Abstract
Objective
This study aimed to assess the prevalence and awareness of hypertension among adults with and without a prior hypertension diagnosis.
Methods
This was a cross-sectional study. The study included adults who presented to the Family Health Centers (FHCs) and was completed with 1,360 participants. Data were collected with a sociodemographic and descriptive characteristics form, a blood pressure measurement and hypertension awareness form, and the Medication Adherence Self-Efficacy Scale–Short Form. Blood pressure measurements were performed in accordance with the guidelines. If the measured blood pressure was in the hypertensive range, the participant was invited for a follow-up.
Results
Mean age was 57.5 ± 13.6 years; 61.5% were women. Percent 44.6 of the participants had diagnosed hypertension. Among those with hypertension, 93.7% were taking antihypertensive medication. Approximately half of the participants perceived their blood pressure as lower. High blood pressure was observed with and without diagnosis of hypertension, respectively, 41.5% and 21.5%. These participants were invited for a follow-up blood pressure measurement, and 46.6% returned for the follow-up. At follow-up, a decrease in blood pressure was observed in 80.8% of those with a diagnosis of hypertension and in 57.0% of those without a diagnosis of hypertension, and medication adherence improved. Additionally, at follow-up, 9.8% received a new diagnosis of hypertension and 17.0% were modified their antihypertensive treatment regimen.
Conclusions
Follow-up and counselling-based interventions implemented in FHCs are effective in improving blood pressure control and increasing treatment adherence. There is a clear need for FHC-based screening and awareness programs, as well as longer-term interventions and follow-up studies.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12889-026-27410-4.
Keywords: Blood pressure, Hypertension, Screening, Prevalence, Adults, Family health centers, Follow-up measurement, Awareness, Medication adherence
Introduction
Hypertension is a leading preventable risk factor for cardiovascular disease and all-cause mortality worldwide [1]. It is estimated that hypertension affects 33% of adults aged 30–79 years worldwide [2]. The prevalence of hypertension is increasing globally due to population ageing and increased exposure to lifestyle-related risk factors such as unhealthy diets (i.e. high sodium and low potassium intake) and lack of physical activity. However, changes in the prevalence of hypertension are not uniform worldwide. Over the past twenty years, high-income countries have experienced modest decreases in hypertension prevalence, whereas low-income and middle-income countries have experienced substantial increases [1].
As elsewhere in the world, hypertension is a common and important public health problem in Turkey. A hypertension study coordinated by the Turkish Society of Endocrinology and Metabolism was conducted in the seven geographical regions of Turkey, and the prevalence of hypertension was identified in 36.5% of the adult population. In the same study, the rate of hypertension awareness was 30%. Although the proportion of patients receiving antihypertensive treatment was 57.3%, the hypertension control rate was only 31.5% [3].
The International Society of Hypertension and the American Society of Hypertension have developed global practice guidelines for the management of hypertension in adults aged 18 years and older to reduce the global burden of high blood pressure. These guidelines were developed based on the best available evidence and have been made available to clinicians, nurses, and community health workers [4]. Internationally accepted hypertension guidelines have been evaluated in the context of Turkey, and their recommendations have been integrated to establish a common approach to the diagnosis and treatment of hypertension in adults [5–7].
In the World and Türkiye, guidelines define hypertension within different ranges in adults [2, 5–8]. The World Health Organization guidelines define hypertension as having systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or taking medication for hypertension. Additionally, controlled hypertension is defined as systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg in individuals taking medication for hypertension [2]. The guideline developed in the United States under the leadership of the American College of Cardiology and the American Heart Association define normal blood pressure as < 120 mm Hg systolic and < 80 mm Hg diastolic; elevated blood pressure as 120 to 129 mm Hg systolic and < 80 mm Hg diastolic; stage 1 hypertension as 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic; and stage 2 hypertension as ≥ 140 mm Hg systolic or ≥ 90 mm Hg diastolic [8]. In this study, analyses were conducted using the hypertension range specified in the current guidelines, which were developed under the leadership of the Turkish Society of Endocrinology and Metabolism in accordance with international guidelines. Blood pressure values below 120/80 mmHg are considered normal. A systolic blood pressure of 120–139 mmHg and/or a diastolic blood pressure of 80–89 mmHg is classified as the elevated blood pressure category (prehypertension). Blood pressure levels are classified as normal, prehypertension, stage 1 hypertension (140–159 and/or 90–99 mmHg), stage 2 hypertension (160–179 and/or 100–109 mmHg), and stage 3 hypertension (≥ 180 and/or ≥ 110 mmHg) (See Fig. 1) [7].
