Managing Hypertension: A Study in Addis Ababa

Hypertension, or high blood pressure, is a serious health issue. You have hypertension if your systolic blood pressure is 140 mmHg or higher, or your diastolic blood pressure is 90 mmHg or more. It is important to manage hypertension because if left untreated, it can lead to serious health problems, including heart disease and stroke.

#How Widespread is Hypertension?

Around 1.3 billion people worldwide suffer from high blood pressure. The numbers are expected to rise, reaching about 1.5 billion by the year 2025. In adults, the prevalence of hypertension is about 30% to 45%. In Africa, approximately 30.8% of adults are affected, while in Sub-Saharan Africa, the prevalence ranges from 30.0% to 31.1%. In Ethiopia, the reports of hypertension vary across different regions, but a meta-analysis in 2019 estimated that 21.8% of people in the country had high blood pressure.

#The Cost of High Blood Pressure

Hypertension carries a significant financial burden. In 2001, the global cost of high blood pressure was about $370 billion. This amount represents 10% of the total health care spending around the world. Moreover, high blood pressure is linked to a high number of cardiovascular diseases and early deaths. It is estimated that 7.7 to 10.4 million deaths each year are caused by high blood pressure, mostly affecting people in low- and middle-income countries.

#Why Don't People Control Their Hypertension?

There are effective medications for high blood pressure, such as diuretics, ACE inhibitors, ARBs, and calcium channel blockers. These drugs help reduce the risk of heart disease and lower the chances of death. However, many people do not manage their hypertension well. It's reported that only 45.6% of people with high blood pressure know they have it. Of those, only 36.9% receive treatment, and just 13.8% successfully control their blood pressure.

Medication Adherence is crucial for long-term health, but sticking to prescribed treatments can be challenging. Many people stop taking their medications. Research shows that poor adherence to medication is a leading reason for inadequate Blood Pressure Control. This can lead to unnecessary prescriptions, worsening health, increased hospital visits, and higher costs for the healthcare system. Poor medication adherence also affects quality of life and increases the risk of severe cardiovascular events like heart attacks and strokes.

#The Aim of the Study

This study aims to examine how well hypertensive patients follow their medication regimens and how effectively they control their blood pressure at certain hospitals in Addis Ababa, Ethiopia. By identifying the factors that contribute to poor medication adherence and blood pressure control, suitable interventions can be designed to improve patient outcomes.

#Study Design and Setting

The research was conducted at two hospitals in Addis Ababa from May 1, 2022, to August 31, 2022. Yekatit 12 Hospital serves around 230,000 people yearly, while Menelik II Comprehensive Specialized Hospital has a long history of providing health services. The study involved patients diagnosed with high blood pressure who were already receiving treatment.

#Who Participated in the Study?

The study involved patients aged 18 and older who had been diagnosed with hypertension and had been on treatment for at least six months. Those who were pregnant or had mental health issues were excluded from the study.

#Data Collection

To gather information, researchers used a structured questionnaire that included various questions related to Participants' demographics, health behaviors, and medication use. Factors like age, gender, education, income, diet, physical activity, and how often patients checked their blood pressure were examined. The data was collected by doctors working in the chronic care clinic at the hospitals.

#Sample Size and Analysis

The researchers calculated that they needed 393 participants. The data was later analyzed using statistical software to determine the relationship between adherence and various factors.

#Key Findings on Participants' Backgrounds

Among the 393 participants, most were middle-aged, with a mean age of 59 years. Over half of them were women, and a significant number lived in urban areas. Around 25% of participants had completed college. Regarding income, 45.8% of the respondents had a monthly income of over 3,000 Ethiopian birr.

#Lifestyle Choices of Participants

In terms of lifestyle, 4.6% of participants were cigarette smokers, while 22.9% consumed alcohol. Many respondents reported eating a variety of vegetables and cereals, but 59.5% said they added more salt to their meals. Most participants had some level of physical activity, averaging about 30 minutes per day.

#Medication Usage

The study found that certain types of medications, like calcium channel blockers and ACE inhibitors, were commonly prescribed. Many patients received combination treatments, with most purchasing their medications from hospitals. A small number reported side effects from their medications.

#Medication Adherence Rates

Using a well-known scale, it was revealed that 72.5% of participants adhered to their medication regimens. More than half of the patients had monitored their blood pressure at home. However, only 23.4% of participants had controlled blood pressure during the study.

#Factors Affecting Medication Adherence

The study investigated various factors that could influence how well patients followed their medication plans. It was found that those who added extra salt to their meals were more likely to adhere to their medication. Interestingly, participants taking one antihypertensive medication were less likely to stick to their treatment compared to those taking two or more medications. Notably, those who didn't engage in moderate physical activity were also less adherent.

#Blood Pressure Control Factors

Further analysis showed that men had better blood pressure control compared to women. Participants who did not consume alcohol also had better control over their blood pressure. Additionally, those who regularly checked their blood pressure at home were more successful in controlling their levels.

#Conclusion

While most participants adhered to their antihypertensive medications, the rate of controlled blood pressure was low. Factors like dietary choices, physical activity, and regular monitoring of blood pressure play a significant role in managing hypertension effectively. This study highlights the need for lifestyle changes alongside medication to achieve better health outcomes for patients with high blood pressure.