 20.07(4.8) (p value <0.001).
Comparison of demographics and knowledge in patients with uncontrolled and controlled hypertension
On comparison of demographics of patients with controlled and uncontrolled hypertension, there was statistically significant difference in; Mean (SD) age (59.05 years (11.2) v 54.33 years (13.4)p <0.001), gender (38.3% males v 11.9% males p 0.03),> 10 years of formal education (38.7% v8.1% p <0.001). Comorbids and history of hospitalization is shown in Table 1.
On comparison of questions related to knowledge, there was statistically significant different in; meaning of hypertension (p <0.001), target SBP (p0.001), target DBP (p 0.001), importance 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) (Table 2).
On comparison of knowledge as a composite score between uncontrolled and controlled hypertensive; Mean (SD) was 21.85(4.74) v18.67 (4.70) (p value :< 0.001) Knowledge score on most of individual item questions between the two group was significantly different (Table 3).
On univariate linear regression for outcome of knowledge score; β(95% CI) was 0.064(0.026,0.102) for age, 1.79(0.89,2.69) for gender,-1.93(−3.3,-0.5) for sindhi ethinicity, -1.66(−3.23,-0.84) for Punjabi ethinicity, -2.22(−4.64,0.18) for balochi ethnicity, -2.84(−4.23,-1.44) for pukhtoon ethinicity, -0.95(−2.21,0.31) for Muhajir ethinicity, -0.99(−2.5,0.54) for education up to <5 years,-1.14(−2.68,0.39) for < 10 years of education, 0.75(−0.48,2.03) for >10 years of education, 0.47(−0.51,1.46) for history of hospitalization for uncontrolled hypertension, -3.17(−4.15,-2.19) for having uncontrolled hypertension. However 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 (Table 4).
We are first to report a knowledge score in patients with hypertension belonging to three different tertiary care hospitals in Karachi, Pakistan. We found that overall knowledge scores in hypertensive patients was not up to the mark. Furthermore scores in patients with uncontrolled hypertension were significantly low. The lowest scores were obtained to questions related to importance of systolic blood pressure versus diastolic blood pressure, high blood pressure being asymptomatic and high blood pressure being an unavoidable part of aging. Factors associated with knowledge scores were male gender, having uncontrolled hypertension and ethnicity. Interestingly formal education did not show any relation with high knowledge scores in these hypertensive patients. This suggests that specific knowledge about disease is needed and just education alone may not suffice.
Sufficient knowledge about hypertension in patients has been associated with greater medication adherence and better blood pressure control. Several knowledge based instruments have been tested for assessment of the same in hypertensive patients. However only one has been reported with specific item questions, the Hypertension knowledge interview schedule which is validated for the Spanish population. High blood pressure(HBP) Knowledge Test has been used as another validated instrument tested on Korean population. The item questions used in this test are comparable to what has been used in our study. A significant proportion of Korean Americans answered incorrectly on items about HBP symptoms and diagnosis, HBP medications, harmful effects of HBP over time, and the relationship between BP and cold weather. Similar responses have been obtained from hypertensive patients in Pakistan (South Asia). The reason for this lack of knowledge among patients is definitely a cause of concern. Besides the fact 