|
| |
 |
|
| ORIGINAL ARTICLE |
|
| Year : 2022 | Volume
: 19
| Issue : 1 | Page : 31-36 |
|
Assessment of knowledge about hypertension among hypertensive patients in Babylon Province
Helen Ali Mahdi, Ameer Kadhim Al-Humairi
Department of Community and Family Medicine, University of Babylon, Babylon City, Iraq
| Date of Submission | 19-Oct-2021 |
| Date of Acceptance | 25-Nov-2021 |
| Date of Web Publication | 20-Apr-2022 |
Correspondence Address:
Helen Ali Mahdi
Department of Community and Family Medicine, University of Babylon, Babylon City
Iraq
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/MJBL.MJBL_73_21
Background: Hypertension is one of the most common health problems in the world and it is considered as the most common risk factor for different heart diseases such as coronary heart disease, stroke, renal disease, and peripheral vascular disease. Knowledge plays an important role in controlling hypertension among patients with hypertension and in preventing the long-term complications of hypertension. Objectives: To assess the knowledge among patients with hypertension in Al-Hilla city. Methods: This study was a “descriptive cross-sectional study” involving about 303 patients with hypertension older than 18 years who came to health-care centers and hospitals; the patients were assessed by a designed questionnaire through the interview method. The data were collected from April to July 2021. Results: The mean age of patients with hypertensive was 54.89 ± 10.42; females represented 51.2%, whereas males represented 48.8%. Good knowledge about hypertension was 36.0%, average knowledge about hypertension was 42.9%, and poor knowledge about hypertension was 21.1%. There is a relationship between the age and duration of hypertension with knowledge, and there is a significant association between the study variables (age, sex, marital status, educational level, residence, employment status, socioeconomic level, duration of hypertension, family history of hypertension, measurement of hypertension) in our study and knowledge. Conclusion: This study in Babylon Province shows that the highest proportion of patients with hypertension have average knowledge about hypertension (42.9%); there is a significant association between age, duration, and study variables (age, sex, marital status, educational level, residence, employment status, socioeconomic level, duration of hypertension, family history of hypertension, measurement of hypertension) with knowledge. Keywords: Blood pressure, hypertension, knowledge
How to cite this article:
Mahdi HA, Al-Humairi AK. Assessment of knowledge about hypertension among hypertensive patients in Babylon Province. Med J Babylon 2022;19:31-6 |
| Introduction | |  |
Hypertension, commonly known as high blood pressure, is defined as a blood pressure reading of 130 mm Hg and higher for the systolic reading and 80mmg and higher for the diastolic reading (American Heart Association, 2017).
According to recent studies, hypertension is the single most common risk factor for ill health, contributing to a higher worldwide disability load.[1]
Elevated blood pressure is linked to a higher risk of stroke and coronary heart disease, as well as to associated consequences such as heart failure, renal impairment, and retinal hemorrhage.[2]
The prevalence and burden of hypertension has increased in low- and middle-income nations, whereas the condition has either stabilized or dropped in high-income countries. According to some reports, the decline in high-income countries is due to preventive and management initiatives.[3]
Many patients with hypertension may be unaware of it early on, because it is rarely accompanied by symptoms and is usually detected through screening or when seeking health care for an unrelated condition. Symptoms such as headache, vertigo, dizziness, and palpitation only appear when blood pressure is extremely high.[4]
Because of its asymptomatic nature, hypertension is known as “the silent killer.”[5] The major risk factors for hypertension have been classified by the World Health Organization (WHO) into metabolic, behavioral, and social determinants as well as cardiovascular diseases-related risk factors. The behavioral risk factors of hypertension include unhealthy diet, tobacco, physical inactivity, and harmful use of alcohol, whereas the metabolic risk factors include obesity, diabetes, and elevated blood lipids.[6]
Hypertension is divided into primary hypertension and secondary hypertension. Primary hypertension is also called essential hypertension (90%), which results from unknown pathophysiologic etiology and is usually not curable; secondary hypertension (10%) results from specific causes such as chronic kidney disease, hyperparathyroidism, Cushing syndrome, primary aldosteronism, hyperthyroidism, and some medications (e.g., corticosteroids, estrogens, nonsteroidal anti-inflammatory drugs, amphetamines, cyclosporine, erythropoietin). Secondary hypertension can be potentially cured.[7]
The importance of hypertension awareness and knowledge, as well as blood pressure education programs have been reported as significant things to control with regard to hypertension in a knowledge, attitude, and patient (KAP) survey, which indicates KAP behaviors regarding health.[8]
High-risk populations for hypertension must be educated and their health state should be checked early in order for them to have good and high awareness and greater adherence to treatment when they are diagnosed.[9]
Several studies, however, demonstrate that having a strong understanding of hypertension is linked to improved drug adherence.[10]
The purpose of this cross-sectional study presented here was to examine the range of knowledge about hypertension among adult patients with hypertension.
