han awareness overall in this group of patients is limited, and even worse in patients who have uncontrolled hypertension. The factors related to this lower level of knowledge are multiple as shown in the current study. However, this patient population is not aware about the target blood pressure on treatment, that antihypertensives are to be taken for life and that control of both systolic and diastolic blood pressure is important.
Less than 75% of people prescribed drugs for hypertension continue using them after 6 months after initiation, and this is associated with an increased risk of hospitalization for cardiovascular problems. Knowledge about target blood pressure among hypertensive patients is also inappropriate in the European high-risk population of coronary in patients. A similar study conducted in aprimary care setting in United States concluded that setting target BPs may promote hypertension self-management in high-risk patient population. This clearly indicates that apart from lack of appropriate health education, there seems to be a lack of transfer of knowledge by physicians to patients and requires exploration. Role of physicians has been critiqued in several studies in terms of lack of knowledge and practice of treating hypertension[30–32]. We found that factors associated with knowledge scores were male gender, having uncontrolled hypertension and ethnicity. The reasons of better scores in men could be limited opportunities available to women in a society with deep rooted gender bias against girls. The knowledge scores show negative associations with all the ethnic groups in our study, however these were more pronounced for balochi and pukhtoon. The reason for this could be that both these are less developed compared to the rest.
The strength of this study is that it is multi centered study focusing on in depth analysis of knowledge regarding hypertension. It points out specific aspects on knowledge about hypertension, by taking care of which the hypertensives may have better blood pressure control. There are several limitations to this study. Firstly the results from this study cannot be generalized to the rural population in Pakistan. Hence similar studies need to me conducted in rural areas as well. Secondly the questionnaire used for knowledge assessment was not validated; however it was pretested before using. Thirdly blood pressure reading at a single occasion was used for classifying patients into controlled and uncontrolled hypertension. Fourthly we did not account for white coat effect while making this classification. Although the research staff was trained in recording the responses of the item questions, the possibility of a small percentage of interviewer bias cannot be completely ruled out. Additionally we did not measure compliance to antihypertensive therapy in this patient population. However adherence related questions were asked and will be reported elsewhere.
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. Alternatively group education of such patients needs to be tested as an intervention to improve knowledge on these aspects in addition to the risk factors of hypertension.
Kaplan RC, Heckbert SR, Furberg CD, Psaty BM: Predictors of subsequent coronary events, stroke, and death among survivors of first hospitalized myocardial infarction. J Clin Epidemiol. 2002, 55 (7): 654-664. 10.1016/S0895-4356(02)00405-5.
Lawes CM, Vander Hoorn S, Rodgers A: Global burden of blood-pressure-related disease, 2001. Lancet. 2008, 371 (9623): 1513-1518. 10.1016/S0140-6736(08)60655-8.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J: Global burden of hypertension: analysis of worldwide data. Lancet. 2005, 365 (9455): 217-223.
Bramlage P, Bohm M, Volpe M, Khan BV, Paar WD, Tebbe U: A global perspective on blood pressure treatment and control in a referred cohort of hyperte