Fig. 1.
Blood pressure categories and corresponding perceived blood pressure levels according to guidelines
Early diagnosis, management, control, and follow-up of hypertension are recommended to be carried out within primary care services [2]. In Turkey, primary care services are delivered through Family Health Centers (FHCs). In FHCs, family physicians and family health nurses play an active role in hypertension screening and follow-up [9]. For individuals aged 18–40 years without a diagnosis of hypertension, blood pressure measurement once every three years is recommended, whereas annual measurement is recommended for all individuals older than 40 years and for those aged 18–40 years with high cardiovascular risk. For individuals with a diagnosis of hypertension, once target blood pressure has been achieved, blood pressure measurement is required every six months in those with high cardiovascular risk and once a year in those with low cardiovascular risk. Depending on blood pressure levels and clinical need, referral to a family physician or cardiologist is recommended [10].
Hypertension screening and follow-up activities are being carried out in FHCs; however, it has been observed that these activities have not reached the desired level of screening and follow-up. In a cross-sectional study including patients diagnosed with hypertension, approximately 20% reported receiving their diagnosis in an FHC, and about 60% stated that their follow-up was conducted in an FHC [11]. In another study evaluating the practices of family health workers regarding chronic diseases, 35% reported that they had measured the blood pressure of all healthy individuals at least once [12].
Previous studies have shown that approximately half or more of adults are not aware that their blood pressure is high and are diagnosed with hypertension incidentally [3, 13–15], and that approximately 40% to 80% of individuals with a diagnosis of hypertension who are receiving antihypertensive treatment do not have blood pressure values within the normotensive range [13–17]. This situation indicates that hypertension awareness is poor both among healthy individuals and among those with a diagnosis of hypertension. Therefore, in Turkey, it is recommended that all individuals over 18 years of age be invited to their registered FHC for hypertension screening; however, there appear to be disruptions in the implementation of this recommendation (Ministry of Health, 2025a).
Every effort should be made to reduce hypertension-related cardiovascular morbidity and mortality. Primary care facilities are the most accessible settings for determining the prevalence of hypertension and for assessing hypertension awareness and adherence to antihypertensive medication. The aim of this study was to assess the prevalence and awareness of hypertension among adults with and without a prior diagnosis who presented to two different FHCs located in the city center of Antalya. The following research questions were addressed:
What is the prevalence of hypertension among adults without a prior diagnosis of hypertension?
What are the blood pressure levels among adults with a diagnosis of hypertension, and is their blood pressure well control?
To what extent does hypertension awareness among adults with and without a diagnosis of hypertension correspond to their actual blood pressure status?
Among adults without a prior diagnosis of hypertension who were classified as having hypertension during screening and referred to a physician, what is the proportion who received a diagnosis of hypertension?
Among adults with a diagnosis of hypertension whose blood pressure was evaluated as ≥140/90 mmHg during screening and who were referred to a physician, what is the proportion who had a change in their treatment protocol?
Among adults with a diagnosis of hypertension whose blood pressure was evaluated as ≥140/90 mmHg during screening, did their blood pressure levels and adherence to antihypertensive medication change at follow-up?
Among adults without a diagnosis of hypertension whose blood pressure was evaluated as ≥140/90 mmHg during screening, did their blood pressure levels change at follow-up?
Methods
Design
This cross-sectional study was conducted and reported in accordance with the STROBE checklist (Strengthening the Reporting of Observational Studies in Epidemiology), which provides a framework for the conduct and reporting of observational epidemiological research [18].
Study setting and sampling
The study was conducted in two FHCs providing primary care services in the Muratpaşa and Kepez districts of Antalya: No. 9 Şehit Hemşire Canan Akkuş FHC and No. 17 Dt. Selahattin Topçu FHC. The study population comprised 39,800 adults aged 18 years and older registered with these two FHCs (20,500 and 19,300 individuals, respectively).
The study included adults (men and women) aged 18 years and older who presented to the FHCs for any health-care related reason on weekdays (Monday–Friday) between October and December 2024 and who volunteered to participate. All individuals who met the inclusion criteria were invited to take part, and the study was completed with 1,360 participants.
