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. 2023 Mar 20;18(1):16. doi: 10.5334/gh.1190

Table 2.

Distribution of key findings.


AUTHOR OUTCOME AND MEASUREMENT KEY DETERMINANTS OF HYPERTENSION CONTROL KEY FINDINGS

Maginga et al., 2015
  • Medication adherence: MMAS-4

  • Knowledge: Self-developed pretested questionnaire

  • Good knowledge (OR = 2.50, 95% CI, 1.00–6.10, p = 0.047)

  • Attitudes (OR = 2.70, 95% CI, 1.00–7.10, p = 0.004)

  • Practices (OR = 5.40, 95% CI, 2.30–13.0, p < 0.001)

  • Patients (47.7%) had controlled hypertension.

  • Obesity and higher medication costs were associated with decreased control.

  • There was high adherence (56.0%) to medication.

  • Participants had moderate scores for knowledge (41.0%), attitudes (45.3%), and practices (49.3%).


Berhe et al., 2017
  • Medication adherence: MMAS

  • Other determinants: Self-developed questionnaire

  • Treatment at general hospitals (OR = 1.89, 95% CI 1.26–2.83)

  • Previously uncontrolled BP (OR = 0.30, 95% CI 0.21–0.43)

  • Treatment regimens with diuretics (OR = 0.68, 95% CI 0.50–0.94)

  • Age (OR = 0.99, 95% CI = 0.98–1.00)

  • BP was controlled in 37.0%, and treatment was intensified for 23.0% of patients with uncontrolled BP.

  • The antihypertensive medication adherence rate (MMAS ≥ 7) was 40.0% and 57.0% for the lower cutoff (MMAS ≥ 6).


Labata et al., 2019
  • Hypertension self-care practices: Adapted H-SCALE questionnaire

  • Normal weight (AOR = 1.82, 95% CI = 1.07–3.09) a predictor of medication usage

  • Good self-efficacy (AOR = 2.58, 95% CI 1.47–0.52) a predictor of a low-salt diet

  • Female predictor physical activity (AOR = 0.51, 95% CI 0.30–0.88) and nonsmoking (AOR = 3.62, 95% CI 1.21–10.85)

  • 61.9%, 30.5%, 44.9%, 88.3%, 93.5%, and 56.9% were adherent to medication, low-salt diet, physical activity, alcohol abstinence, nonsmoking, and weight management, respectively.

  • Adequate knowledge of hypertension was 2.58 times more likely, and females were less likely to adhere to physical activity.


Niriayo et al., 2019
  • Self-care behaviors: H-SCALE

  • Beliefs about medication: Belief about medicine questionnaire (BMQ)

  • Rural resident (AOR = 0.45, 95% CI: 0.21–0.97)

  • Comorbidity (AOR = 0.16, 95% CI 0.08–0.31)

  • Negative medication belief (AOR = 0.25, 95% CI 0.14–0.46)

  • Antihypertensive medications adherent (48.2%) and recommended physical activity (44.9%)

  • Female (AOR = 1.97, 95% CI 1.03–3.75) and lack of knowledge on self-care (AOR = 0.07, 95% CI 0.03–0.16) were associated with alcohol abstinence and a low-salt diet.


Berhe et al., 2020
  • Adherence to self-care activities: H-SCALE

  • Age ≥ 50 years (AOR = 2.33, 95% CI 1.25, 4.35)

  • Nonadherence to antihypertensive medication (AOR = 1.82, 95% CI 1.08–3.04)

  • Nonadherence to physical exercise (AOR = 1.79, 95% CI 1.13–2.83)

  • Nonadherence to low-salt diet (AOR = 1.98, 95% CI 1.18–3.31)

  • Nonadherence to weight management (AOR = 2.06, 95% CI 1.31–3.23)

  • Prevalence of uncontrolled hypertension was found to be 48.6%.

  • 26.1%, 59.1%, 73.9%, and 38.6% of hypertensive patients were nonadherent to medication, physical exercise, low-salt diet, and weight management, respectively.


Gebremichael et al., 2019
  • Self-care practice: H-SCALE

  • Knowledge: Hypertension evaluation of lifestyle and management (HELM) scale

  • Sex (AOR = 2.25, 95% CI 1.09–4.65)

  • Age (AOR = 3.26, 95% CI 1.03–10.35)

  • Educational status (AOR = 4.20, 95% CI 1.30–13.55)

  • Disease duration (AOR = 3.12, 95% CI 1.20–8.10)

  • BP status (AOR = 2.72, 95% CI 1.25–5.92)

  • Knowledge (AOR = 6.19, 95% CI 2.90–13.21)

  • Good self-care practice was only found among 20.3% of patients.