Aim of study
To assess the knowledge about hypertension among patients with hypertension.
| Materials and Methods | | |
Data were collected from Merjan Teaching and Babylon Maternity and Children Hospitals and from Merjan and Babil Al-Tadreby Health Care Centers in Babylon province. This study was a descriptive cross-sectional one. The data were collected from patients with hypertension who came to the emergency unit, those who were admitted in the wards, from the patients’ relatives who were hypertensive, and from the patients who attended health-care centers; the data were collected by a designed questionnaire through an interview method. Data were collected from April to July 2021. Inclusion criteria include patients with hypertension older than 18 years; exclusion criteria include patients who refuse to participate in answering the questionnaire and who are younger than 18 years.
A pilot study was performed for two days. Overall, 20 patients were taken and excluded from the study to assess their understanding of the questionnaire and to assess the time needed for data collection. The total sample size in this study was 303 patients with hypertension, which was estimated according to the following equation:
N = z2p (1–p)/d2
N = (1.96)2*0.265 (1–0.265)/(0.05)2
n = 300, where N = sample size, Z = 1.96, P = prevalence, and d = relative precision = 0.05.
The first part of the questionnaire is about sociodemographic information, which includes: age, sex, marital status, educational level, employment status, residence, socioeconomic level, family history of hypertension, any associated diseases, the duration of hypertension, and the blood pressure reading.
The second part of the questionnaire is about the knowledge of hypertension[4] among patients with hypertension, which includes asking the patients about the following with answers (Yes, No, I don’t know), including 16 questions that assess the knowledge with 1 point if the answer is “Yes,” 0 point if the answer is “No” or “I don’t know” with the score which categorized as poor knowledge if (0–6), average if (7–11) and good if (12–16). This study was approved by the ethical committee of the College of Medicine, University of Babylon. Verbal consent was obtained from each patient prior to data collection, and the aim of the study was explained to each patient.
Statistical analysis was carried out using SPSS version 25. Categorical variables were presented as frequencies and percentages. Continuous variables were presented as (Means ± SD). Student t-test was used to compare means between two groups. ANOVA test was used to compare means between three groups or more. Pearson’s chi square (X2) and Fisher-exact tests were used to find the association between categorical variables. A value of P ≤ 0.05 was considered significant.
| Ethical approval | | |
The study was conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki. It was carried out with patients verbal and analytical approval before sample was taken. The study protocol and the subject information and consent form were reviewed and approved by a local ethics committee according to the document number 414 (including the number and the date in 11/2/2021) to get this approval.
| Results | | |
The patients with hypertension were distributed according to study variables, including age and blood pressure [Table 1].
[Figure 1] shows the distribution of patients with hypertension according to knowledge. The largest proportion (42.9%) of patients with hypertension presented with average knowledge, 36.0% have good knowledge, and 21.1% have poor knowledge. *The scoring system about knowledge includes 16 points, with (12–16) considered as good knowledge, (7–11) considered as average knowledge, and (0–6) considered as poor knowledge. | Figure 1: Distribution of patients with hypertension according to knowledge; mean knowledge was (10.50 ± 3.49)
Click here to view |
[Table 2] shows the mean difference of age and duration according to knowledge. There were significant differences between the means of study variables by knowledge regarding patients with hypertension.
| Discussion | | |
This cross-sectional study which was done on hypertensive patients in Al-Hilla city when mean age was (54.89 ± 10.42) years (range 19–80) and of Systolic BP mean was (140.54 ± 13.83) with range(120–200) while Diastolic BP mean was (87.23± 9.45) with range (70–110), (48.8%) male and (51.2%) female, (86.8%) were married,(32.7%) were secondary education,(33.7%) housewife,(80.9%) urban area,(39.3%) low socioeconomic level, (61.4%) of them had a family history of hypertension,(58.7%) had no history of any associated diseases with (17.2%) had history of diabetes mellitus (43.9%) with duration of hypertension 5–10 years [Table 3]. | Table 3: Distribution of patients with hypertension according to the study
Click here to view |
In other studies in Urban Ghana,[11] results indicated that mean age was (64.1±1.31) years (range 27–94), (29.14%) male and (70.82%) female,(30.28%) had no history of any associated diseases while (69.73%) had history of associated diseases. In other study in South Ethiopia[12] the results was nearly similar to our study with mean age was (53.9% ± 9.64%) years,(48.8%) male which is similar to our study while(51.2%) female which also similar to our study.
In this study, we found that the largest proportion of patients have average knowledge about hypertension (42.9%), 36.0% have good knowledge, and 21.1% have poor knowledge. So we need more recommendations to our patients about their hypertension knowledge. Another study in Kitwe, Zambia[4] also shows that the largest proportion of patients have average knowledge (60.0%), 24.4% have poor knowledge, and only 15.6% have good knowledge.
In our study show significant differences between sex and knowledge (P < 0.001) with (62.4%) of patients have good knowledge were males. Other study in Bamenda health of Cameroon[13] shows similar result with significant differences between sex and knowledge (P = 0.036) with (83.7%) of patients have good knowledge were males; also there is high association between marital status and knowledge (P = 0.001) with (90.8%) of patients who have good knowledge were married. Another study in Turkey[14] also shows a significant association between marital status and knowledge (P = 0.003), with 83.5% of patients having good knowledge and being married, There is also an association between educational status and knowledge (P < 0.001), with 59.6% of patients having good knowledge and being highly educated. Another study in Poland[15] showed no significant association between educational status and knowledge. Regarding the employment status in our study, an association is observed between knowledge and employment status (P < 0.001), with 49.5% of patients having good knowledge and being government employees. Another study in the United States[16] showed no significant association between employment status and knowledge (P = 0.12) and high education (90.1%). There is a significant association between knowledge and residence (P < 0.001), with 91.7% of patients having good knowledge and living in urban areas.