Study measures
Data were collected face-to-face using three instruments: (1) a data collection form on sociodemographic and descriptive characteristics (2), a blood pressure measurement and hypertension awareness form, and (3) the Medication Adherence Self-Efficacy Scale–Short Form (MASES-SF).
Sociodemographic and descriptive characteristics form
The sociodemographic and descriptive characteristics data collection form was developed by the researchers based on the literature. It included questions on age, sex, education level, marital status, smoking status, presence of diabetes, previous blood pressure measurement, the presence of physician-diagnosed hypertension, and the use of antihypertensive medication. You can find the form developed by the authors for this study, with its English version, in the supplementary file (Supplementary file 1).
Blood pressure measurement and hypertension awareness form
Blood pressure measurements were performed and noted in both arms by the researchers in accordance with the standards set out in the guidelines of the World Health Organization, the Turkish Society of Cardiology, and the Turkish Society of Endocrinology and Metabolism [2, 5–7].
All participants were asked the question, “In your opinion, what is your blood pressure level?” Hypertension awareness was assessed by comparing the measured blood pressure level with the participant’s self-perceived blood pressure level, using the classification shown in Fig. 1. You can find the form developed by the researchers based on the literature for this study, with its English version, in the supplementary file (Supplementary file 1).
Medication Adherence Self-Efficacy Scale-Short Form (MASES-SF)
This scale was used only in adults with a diagnosis of hypertension who were taking antihypertensive medication, in order to assess adherence to antihypertensive treatment. The Medication Adherence Self-Efficacy Scale–Short Form (MASES-SF) was revised and validated by Fernandez et al. in 2008 to measure self-efficacy beliefs related to adherence to prescribed antihypertensive medication in a population at high risk for hypertension-related morbidity and mortality [19].
The Turkish validity and reliability study of the MASES-SF was conducted in patients with hypertension attending a FHC [20]. In this scale, patients rate how confident they are in their ability to take their antihypertensive medication in various situations. It is a 13-item, four-point Likert-type scale. Each item is scored from 1 to 4 (1 = not at all sure, 2 = somewhat sure, 3 = quite sure, 4 = extremely sure). Higher scores indicate better medication adherence self-efficacy. The internal reliability coefficient of the Turkish version of the scale was 0.94. In this study, Cronbach’s alpha was 0.97 in both the pre-test and the follow-up measurement.
Data collection
The comprehensibility and feasibility of the data collection form were first tested in a pilot study with 30 adults who met the inclusion criteria. After the necessary revisions had been made, data collection for the study was initiated. Data from the pilot study were not included in the analyses. After written informed consent had been obtained, the data collection forms were completed face-to-face by the researchers. Completion of each form took approximately 5–10 min. Blood pressure measurements were also performed by the researchers in accordance with the relevant guidelines and recorded [4, 5, 7]. If the measured blood pressure corresponded to stage 1, 2, or 3 hypertension, the participant was immediately referred to their family physician or, if applicable, to the physician who was following them, and was invited to return for a follow-up blood pressure measurement one week later. If the participant did not attend the follow-up measurement within one month, they were contacted by telephone one month later and were asked about their current blood pressure level, whether they had received a new diagnosis of hypertension, and whether there had been any changes in their antihypertensive treatment. If the measured blood pressure was in the prehypertension range, participants were advised to have a follow-up blood pressure measurement performed after three months.
Data analysis
The data were analysed using IBM SPSS Statistics 23. Skewness and kurtosis values were examined, and since they were between − 2 and + 2, the data were considered to be normally distributed. Descriptive statistics (frequency, percentage, mean, and standard deviation) were used to summarize the data. For comparisons of means between independent groups, the independent samples t-test and one-way ANOVA were used. For comparisons of paired measurements, the paired samples t-test was used. For comparisons of categorical variables between independent groups, the chi-square test was used. The level of statistical significance was set at p < 0.05, and the confidence level was 95%.
Ethical considerations
Ethical approval for the study was obtained from the Clinical Research Ethics Committee of the Akdeniz University Faculty of Medicine (03.10.2024/633), and institutional permission was obtained from the Antalya Provincial Health Directorate (25.10.2024/257673890). In addition, written and verbal informed consent was obtained from all participants. The study was conducted in accordance with the principles of the Declaration of Helsinki.