  • Adherence to not smoking, antihypertensive medication, alcohol abstinence, dietary management, physical exercise, and weight management was found to be 99.1%, 74.1%, 67.2%, 63.1%, 49.4%, and 40.6%, respectively.


Okai et al., 2020
  • Blood pressure control: Pretested self-developed questionnaire with expert opinion

  • Sex (AOR = 3.53, 95% CI 1.73–7.25)

  • Educational at junior high school (AOR = 3.52, 95% CI 1.72–7.22)

  • Senior and junior high school (AOR = 2.64, 95% CI 1.40–6.66 and AOR = 3.06, 95% CI 1.03–6.67)

  • Comorbidity (AOR = 2.41, 95% CI 1.32– 4.42)

  • Increased pill burden (AOR = 0.27, 95% CI 0.10–0.73)

  • Length of diagnosis of 2–5 years (AOR = 0.32, 95% CI 0.18–0.57)

  • No comorbidities (18.0%) had achieved hypertension control.

  • Dyslipidemia (8.9%) had controlled hypertension (p < 0.006).

  • Taking a higher number of antihypertensive pills per day was also associated with a reduced likelihood of attaining hypertension control.

  • Most patients reported forgetfulness, side effects of medication, and high pill burden as reasons for missing their medications.


Herskind et al., 2019
  • Medication adherence: Medication possession ratio

  • Patients were most likely to cite transportation (81.0%), financial burden (69.0%), and schedule conflicts with work or other prior commitments (25.0%) as barriers to care.

  • Forgetfulness (12.0%) and lack of symptoms (9.0%) were challenges that patients reported facing in attending follow-up appointments.

  • Home visits (13.0%), outreach (13.0%), and phone or mobile reminders (12.0%) were strategies to improve adherence.


Adidja et al., 2018
  • Medication adherence: MMAS

  • Forgetfulness (AOR = 7.90, 95% CI 3.00–20.80)

  • Multiple daily doses (AOR = 2.50, 95% CI 1.20–5.60)

  • Financial constraints (AOR = 2.80, 95% CI 1.10–6.90)

  • Adverse drug effects (AOR = 7.60, 95% CI 1.70–33.0)

  • Participants (67.7%) were nonadherent to medications.

  • BP was controlled in only 21.3% of participants and was better in those who were adherent to medication (47.5%, p < 0.010).


Gebrezgi et al., 2017
  • Facilitators and barriers to self-care: Self-developed interview guide and focus group discussion guide

  • Individual factors: economic barriers, stress, nonadherence to medications due to the use of traditional remedies, and difficulties and misconceptions about following physical activity guidelines influenced self-care.

  • Individual knowledge, family, and government support were important factors to the patient’s success in the personal hypertension management.


Ware et al., 2019
  • Predictors of hypertension prevalence and management: World Health Survey (WHS, 2002–2004; 70 countries)

  • Waist-to height ratio > 0.5 and diabetes comorbidity were the most significant predictors of hypertension presence, awareness, and treatment.

  • Women and individuals reporting lower salt use were more likely to be aware of and treated for hypertension.

  • Older age, larger waist-to-height ratio, lower levels of education, and diabetes comorbidity were also predictive of individuals with hypertension being aware of their status.

  • Older age, female sex, larger waist-to-height ratio, diabetes comorbidity, lower levels of education, and not adding salt to food at the table were predictive of current antihypertensive medication use.


Mohamed et al., 2018
  • World Health Organization’s STEPs survey methodology tool

  • Among those aware, only 26.9% were on treatment, and 51.7% among those on treatment had achieved blood pressure control.

  • Factors associated with hypertension were older age, higher BMI, and harmful use of alcohol.

  • The overall age-standardized prevalence for hypertension was 24.5%.

  • Only 15.6% were aware of their elevated blood pressure.

  • Factors associated with awareness were older age (p = 0.013) and being male (p < 0.001).


Adeniyi et al., 2016
  • Uncontrolled hypertension: Self-developed questionnaire

  • Unemployed status (p < 0.001)

  • Excessive alcohol intake (p = 0.007)

  • Consumption of a Western-type diet (p < 0.001)

  • Independent determinants of uncontrolled hypertension were unemployment, current excessive drinker of alcohol and adherence to Western-type diet.


Legends: AOR = adjusted odds rations; BMI = body mass index; BMQ = belief about medicine questionnaire; CI = confidence interval; HELM = hypertension evaluation of lifestyle and management; MMAS = Morisky Medication Adherence Scale; WHS = World Health Survey.