DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20210235

Prevalence and risk factors of uncontrolled hypertension in the urban population of Kerala

Jishnu Sathees Lalu, Alexander John, Nimitha Paul, Arjun Balasubramanian

Abstract


Background: Hypertension is leading risk factor for cardiovascular diseases and stroke, and leads to 12.8% of all deaths in the world. Uncontrolled hypertension doubles the risk of cardiovascular disease among the adults with hypertension. Globally 65% of the treated hypertensive have uncontrolled hypertension and in Kerala about three forth of the treated hypertensive have poor blood pressure control. The burden of uncontrolled hypertension is suggestive of preventable deaths and cardiovascular events.

Methods: A cross-sectional study was conducted among 1210 residents of Kochi Corporation of Kerala aged 18 years and above during the period of Sept. 2014 to Sept. 2016. Pre-tested, semi-structured questionnaire was used to collect data on socio-demographic factors such as age, sex, occupation, socio-economic status, education and marital status. Behavioural factors such smoking, alcohol intake, physical activity and dietary factors were collected. Data was analysed by using statistical package for social sciences software version 20.0.

Results: The prevalence of uncontrolled hypertension was 13.14% among the study population. Majority of the uncontrolled hypertensive were females (67.3%) and belonged to the age group 45 years and above (92.5%). The independent predictive factors of uncontrolled hypertension were additional salt intake (aOR 3.62; 95% CI 1.36-9.66), health education by a doctor (aOR 3.58; 95% CI 1.48-8.64), poor adherence to medication (aOR 4.45; 95% CI 1.23-16.03) and patients having no other co-morbidity (aOR 3.24; 95% CI 1.36-7.72).

Conclusions: The burden of uncontrolled hypertension was high in this urban setting. A comprehensive measure involving doctors and healthcare workers have to be adopted to achieve optimum blood pressure among the hypertensive.


Keywords


Adherence to medication, Cardiovascular diseases, Complications of hypertension, Uncontrolled hypertension

Full Text:

PDF

References


World Health Organization. A global brief on Hypertension-Silent killer, global public health crisis [Internet]. WHO; 2013. Available from: http://ish-world.com/downloads/pdf/global_brief_hypertension.pdf [Last accessed on 15th Oct. 2020]

Krishnan A, Garg R, Athula K. Hypertension in the South East Asia: an overview. WHO Regional Health Forum. 2013;1;17

Gupta R, al-Odat NA, Gupta VP. Hypertension epidemiology in India: meta-analysis of 50 year prevalence rates and blood pressure trends. J Hum Hypertens. 1996;10(7):465-72.

Zachariah MG, Thankappan KR, Alex SC, Sarma PS, Vasan RS. Prevalence, correlates, awareness, treatment, and control of hypertension in a middle-aged urban population in Kerala. Indian Heart J. 2003;55(3):245-51.

Vimala A, Ranji SA, Jyosna MT, Chandran V, Mathews SR, Pappachan JM. The prevalence, risk factors and awareness of hypertension in an urban population of Kerala (South India). Saudi J Kidney Dis Transplant off Publ Saudi Cent Organ Transplant Saudi Arab. 2009;20(4):685-89.

Thankappan KR, Sivasankaran S, Sarma PS, Mini G, Khader SA, Padmanabhan P, et al. Prevalence-correlates-awareness-treatment and control of hypertension in kumarakom, Kerala: baseline results of a community-based intervention program. Indian Heart J. 2006;58(1):28-33.

Centers for Disease Control and Prevention (CDC). Vital signs: awareness and treatment of uncontrolled hypertension among adults--United States, 2003-2010. MMWR Morb Mortal Wkly Rep. 2012;61:703-9.

Moser KA, Agrawal S, Davey Smith G, Ebrahim S. Socio-Demographic Inequalities in the Prevalence, Diagnosis and Management of Hypertension in India: Analysis of Nationally-Representative Survey Data. Guo Y, editor. PLoS ONE. 2014;9(1):e86043.

Pereira M, Lunet N, Azevedo A, Barros H. Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries. J Hypertens. 2009;27(5):963-75.

Mohan S, Campbell N, Chockalingam A. Time to effectively address hypertension in India. Indian J Med Res. 2013;137(4):627-31.

Kalavathy MC, Thankappan KR, Sarma PS, Vasan RS. Prevalence, awareness, treatment and control of hypertension in an elderly community-based sample in Kerala, India. Natl Med J India. 2000;13(1):9-15.