Results
In this study designed to assess the prevalence and awareness of hypertension, the mean age of the participants was 57.5 ± 13.6 years; 61.5% were women, 82.4% were married, 48.1% had primary school education as their highest level of education, 24.2% were smokers, 33.3% had a diagnosis of diabetes, and 90.7% had previously had their blood pressure measured at least once. A total of 44.6% of the participants had physician-diagnosed hypertension. Among those with a diagnosis of hypertension, 93.7% were taking antihypertensive medication, while 6.3% reported not taking antihypertensive medication despite having a diagnosis (Table 1).
Table 1.
Descriptive characteristics
| With a diagnosis of hypertension | Without a diagnosis of hypertension | Total | |||||
|---|---|---|---|---|---|---|---|
| n | % | n | % | n | % | ||
| Sex | Women | 389 | 64,1 | 447 | 59,4 | 836 | 61.5 |
| Men | 218 | 35,9 | 306 | 40,6 | 524 | 38.5 | |
| Marital status | Married | 509 | 83,9 | 611 | 81,1 | 1120 | 82.4 |
| Singled | 98 | 16,1 | 142 | 18,9 | 240 | 17.6 | |
| Education level | Literate | 56 | 9,2 | 42 | 5,6 | 98 | 7.2 |
| Primary school | 336 | 55,4 | 318 | 42,2 | 654 | 48.1 | |
| Secondary school | 76 | 12,5 | 83 | 11,0 | 159 | 11.7 | |
| High school | 89 | 14,7 | 156 | 20,7 | 245 | 18.0 | |
| College | 46 | 7,6 | 140 | 18,6 | 186 | 13.7 | |
| Post graduate | 4 | 0,7 | 14 | 1,9 | 18 | 1.3 | |
| Smoking status | Yes | 131 | 21,6 | 198 | 26,3 | 329 | 24.2 |
| No | 432 | 71,2 | 493 | 65,5 | 925 | 68.0 | |
| Quitted | 44 | 7,2 | 62 | 8,2 | 106 | 7.8 | |
| Presence of diabetes | Yes | 281 | 46,3 | 172 | 22,8 | 453 | 33.3 |
| No | 326 | 53,7 | 581 | 77,2 | 907 | 66.7 | |
| Status of previously having a blood pressure measurement at least once | Yes | 607 | 100,0 | 627 | 83,3 | 1234 | 90.7 |
| No | 0 | 0,00 | 126 | 16,7 | 126 | 9.3 | |
| Use of antihypertensive medication | Yes | 569 | 93,7 | 0 | 0,00 | 569 | 41.8 |
| No | 38 | 6,3 | 753 | 100,0 | 791 | 58.2 | |
| Measured blood pressure levels | Normal | 130 | 21,4 | 290 | 38,5 | 420 | 30.9 |
| Elevated blood pressure (prehypertension) | 225 | 37,1 | 301 | 40,0 | 526 | 38.7 | |
| Stage 1 hypertension | 161 | 26,5 | 119 | 15,8 | 280 | 20.6 | |
| Stage 2 hypertension | 74 | 12,2 | 39 | 5,2 | 113 | 8.3 | |
| Stage 3 hypertension | 17 | 2,8 | 4 | 0,5 | 21 | 1.5 | |
| Self-perceived blood pressure levels | Normal | 360 | 59,3 | 603 | 80,1 | 963 | 70.8 |
| Slightly above normal | 139 | 22,9 | 107 | 14,2 | 246 | 18.1 | |
| High (Stage 1 hypertension) | 100 | 16,5 | 40 | 5,3 | 140 | 10.3 | |
| Very high (Stage 2–3 hypertension) | 8 | 1,3 | 3a | 0,4 | 11 | 0.8 | |
| The correspondence between participants’ perceived and measured blood pressure levels | Correspondence | 248 | 40,9 | 367 | 48,7 | 615 | 45.2 |
| Underestimate | 333 | 54,9 | 371 | 49,3 | 704 | 51.8 | |
| Overestimate | 26 | 4,3 | 15 | 2,0 | 41 | 3.0 | |
| Did a follow-up blood pressure measurement needed? | Yes | 252 | 41,5 | 162 | 21,5 | 414 | 30.4 |
| No | 355 | 58,5 | 591 | 78,5 | 946 | 69.6 | |
| Total | 607 | 44.6 | 753 | 55.4 | 1360 | 100.0 | |
| If a follow-up blood pressure measurement was needed, did they have it? | Yes | 125 | 49.6 | 68 | 42.0 | 193 | 46.6 |
| No | 127 | 50.4 | 94 | 58.0 | 221 | 53.4 | |
