-Saharan African countries, focusing on access to care, health outcomes, and factors related to NCDs. Critical appraisal of study quality was performed using the Joanna Briggs Institute (JBI) analytical cross-sectional studies critical appraisal tool. Data were extracted and synthesized, highlighting the main findings and relevant limitations.

FINDINGS

This review included 30 primary studies with a cumulative sample size of 25634 participants, conducted in seven sub-Saharan African countries. These studies demonstrated that the COVID-19 pandemic significantly disrupted regular NCD patient care provision, with regional variations. The studies also identified a reduction in patient health-seeking behavior and reduced medication adherence, leading to poor treatment outcome. Furthermore, the pandemic and related lockdowns have been implicated in the increased prevalence of substance use, decreased physical exercise, and increased mental health problems.

CONCLUSION

This systematic review identified the complex challenges faced by NCD patients in sub-Saharan Africa during the COVID-19 pandemic. It also underlines the need to consider the indirect impact on vulnerable populations while developing pandemic prevention and control strategies for the future. The current NCD management strategies should prioritize the restoration of access to essential healthcare services while considering the multifaceted risks posed by decreased physical activity, poor dietary practices, and increased substance use. The main limitation of this review was the study design and setting. All of the studies included in this review employed a cross-sectional design, which may result in a low quality of evidence. This study identified research conducted in only seven countries among the 46 UN-classified sub-Saharan nations, which may impair the generalizability of the result.

Prevalence of uncontrolled hypertension and contributing factors in Ethiopia: a systematic review and meta-analysis

Background

Uncontrolled hypertension (HTN) is a major risk factor for cardiovascular and cerebrovascular disease. The prevalence of HTN in the Ethiopian adult population is almost 20%.This study aimed to determine the prevalence of uncontrolled HTN and its contributing factors among patients with HTN in Ethiopia undergoing treatment.

Methods

Electronic bibliographic databases such as PubMed, Google Scholar, Hinari (Research4Life), Embase, and Scopus were searched for original records in the English language that assessed HTN control in Ethiopia and were available before 29 June 2023. The data were extracted using a format prepared in Microsoft Excel and exported to the software STATA 17.0 for analysis. The study protocol was registered at PROSPERO with the reference number CRD42023440121.

Results

A total of 26 studies with 9,046 patients with HTN were included in the systematic review and meta-analysis, of which 11 studies were used to assess factors contributing to uncontrolled blood pressure (BP) in patients in Ethiopia. The estimated prevalence of uncontrolled HTN in the population of Ethiopia is 51% [95% confidence interval (CI), 42%-60%]. The subgroup analysis, based on the assessment tools, region, and follow-up period, revealed that the prevalence of uncontrolled BP was highest following the guidelines of the American Heart Association/American College of Cardiology (AHA/ACC) (89%; 95% CI: 87%-91%) and in Addis Ababa (58%; 95% CI: 40%-76%), and the lowest proportion of uncontrolled BP was in the 3-month follow-up period (34%; 95% CI: 29%-39%). The presence of diabetes mellitus showed the highest impact (pooled odds ratio: 5.19; CI: 1.41-19.11) for uncontrolled HTN. The univariate meta-regression method confirmed that the sample size, year of publication, and subgroups were not sources of heterogeneity in the pooled estimates. Egger's regression test did not indicate the presence of publication bias.

Conclusion

More than half of the hypertensive patients in Ethiopia have uncontrolled BP. Diabetes mellitus, advanced age, male sex, and the presence of comorbidities are among the factors contributing to uncontrolled HTN in Ethiopia. The concerned bodies working in this area should implement interventional strategies and recommendations that might be helpful in achieving optimal BP in hypertensive patients.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023440121, PROSPERO (CRD42023440121).