Gupta R, Pandey RM, Misra A, Agrawal A, Misra P, Dey S, et al. High prevalence and low awareness, treatment and control of hypertension in Asian Indian women. J Hum Hypertens. 2012;26(10):585-93.

Prince MJ, Ebrahim S, Acosta D, Ferri CP, Guerra M, Huang Y, et al. Hypertension prevalence, awareness, treatment and control among older people in Latin America, India and China: a 10/66 cross-sectional population-based survey. J Hypertens. 2012;30(1):177-87.

Kasturiratne A, Warnakulasuriya T, Pinidiyapathirage J, Kato N, Wickremasinghe R, Pathmeswaran A. P2-130 Epidemiology of hypertension in an urban Sri Lankan population. J Epidemiol Community Health. 2011;65(Suppl 1):A256–A256.

Mohan V, Deepa M, Farooq S, Datta M, Deepa R. Prevalence, awareness and control of hypertension in Chennai--The Chennai Urban Rural Epidemiology Study (CURES-52). J Assoc Physicians India. 2007;55:326-32.

Yang L, Xu X, Yan J, Yu W, Tang X, Wu H, et al. Analysis on associated factors of uncontrolled hypertension among elderly hypertensive patients in Southern China: a community-based, cross-sectional survey. BMC Public Health. 2014;14(1):903.

Devkota S, Dhungana RR, Pandey AR, Bista B, Panthi S, Thakur KK, et al. Barriers to Treatment and Control of Hypertension among Hypertensive Participants: A Community-Based Cross-sectional Mixed Method Study in Municipalities of Kathmandu, Nepal. Front Cardiovasc Med. 2016;3:26.

Berlowitz DR, Ash AS, Hickey EC, Friedman RH, Glickman M, Kader B, et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med. 1998;339(27):1957-63.

Hathial M. Blood pressure control among Indians with hypertension: the I-Target survey. J Indian Med Assoc. 2007;105(7):404-10.

Meena J, Raghav P, Rustagi N. LBOS 03-06 Anti Hypertensive Treatment Compliance And Adverse Effect Profile Among Hypertension Clinic Attendees In Jodhpur, India. J Hypertens. 2016;34 Suppl1:e552.

Li YT, Wang HHX, Liu KQL, Lee GKY, Chan WM, Griffiths SM, et al. Medication Adherence and Blood Pressure Control Among Hypertensive Patients With Coexisting Long-Term Conditions in Primary Care Settings: A Cross-Sectional Analysis. Medicine (Baltimore). 2016;95(20):e3572.

Sandhu A, Ho PM, Asche S, Magid DJ, Margolis KL, Sperl-Hillen J, et al. Recidivism to uncontrolled blood pressure in patients with previously controlled hypertension. Am Heart J. 2015;169(6):791-7.

Aslami AN, Jobby A. Compliance to Hypertension Treatment in Residents of a Fishermen Colony in District Kollam, Kerala. Nepal J Epidemiol. 2015;5(2):1-4.

Borghi C, Tubach F, De Backer G, Dallongeville J, Guallar E, Medina J, et al. Lack of control of hypertension in primary cardiovascular disease prevention in Europe: Results from the EURIKA study. Int J Cardiol. 2016;218:83-8.

Gudmundsdottir H, Hoieggen A, Stenehjem A, Waldum B, Os I. Hypertension in women: latest findings and clinical implications. TherAdv Chronic Dis. 2012;3(3):137-46.

Darabont R, Tautu O, Ardeleanu M, Dorobantu M. [OP.7A.10] Common and Emergent Factors Associated With Hypertension Control in Romania. J Hypertens. 2016;34 Suppl 2:e84-5.

Sadeghi E, Behnood-Rod A, Aerab-Sheibani H, Shobeiri E, Pourzargar P, Ormoz E, et al. Controlled Blood Pressure in Iranian Patients: A Multi-Center Report. Glob J Health Sci. 2015;8(4):188.

DegliEsposti E, Di Martino M, Sturani A, Russo P, Dradi C, Falcinelli S, et al. Risk factors for uncontrolled hypertension in Italy. J Hum Hypertens. 2004;18(3):207-13.

Ahmed N, Abdul Khaliq M, Shah SH, Anwar W. Compliance to antihypertensive drugs, salt restriction, exercise and control of systemic hypertension in hypertensive patients at Abbottabad. J Ayub Med Coll Abbottabad JAMC. 2008;20(2):66-9.

Simpson SH, Duff EM, Whittle S, Wilks R. Profile of uncontrolled hypertensive patients attending the Specialist Hypertension Clinic, University Hospital of the West Indies. West Indian Med J. 2000;49(2):118-22.