| Total | 252 | 60.9 | 162 | 39.1 | 414 | 100.0 | |
| Reason for not taking follow-up blood pressure measurement | Could not be reached | 96 | 75.6 | 79 | 84,0 | 175 | 79.2 |
| Thinking it was unnecessary | 10 | 7.9 | 13 | 13,8 | 23 | 10.4 | |
| Not going to the doctor and monitoring themselves at home | 18 | 14.1 | 1 | 1,1 | 19 | 8.6 | |
| Not having the opportunity to come to the FHC | 3 | 2.4 | 1 | 1,1 | 4 | 1.8 | |
| Total | 127 | 55.4 | 94 | 44.6 | 221 | 100.0 | |
| Did the blood pressure level change compared to the first assessment in the follow-up measurement? | Increased | 5 | 4.0 | 2 | 2.9 | 7 | 3.6 |
| Decreased | 101 | 80.8 | 39 | 57.4 | 140 | 72.6 | |
| Unchanged | 19 | 15.2 | 27 | 39.7 | 46 | 23.8 | |
| Total | 125 | 64.7 | 68 | 35.3 | 193 | 100.0 | |
High blood pressure (systolic ≥ 140 and/or diastolic ≥ 90 mmHg) was observed in 41.5% of participants with a diagnosis of hypertension and in 21.5% of participants without a diagnosis of hypertension; these participants were referred to a physician and invited to return one week later for a follow-up blood pressure measurement. Among the 414 participants with high blood pressure, 46.6% (n = 193) returned for the follow-up blood pressure measurement, whereas 221 did not attend the follow-up visit for various reasons. Among those who returned for follow-up, a decrease in blood pressure was observed in 80.8% (n = 101) of those with a diagnosis of hypertension and in 57.0% (n = 39) of those without a diagnosis of hypertension (Table 1).
Among participants with a diagnosis of hypertension, 41.5% (n = 252) had high measured blood pressure (systolic ≥ 140 and/or diastolic ≥ 90 mmHg), whereas 17.8% (n = 108) perceived their blood pressure as high. In this group, 23.7% (n = 144) had high measured blood pressure but perceived their blood pressure as normal. Among participants without a diagnosis of hypertension, 21.5% (n = 162) had high measured blood pressure, whereas 5.7% (n = 43) perceived their blood pressure as high. In this group, 15.8% (n = 119) had high measured blood pressure but perceived their blood pressure as normal (Table 1).
In this study, 54.9% of participants with a diagnosis of hypertension and 49.3% of those without a diagnosis of hypertension perceived their blood pressure to be in a lower category than it actually was. As shown in Fig. 1, blood pressure categories increase in the following order: normal, elevated blood pressure (prehypertension), stage 1 hypertension, stage 2 hypertension, and stage 3 hypertension. Approximately half of the participants in both groups perceived their blood pressure to be at least one category lower than the category indicated by their measured blood pressure (Table 1).
The correspondence between participants’ perceived and measured blood pressure levels was lower among male participants, those with primary school education as their highest level of education, those who had quit smoking, those with diabetes, those with a diagnosis of hypertension, those taking antihypertensive medication, those whose measured blood pressure was in the stage 2 hypertension range, those who perceived their blood pressure as normal, and those for whom a follow-up blood pressure measurement was required (Table 2).
Table 2.
