mportance of SBP versus DBP, improvement of health with lowering of blood pressure (p 0.002), high blood pressure being asymptomatic (p <0.001), changing lifestyle improves blood pressure(p 0.003),hypertension being a lifelong disease (<0.001), lifelong treatment with antihypertensives(<0.001) and high blood pressure being part of aging(<0.001). On comparison of knowledge as a composite score between uncontrolled and controlled hypertensive; Mean (SD) score was 21.85(4.74) v18.67 (4.70) (p value: < 0.001). On multivariate analysis; gender β (95% CI) 1.67(0.75, 2.59) p <0.001, uncontrolled blood pressure; -2.70(−3.76,-1.67) p <0.001, Sindhi ethnicity; -1.79(−3.25,-3.27) p 0.01 and pukhtoon ethnicity; -2.72(−4.13,-1.32) p <0.001 were significantly associated with knowledge score.
Knowledge about hypertension in hypertensive patients is not adequate and is alarmingly poor in patients with uncontrolled hypertension. More emphasis needs to be made on target blood pressure and need for taking antihypertensives for life to patients by physicians.
Hypertension (HTN) is one of the most common medical disorders, associated with an increased incidence of all-cause and cardiovascular disease (CVD) mortality. Fifty-four per cent of strokes and 47% of cardiac deaths are attributed to suboptimal blood pressure control. Despite presence of a variety of antihypertensive medications hypertension remains uncontrolled. Data on 22,282 patients, from national and regional blood pressure control and antihypertensive pharmacotherapy prescribed in cardiology practice quotes figure of overall 21.2% controlled hypertension. The control rates of hypertension in patients presenting to primary care range from 37% in Italy to 65% in South Africa and Canada[4–7]. According to a survey in 2010 control rates of hypertension are barely 6% in primary health care settings of Pakistan.
According to the National Health Survey of Pakistan (NHSP) the prevalence of HTN amongst adults >15 yrs was 17.9% and amongst them only 3% had their BP under control as opposed to a prevalence of 28.7% and control of around 31% being reported from US[9, 10]. Hence there is sharp contrast in the control of hypertension in between the two countries. Several studies have been conducted to identify these factors and they have been broadly classified into patient-related and physician related factors. Physician related factors responsible for control of hypertension include practice patterns of the physicians, their knowledge base and perceptions about the care delivered by them.
The NHSP showed that 70% of all hypertensive in Pakistan are unaware if their condition. Knowledge regarding control of hypertension including preventive mechanisms, factors affecting control of hypertension like diet, physical activity and insight into measures which can prevent complications of hypertension, have not been studied in depth in our population. There are studies done on medical students and physicians on their knowledge about hypertension but there is limited data from patients. Some studies have been done on awareness in hypertensive patients in Pakistan, however these have mainly focused on risk factor identification for hypertension and not primarily on control of hypertension[13, 14]. We therefore designed this study to elucidate the knowledge about hypertension in hypertensive patients at three tertiary care centers in Karachi. Secondly we sought to compare the knowledge of patients with uncontrolled hypertension and controlled hypertension.
Study design and population
It was a crossectional study conducted at three tertiary care hospitals in Karachi; Aga Khan Hospital, Ziauddin Hospital and Civil Hospital Karachi. The Aga Khan Hospital is a 577 bedded facility, which provides high quality of patient care in a broad range of secondary and tertiary services to over 50,000 hospitalised patients and to approximately 600,000 outpatients annually. It is located in the center of Karachi. The Ziauddin hospital is a 300 bedded hospital and is located in north of Karachi. The Civil hospital is a