.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 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 t