Assessment of factors affecting the correspondence between self-perceived and measured blood pressure
| Correct estimate n(%) | Underestimate n(%) | Overestimate n(%) | Chi-Square | p* | ||
|---|---|---|---|---|---|---|
| Sex | Women | 415 (49.6) | 390 (46.7) | 31 (3.7) | 23,799 | < 0.000 |
| Men | 200 (38.2) | 314 (59.9) | 10 (1.9) | |||
| Marital status | Married | 496 (44.3) | 594 (53.0) | 30 (2.7) | 5586 | 0.061 |
| Singled | 119 (49.6) | 110 (45.8) | 11 (4.6) | |||
| Education level | Literate | 47 (48.0) | 48 (49) | 3 (3) | 25,553 | < 0.000 |
| Primary and secondary school | 328 (40.3) | 456 (56.1) | 29 (3.6) | |||
| High school | 120 (49.0) | 120 (49.0) | 5 (2.0) | |||
| College and above | 120 (58.8) | 80 (39.2) | 4 (2.0) | |||
| Smoking status | Yes | 177 (53.8) | 142 (43.2) | 10 (3.0) | 17,567 | 0.001 |
| No | 403 (43.6) | 495 (53.5) | 27 (2.9) | |||
| Quitted | 35 (33.0) | 67 (63.2) | 4 (3.8) | |||
| Presence of diabetes | Yes | 183 (40.4) | 254 (56.1) | 16 (3.5) | 6530 | 0.038 |
| No | 432 (47.6) | 450 (49.6) | 25 (2.8) | |||
| Presence of hypertension | Yes | 242 (41.2) | 321 (54.5) | 25 (4.3) | 10,641 | 0.005 |
| No | 373 (48.3) | 383 (49.6) | 16 (2.1) | |||
| Use of antihypertensive medication | Yes | 236 (41.5) | 308 (54.1) | 25 (4.4) | 10,261 | 0.006 |
| No | 379 (47.9) | 396 (50.1) | 16 (2.0) | |||
| Measured blood pressure levels | Normal | 395 (94.0) | 0 (0.0) | 25 (6.0) | 679,579 | < 0.000 |
| Elevated blood pressure (prehypertension) | 140 (26.6) | 370 (70.3) | 16 (3.1) | |||
| Stage 1 hypertension | 69 (24.6) | 211 (75.4) | 0 (0.0) | |||
| Stage 2 hypertension | 6 (5.3) | 107 (94.7) | 0 (0.0) | |||
| Stage 3 hypertension | 5 (23.8) | 16 (76.2) | 0 (0.0) | |||
| Self-perceived blood pressure levels | Normal | 399 (41.4) | 563 (58.5) | 1 (0.1) | 157,238 | < 0.000 |
| Slightly above normal | 138 (56.1) | 89 (36.2) | 19 (7.7) | |||
| High (Stage 1 hypertension) | 68 (48.6) | 51 (36.4) | 21 (15.0) | |||
| Very high (Stage 2–3 hypertension) | 10 (90.9) | 1 (9.1) | 0 (0.0) | |||
| Did a follow-up blood pressure measurement needed? | Yes | 80 (19.3) | 334 (80.7) | 0 (0.0) | 203,320 | < 0.000 |
| No | 535 (56.6) | 370 (31.9) | 41 (4.3) |
*Chi-square
At pre-test, the mean systolic blood pressure was 154.96 ± 14.53 mmHg in participants with a diagnosis of hypertension and 153.00 ± 12.57 mmHg in those without a diagnosis of hypertension. At pre-test, the mean diastolic blood pressure was 87.32 ± 10.72 mmHg in participants with a diagnosis of hypertension and 84.08 ± 9.34 mmHg in those without a diagnosis of hypertension (Table 3).
Table 3.
Comparison of blood pressure and adherence with and without a hypertension diagnosis in pre-tests/post-tests
| Systolic blood pressure | Diastolic blood pressure | Adherence to medication | ||
|---|---|---|---|---|
| With and without diagnosis of hypertension | n | 193 | 193 | This section could not be evaluated because those without a diagnosis of hypertension did not take medication. |
| Pre-test Mean ± SD | 154,27 ± 13.87 | 88,74 ± 10.61 | ||
| Post-test Mean ± SD | 136,62 ± 12.48 | 82,12 ± 9.75 | ||
| t | 15,584 | 8,946 | ||
| p | < 0.000* | < 0.000* | ||
| With a diagnosis of hypertension | n | 125 | 125 | 146 |
| Pre-test Mean ± SD | 154,96 ± 14.53 | 87,32 ± 10,72 | 3,13 ± 0,66 | |
| Post-test Mean ± SD | 135,68 ± 12.67 | 81,06 ± 9,84 | 3,41 ± 0,56 | |
| t | 13,623 | 6,438 | −7,852 | |
| p | < 0.000* | < 0.000* | < 0.000* | |
| Without a diagnosis of hypertension | n | 68 | 68 | This section could not be evaluated because those without a diagnosis of hypertension did not take medication. |
| Pre-test Mean ± SD | 153,00 ± 12,57 | 91,35 ± 9,96 | ||
| Post-test Mean ± SD | 138,36 ± 12,01 | 84,08 ± 9,34 | ||
| t | 7,934 | 6,582 | ||
| p | < 0.000* | < 0.000* |
Notes: SD Standart deviation. *Paired sample t test
At follow-up, systolic and diastolic blood pressure decreased, and medication adherence improved among participants with and without a diagnosis of hypertension (Table 3). Among participants who attended the follow-up blood pressure measurement, 9.8% (n = 19) received a new diagnosis of hypertension and 17.0% (n = 33) had their antihypertensive treatment regimen modified.
