that the physicians’ role has been critical, lack of proper health infrastructure, less resources and almost a non existing health education system through media are several other factors complicating the situation.
Gaps in knowledge have been reported with regard to risk factors associated with hypertension in 110 university students in a crossectional study conducted in Gulf region. Nationality, course of study, raised blood pressure, and history of diabetes showed significant association with good knowledge, however their net effect was not significant by the Adjusted Odds Ratio. We report in this study the knowledge about hypertension in hypertensive patients belonging to three different hospital setups. In contrast we found significant association of knowledge with high blood pressure. The questions were focused not only on risk factors, but also on target blood pressure values, target organ damage, factors related to control of hypertension. This patient population with controlled hypertension comprised mainly of men, Urdu speaking ethnicity and those who were educated for more than 10 years. Previous studies have reported controlled hypertension to be associated with women[23, 24]. Additionally the control rates in this patient population is much better than what has been earlier reported in the National health survey of Pakistan(NHSP). The main reason behind this is that this data is from tertiary care setting whereas the NHSP is from the population across Pakistan. Multiple reasons exist, which are responsible for these variable control rates of hypertension. These comprise of physicians `overestimate control rates and limited efforts to control BP at BP values close to normal, lack of awareness on the patient side and non compliance to antihypertensives[25, 26].
Similar results have been reported from Karachi, Pakistan on hypertensive and normotensives[13, 14]. The focus in them was also risk factors of hypertension and normotensives were also included in the study. We have shown that knowledge rather than 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 co