Abstract:
Background: Only 21% of hypertensive patients attain their blood pressure target at global
level. When hypertension is not adequately controlled, its negative effects increased. Many
determinants were not adequately addressed. This study may provide further insights into
hypertension control by providing additional evidences on key factors like therapeutic inertia and
medical advice.
Objective: The objective of this study was to identify determinants of uncontrolled hypertension
among adult hypertensive patients having follow up at public health facilities of Adea Berga
district from September 1 to 30, 2022.
Methods: A Facility-based unmatched case control study was conducted. Study period was from
September 1 to October 30, 2022. A total of 264 (88 cases and 176 controls) respondents were
selected for the study by systematic random sampling. Structured questionaries were used to
collect data from participants. EPI Info version 7.2.4 software was used for data entry and
cleaning which was then exported to SPSS version 26 for further analysis. Binary logistic
regression model was fitted and multivariable analysis was conducted to see the association
between determinant factors and uncontrolled hypertension. Results were presented by tables and
figure.
Result: Of the 264 eligible patients attending at the chronic follow up care clinics in the three
health facilities in Adea Berga district in the two months of data collection, 264 participated in
this study making response rate of 100%. Duration of hypertension >1 to 5 years (AOR =
0.229; 95 % CI 0.069, 0.764), body mass index 25 Kg/m2 (AOR = 8.461; 95 % CI 3.232,
22.151), DASH diet non-adherence (AOR= 5.631; 95% CI 2.298, 13.801), not being well
advised (AOR= 3.355; 95% CI 1.420, 7.928), non-adherence to salt reduction (AOR= 3.857;
95%CI 1.183, 12.574), non-adherence to adequate physical exercise (AOR= 3.896; 95% CI
1.224, 12.402), availability of antihypertensive drugs in health facility (AOR= 0.246; 95% CI
0.078, 0.779), medication non-adherence (AOR= 4.628; 95 % CI 1.914, 11.188) and therapeutic
inertia (AOR= 3.069; 95 % CI 1.153, 8.164) have shown significant association with
uncontrolled hypertension (p<0.05).
Conclusion: This study revealed that hypertension duration >1 to 5 years from time of
diagnosis, body mass index 25 Kg/m2, DASH diet non-adherence, poor advice given by
healthcare providers for patients, non-adherence to salt reduction, non-adherence to adequate
physical exercise, availability of antihypertensive drugs in health facility, medication nonadherence
and therapeutic inertia, are determinants of uncontrolled hypertension. Provider and
VII
system related factors should be well addressed in addition to behavioral and medication related
factors to tackle the problem of uncontrolled hypertension
