Determinants Of Uncontrolled Hypertension Among Adult Hypertensive Patients On Follow-Up At Ambo University Referral Hospital, West Shewa, Ethiopia, 2024: Unmatched Case Control Study

Abstract

Background: Hypertension affect 33% of adults worldwide and control rates among people with hypertension in 2019 were 21%. In Ethiopia, prevalence of uncontrolled hypertension was 48%. If hypertension is not controlled it leads to stroke, heart attack, heart failure, kidney damage and many other health problems. Despite the availability of many preventive measures and pharmacologic treatment of hypertension, the rate of blood pressure control remains poor. There is limited data concerning determinants of uncontrolled hypertension in the study area. Objective: To identify determinants of uncontrolled hypertension among adult hypertensive patients on follow-up at Ambo university Referral Hospital, west Shewa, Ethiopia, 2024 Methods: Institution based unmatched case control study was conducted between May 7- August 30, 2024 on 373 hypertensive patients that were selected by systematic sampling technique for both cases and controls. Data was collected through face-to-face interview using structured checklist. The collected data was entered in to Epidata version 3.1, and exported to SPSS version 27 for analysis. Bivariable logistic regression was used to identify candidate variable for multivariable logistic regression. The possible effects of confounders were controlled through multivariable logistic regression to identify the predictor of the outcome variables. Association between the explanatory and dependent variables was declared at p-value of 0.05. The strength of association between independent and dependent variables was assessed using adjusted odds ratio with 95% confidence interval. Results: In this study, male sex (AOR=2.40,95% CI:(1.12-5.14)), age >60 years (AOR=3.49, 95% CI:(1.09-11.13)), not adherence to low diet salt intake (AOR=2.34,95% CI:(1.07-5.14)), alcohol intake (AOR=4.09,95%CI:( (1.60-10.49)), physical inactivity (AOR=2.21, 95% CI:(1.04-4.69)),duration of sleep <7 hours /day (AOR=5.15,95% CI (1.62-16.41)) and >9hours/day (AOR= 2.24, 95% CI ( 1.03-4.88)), not adherence to medication (AOR= 4.03, 95% CI:(1.59-10.20)), dual number of anti-hypertensions medications (AOR=.36, 95% CI: (.18 .75)), high waist circumference (AOR= 4.04, 95% CI: (1.72-9.51)), Overweight (AOR=2.16,95% CI:(1.00-4.67)),diabetes (AOR=2.76, 95% CI: (1.06-7.17) and lack of awareness of hypertension complications (AOR=3.85, 95% CI:(1.63-9.08) were found to be statistically significant determinants of uncontrolled hypertension. Conclusions: In this study determinants of uncontrolled hypertension were male sex, age > 60 years, not adherence to low diet salt intake and medication, double anti-hypertensive medication, alcohol intake, physical inactivity, abnormal duration of sleep/day, high waist circumference, overweight, diabetes and lack of awareness of hypertension complications. Recommendation: Focusing on adherence to lifestyle modification and medication, along with awareness of hypertension complications of patients, is crucial for effective hypertension control.