Determinants of Uncontrolled hypertension in Addis Ababa Public Hospitals - Case Control Study

Abstract

ABSTRACT Introduction Hypertension is persistent elevation of blood pressure greater than or equal to 140/90 in two or more office measurements. Uncontrolled hypertension is a major problem both in developed and developing countries. Only one third to half of hypertensive patients have their blood pressure controlled. Objective: This study is designed to assess determinants of uncontrolled hypertension among hypertensive patients on follow up in public hospitals in Addis Ababa. Methods: Unmatched 1:2 case control study was conducted between July and August, 2019 in three selected Addis Ababa public hospitals. Hypertensive patients on follow up for more than 12 months at selected Addis Ababa public hospitals except those who are not on anti- hypertensive medication and those who are very sick and not able to respond to questions are included in the study. Purposive sampling is used to select the hospitals and then convenience sampling method is used to collect data’s of both cases and controls proportional to caseloads of the hospitals. Adjusted odds ratios were calculated using logistic regression and variables with p- value of less than 5% were considered significant. Results: The sample size was 330, but only 108 cases and 210 controls were included in the study with response rate of 96%. One hundred seventy-seven (55.7%) of the patients were male. Forty-six (42.6%) of the cases and 96(45.7%) of the controls were female. Mean age ±SD of the patients was 53 ±10.9 years (range from 27-81). Patients who adhere to medication have less risk of developing uncontrolled hypertension (AOR: 0.248, P-value <0.0001, 95% CI0.13-0.45). Patients who do not have awareness of hypertension complication are at higher risk of developing uncontrolled hypertension (AOR: 2.02, p-value: 0.032 and 95%CI: 1.06-3.85). Those with other chronic comorbidities were at more risk of developing uncontrolled hypertension (p value <0.0001, 95%CI: 2.3-13.9. Age > 65 increases the risk of uncontrolled hypertension five times P-value 0.048 and 95% CI of (0.9-28.3). Conclusion and Recommendations Adherence to anti-hypertensive medication and awareness of hypertension complication were factors with negative association with uncontrolled hypertension whereas, presence of comorbidity and being in the age group >65 are factors that showed positive association. To ensure better controls of BP, implementing aggressive blood pressure control measures, especially in older age group and in patients with comorbidities is recommended. Adherence support and awareness creation on complications of hypertension is recommended Key words: Uncontrolled hypertension, Case Control, Addis Ababa, Ethiopia