Discussion
In this sample, nearly half of adults attending FHCs had a diagnosis of hypertension, and a minority of those with a diagnosis were not taking antihypertensive medication despite having a diagnosis of hypertension. According to global data, approximately 600 million adults (44%) with hypertension are unaware of their condition. In addition, about 630 million individuals (44%) have been diagnosed and are receiving treatment; however, only 320 million (23%) are able to keep their hypertension effectively under control. These figures indicate that there are substantial global gaps in the early diagnosis, awareness, and effective management of hypertension [15]. Previous studies have reported a marked discrepancy between measured and self-perceived blood pressure levels. These studies have shown that a considerable proportion of participants perceive their blood pressure to be lower than it actually is and that hypertension awareness is poor [21–23]. Similarly, a study conducted in Türkiye reported that one-third of participants had insufficient awareness of hypertension [23]. Taken together, global data and the findings of these studies suggest that blood pressure awareness remains inadequate across different populations and highlight the need for brief but effective interventions to improve individual awareness.
In this study, participants whose blood pressure was above the normal range at the initial measurement were referred to their family physician or the physician who was following them. In this group, both systolic and diastolic blood pressure decreased significantly at follow-up compared with the initial measurement, and adherence to antihypertensive medication improved. This finding suggests that blood pressure measurement, feedback, and referral can enhance not only awareness but also blood pressure control and adherence to antihypertensive treatment, and is consistent with previous studies [24, 25]. This study demonstrates the effectiveness of blood pressure measurement combined with feedback among adult participants.
The prevalence of hypertension was 44.6%. When this prevalence is compared with large-scale epidemiological studies conducted in Türkiye, it is evident that the prevalence of hypertension in the adult population remains high. In the Turkish Noncommunicable Diseases STEPS surveys, which provide national representativeness, the population prevalence of hypertension was reported as 16.2% in 2017 and 18.3% in 2023 [26]. In the TEMD Hypertension Study (2021), the prevalence was reported as 36.5% in a multicentre sample including approximately 9,000 adults from different regions [3]. The fact that the prevalence observed in this study is even higher than that reported in the TEMD and STEPS studies suggests that hypertension continues to be an important public health problem in Türkiye.
The higher prevalence of hypertension observed in this study may be attributable to the fact that the sample consisted predominantly of middle-aged and older adults, the high frequency of diabetes and smoking, and the inclusion of individuals attending FHCs, which may have led to a greater representation of high-risk groups. According to World Health Organization data, the prevalence of hypertension in adults worldwide is above 30%, and in the European region it ranges between 35% and 45% [2]. In this context, the findings of this study are consistent not only with national data but also with global trends.
Approximately half of the participants in both groups perceived their blood pressure to be at least one category lower than the category indicated by their measured blood pressure. In the national TEMD Hypertension Study, hypertension awareness was reported to be only around one-third, and international research likewise shows that hypertension is an important public health problem not only in terms of measured blood pressure but also in terms of perceived blood pressure. For example, in a population-based study conducted in China, only 37.3% of hypertensive individuals in Guizhou were aware of their condition, whereas in regions such as Shanghai and Beijing this proportion rose to 87–89% [27]. In a cohort study conducted in Tehran, 68.2% of hypertensive individuals were aware of their hypertension; however, the blood pressure control rate was 40.4% [28]. Furthermore, in the Navrongo study in Ghana, although 84% of individuals reported that they knew about hypertension, only 22.3% were aware that they themselves had hypertension; this finding indicates substantial gaps not only in knowledge but also in individual perception [29]. Taken together, these findings show that hypertension awareness is insufficient both in Türkiye and globally [13, 30]. Additionally, they support the importance of screening and follow-up activities implemented in FHCs. Therefore, screening and counselling programmes aimed at increasing hypertension awareness at both national and international levels are critical.