Changes in Healthcare Utilization During the COVID-19 Pandemic and Potential Causes-A Cohort Study From Switzerland

Objectives: To describe the frequency of and reasons for changes in healthcare utilization in those requiring ongoing treatment, and to assess characteristics associated with change, during the second wave of the pandemic. Methods: Corona Immunitas e-cohort study (age ≥20 years) participants completed monthly questionnaires. We compared participants reporting a change in healthcare utilization with those who did not using descriptive and bivariate statistics. We explored characteristics associated with the number of changes using negative binomial regression. Results: The study included 3,190 participants from nine research sites. One-fifth reported requiring regular treatment. Among these, 14% reported a change in healthcare utilization, defined as events in which participants reported that they changed their ongoing treatment, irrespective of the reason. Reasons for change were medication changes and side-effects, specifically for hypertension, or pulmonary embolism treatment. Females were more likely to report changes [Incidence Rate Ratio (IRR) = 2.15, p = 0.002]. Those with hypertension were least likely to report changes [IRR = 0.35, p = 0.019]. Conclusion: Few of those requiring regular treatment reported changes in healthcare utilization. Continuity of care for females and chronic diseases besides hypertension must be emphasized.

Impact of the COVID-19 pandemic on some modifiable risk factors of dementia in an aging, rural Indian population

Introduction

The impact of the COVID-19 pandemic and associated lockdowns is likely to have caused adverse changes in lifestyle-related/cardiovascular risk factors and other such modifiable risk factors of dementia. We aimed to examine the pandemic's impact on some modifiable risk factors of dementia among rural Indians belonging to a large, prospective aging cohort-Srinivaspura Aging, NeuoSenescence, and COGnition (SANSCOG).

Methods

This was a cross-sectional study among adults aged ≥ 45 years (n = 3,148; 1,492 males and 1,656 females) residing in the villages of Srinivaspura in Karnataka state, India. SANSCOG study data (clinical and biochemical assessments) of these participants were obtained from three distinct periods: (i) the "pre-COVID period"-before India's nationwide lockdown on 24 March 2020, (ii) the "COVID period"-during the first and second waves of the pandemic, wherein the social restrictions were prominent (25 March 2020 to 30 September 2021), and (iii) the "post-COVID period"-after easing of restrictions (from 1 October 2021 onward). Proportions of participants with diabetes, hypertension, obesity, dyslipidemia (diagnosed using standard criteria), and depression (diagnosed using the Geriatric Depression Scale) were compared between the above three periods.

Results

The odds of having obesity, abnormal triglycerides, and depression among individuals in the COVID period were 1.42 times, 1.38 times, and 2.65 times more than the odds in the pre-COVID period, respectively. The odds of having hypertension, obesity, abnormal total cholesterol, abnormal triglycerides, abnormal LDL, and depression among individuals in the post-COVID period were 1.27 times, 1.32 times, 1.58 times, 1.95, 1.23, and 3.05 times more than the odds in the pre-COVID period, respectively. The odds of diabetes did not differ between any of the three periods.

Discussion

We found significantly higher odds of some of the studied risk factors in the COVID and post-COVID periods compared to the pre-COVID period, suggesting that the pandemic adversely impacted the physical and psychological health of this marginalized, rural Indian population. We call for urgent public health measures, such as multimodal, lifestyle-based, and psychosocial interventions, to mitigate this negative impact and reduce the future risk of dementia.

Uncontrolled blood pressure and associated factors in adult hypertensive patients undergoing follow-up at public health facility ambulatory clinics in Bishoftu town, Ethiopia: a multi-center study

BACKGROUND

Uncontrolled blood pressure is an important medical and public health problem in developing countries like Ethiopia. Improving the management of hypertension requires a better comprehension of the factors influencing blood pressure control and the application of interventions. But in clinical practice, blood pressure is still not adequately controlled. Thus, this study aimed to assess uncontrolled blood pressure and associated among adult hypertensive patients on follow-up at public health facility ambulatory clinics in Bishoftu, Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted among 398 adult hypertensive patients who were on treatment and follow-up from April to May 31, 2022. Systematic random sampling was used to select study participants. Data were collected using an interviewer-administered, semi-structured questionnaire and chart review. The Eighth Joint National Committee (JNC 8) criteria was applied to define blood pressure control status. Binary logistic regression analysis was used to model the association between dependent and independent variables. An adjusted odds ratio and 95% confidence interval were used to measure the strength of the association. Finally, at a p-value < 0.05, statistical significance was proclaimed.