There is also a significant association between knowledge and socioeconomic level (P < 0.001), with 44.0% of patients having good knowledge and a moderate socioeconomic level. Another study in Turkey[14] showed no significant association between knowledge and socioeconomic level (P = 0.2). Regarding family history, our study also showed a significant association between knowledge and family history (P = 0.012); 72.5% of patients having good knowledge had a positive family history of hypertension. Another study in Baghdad, Iraq[17] also showed a significant association between knowledge and family history (P < 0.001); 67.4% of patients having good knowledge had a positive family history of hypertension [Table 4].
| Conclusions | | |
In this study, it was found that the highest proportion of patients with hypertension (42.9%) have average knowledge about their hypertension (65.3%). There was a correlation between age and knowledge. The patients who belong to the younger age groups have good knowledge. Also, there was an association between the duration of hypertension and knowledge, whereby the patients who have a less duration of hypertension have good knowledge. There was also a significant association between the knowledge about hypertension and study variables (sex, educational and employment status, socioeconomic level, marital status, residence, and family history of hypertension).
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Danaei G, Lu Y, Singh G, Carnahan E, Stevens GA, Cowan MJ, et al. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors. Lancet Diabetes Endocrinol2014;8:634-47.  |
| 2. | Mendis S, Puska P, Rao V. World Health Organization (WHO) global atlas on cardiovascular disease prevention and control. Framingham Heart Study2011;4:546-53. |
| 3. | Forouzanfar MH, Afshin A, Alexander LT, Ross Anderson H, Bhutta ZA, Biryukov S, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: A systematic analysis for the Global Burden of Disease Study. Lancet2016;388:1659-724. |
| 4. | Kasaya I, Wanakasale M, Owen A, Reed JE. Knowledge, attitudes and practices of hypertension among hypertensive patients at Buchi Clinic, Kitwe, Zambia. J Hum Hypertens2018;1:78-89. |
| 5. | Arima H, Barzi F, Chalmers J Mortality patterns in hypertension. J Hypertens 2011;29:S3-7. |
| 6. | Tesfaye F Epidemiology of cardiovascular disease risk factors in Ethiopia: The rural-ruban gradient. Epidemiol Folkhälsovetenskap 2008;17:1-92. |
| 7. | Alefan Q, Huwari D, Omran AR. Factors affecting hypertensive patients compliance with healthy lifestyle. BMC Bioinform 2019;13:577-85. |
| 8. | Chijioke C, Anakwue R, Okolo T, Ekwe E, Eze C, Agunyenwa C. Awareness, treatment, and control of hypertension in primary health care and secondary referral medical outpatient clinic settings at Enugu, Southeast Nigeria. Int J Hyperten2016;2016:5628453. |
| 9. | Sánchez D, José LR, Gonzalez Z, Ijoma CK. Intervención educativa sobre hipertensión arterial en pacientes hipertensos. Rev Inf Cient 2014;85:450-8. |
| 10. | Goussous LS, Halasah NA. Non-compliance to antihypertensive treatment among patients attending Prince Zaid Military Hospital. Arch Int Med 2015;13:9-15. |
| 11. | Emfa MA, Darlene EO, Davis CC, Mangwiro JC. The role of lifestyle factors in controlling blood pressure among hypertensive patients in two health facilities in Urban Ghana. Int J Hyperten 2020;2020:1-8. |
| 12. | Eyasu SB, Lolemo KH, Viera AJ. Lifestyle modification practice and associated factors among diagnosed hypertensive patients in selected hospitals South Ethiopia: Buda et al. Clin Hyperten 2017;23:1-9. |
| 13. | Bentley MA, Peter NF, Renzaho AM. Knowledge of hypertension and compliance with therapy among hypertensive patients in the Bamenda health district of Cameroon. Cardiol Ther 2016;6:53-67. |
| 14. | Mahmut K, Tugba U, Mohan V, Farooq S. The effect of knowledge about hypertension on the control of high blood pressure. Int J Cardiovas Acad 2015;2:27-32. |
| 15. | Beata J, Izabella U, Rangarajan S. Relationship between patients knowledge and medication adherence among patients with hypertension. Patients Pref Adheren 2016;10:2437-47. |
| 16. | Abu H, Aboumatar H, Carson KA, Musau S. Hypertension knowledge, heart healthy lifestyle practices and medication adherence among adults with hypertension. Popul Health Manage 2018;6:108-14. |
| 17. | Raghdaa S, Riyadh KL Knowledge, attitude and practice about hypertension in hypertensive patients attending hospitals in Baghdad, Iraq. South East Asia J Pub Health 2017;1:34-9. |
[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4]
|
Search Pubmed for