RESULT

Of the total study participants, 249(62.6%) were male. The mean age was 62.26 ± 11.55 years. The overall proportion of uncontrolled blood pressure was 58.8% (95% CI: 54-64). Salt intake (AOR = 2.51; 95% CI: 1.49-4.24), lack of physical activity (AOR = 1.40; 95% CI: 1.10-2.62), habitual coffee consumption (AOR = 4.52; 95% CI: 2.67-7.64), higher BMI (AOR = 2.08; 95% CI: 1.24-3.49), and non-adherence to antihypertensive medications (AOR = 2.31; 95% CI: 1.3-3.89) were independent predictors of uncontrolled blood pressure.

CONCLUSION

More than half of the hypertensive patients in this study had uncontrolled blood pressure. Healthcare providers and other accountable stakeholders should urge patients to follow salt restriction, physical activity, and antihypertensive medication regimes. Reduced coffee consumption and weight maintenance are other crucial blood pressure control measures.

Impact of health literacy and social support on medication adherence in patients with hypertension: a cross-sectional community-based study

BACKGROUND

Previous studies have examined the associations of health literacy and social support with medication adherence among patients with hypertension. However, limited evidence exists regarding the mechanisms underlying the relationship between these factors and medication adherence.

PURPOSE

To explore the prevalence of medication adherence and its determinants in patients with hypertension in Shanghai.

METHODS

A community-based cross-sectional study was conducted among 1697 participants with hypertension. We collected sociodemographic and clinical characteristics as well as data regarding health literacy, social support, and medication adherence using questionnaires. We examined interactions among the factors using a structural equation model.

RESULTS

The participants included 654 (38.54%) patients with a low degree of medication adherence and 1043 (61.46%) patients with a medium/high degree of adherence. Social support directly influenced adherence (β = 0.165, P < 0.001) and indirectly influenced adherence through health literacy (β = 0.087, P < 0.001). Health literacy directly influenced adherence (β = 0.291, P < 0.001). Education indirectly affected adherence through both social support (β = 0.048, P < 0.001) and health literacy (β = 0.080, P < 0.001). Moreover, there was a sequential mediating effect of social support and health literacy on the association between education and adherence (β = 0.025, P < 0.001). After controlling for age and marital status, similar results were also obtained, indicating a good model fit.

CONCLUSIONS

The degree of medication adherence among hypertensive patients needs to improve. Health literacy and social support had both direct and indirect effects on adherence, and thus, these factors should be considered as tools to improve adherence.

Uncontrolled blood pressure and contributing factors among patients with hypertension at outpatient care of Bedele General Hospital, Southwest Ethiopia: A cross-sectional study

Objective

This study aimed to assess uncontrolled blood pressure and contributing factors among patients with hypertension.

Methods

Hospital-based cross-sectional study was conducted from January to April 2021 at Bedele General Hospital. Data were collected using the semi-structured questionnaire. All patients with hypertension were included using consecutive sampling technique unless ineligible. EpiData 4.4.2 was used for data entry, and SPSS 24.0 was employed for analysis. Binary logistic regression analysis was performed to identify factors associated with uncontrolled blood pressure.

Results

A total of 219 patients with hypertension were included in the study. About 60.3% of participants were male. The mean age of the study participants was 48.54 ± 12.93 years. The prevalence of uncontrolled blood pressure among the study participants was 56.2%. The factors significantly associated with uncontrolled blood pressure were age >60 years (adjusted prevalence ratio = 4.42; 95% confidence interval = (1.71, 11.46); p = 0.002) and the presence of comorbidity (adjusted prevalence ratio = 2.16; 95% confidence interval = (1.22, 3.82); p = 0.008).

Conclusion

More than half of the study participants had uncontrolled blood pressure. Older age and comorbidity were the predictors of uncontrolled blood pressure. Attaining controlled blood pressure is important to avoid consequences of high blood pressure. So, healthcare provider should focus on achieving target blood pressure goal.