This study found that the correspondence between measured and perceived blood pressure was lower among men, individuals with lower levels of education, those with diabetes, and those taking antihypertensive medication. This lower correspondence may be related to low health literacy, a high burden of chronic disease, and insufficient counselling during the treatment process. Similarly, in a cohort study conducted in Tehran, men had lower rates of hypertension awareness, treatment, and control [28]. According to data from the Brazilian National Health Survey, women had significantly higher levels of hypertension awareness, treatment, and control, and hypertension control rates increased significantly among individuals with higher levels of education [31]. These findings provide international evidence that hypertension awareness, treatment, and control are poorer among men and individuals with lower educational attainment and are consistent with the findings of this study. Indeed, the literature also reports that men are more passive in their use of health services and that a lower level of education negatively affects hypertension awareness. Studies have shown that men with low socioeconomic status have lower levels of health knowledge and awareness, which in turn negatively affects their health-seeking behaviour [32, 33]. Based on our findings, the persistence of a lack of awareness even among individuals with a diagnosis of hypertension who are receiving treatment indicates that health professionals should not only perform measurements but also support individuals in interpreting their measurement results.
At follow-up, systolic and diastolic blood pressure decreased significantly among participants with and without a diagnosis of hypertension. The literature likewise reports that various interventions are effective in improving blood pressure control and adherence to antihypertensive medication. For example, mHealth applications have been associated with increases in medication adherence of up to 38.3%, and digital technologies have been found to be effective in providing personalised patient support [34]. Nurse-led interventions have also been shown to produce substantial improvements in blood pressure control, particularly when educational and counselling components are combined to enhance patients’ adherence to treatment [35]. The integration of technological advances into health care delivery also creates new opportunities. Remote patient monitoring systems and electronic health–based self-management interventions have been shown to lead to significant reductions in systolic and diastolic blood pressure [36]. Moreover, even in low-resource settings such as Nepal, mHealth interventions have resulted in improvements in blood pressure control [37]. Long-term follow-up studies underscore the importance of regularly monitoring medication use and changes in blood pressure and indicate that future research should focus on the integration of different intervention approaches and the use of digital technologies [38].
Another noteworthy finding of this study was that medication adherence increased at follow-up among participants with a diagnosis of hypertension. Numerous contextual factors influence medication adherence; among these, access to health care, treatment costs, and the scope of health insurance coverage are particularly prominent. The burden of chronic diseases, rising health expenditures, and broader public health challenges also directly affect adherence [39]. Therefore, for strategies aimed at improving medication adherence to be successful, it is important that these factors are addressed in a holistic and comprehensive manner [40]. Multifaceted approaches are required to improve patient outcomes. In this context, strengthening the education of health professionals and patients, using both active and passive communication methods, and collaborating with community-based organisations are of particular importance [39]. In this study, establishing direct and active communication with participants not only improved medication adherence but as evidenced by higher scores in pre-test and post-test comparisons, also clearly demonstrated the positive impact of counselling and awareness-raising.
One of the main strengths of this study is its large sample size. The large sample enhanced the reliability of the findings and strengthened the generalisability of the results. Conducting the study in a primary care setting meant that the findings could be directly reflected at the community level and facilitated the development of practical recommendations for health care delivery. In addition, the use of measurement methods consistent with national and international guidelines increased the comparability of the findings both within Türkiye and globally. By including not only individuals with a diagnosis of hypertension but also those without a diagnosis of hypertension, this study made it possible to identify differences in awareness and diagnostic processes, thereby providing an important contribution to public health.
Limitations
This study has several limitations. First, while relationships between variables could be examined, the cross-sectional design precludes causal inference. In addition, the short follow-up period (repeat measurements between 1 week and 1 month) and the fact that 53.4% of participants did not attend the follow-up measurement may have introduced selection bias and reduced the representativeness of the results. Finally, obtaining some data—such as medication adherence and awareness—through self-report may have increased the risk of responder bias and limited the objectivity of the findings.
Conclusions and recommendations
This study once again demonstrates the high prevalence of hypertension and insufficient levels of awareness within the context of primary health care services. Despite having previously had their blood pressure measured, many participants underestimated their current blood pressure category, indicating gaps in health literacy and counselling. The findings suggest that follow-up and counselling-based interventions implemented in FHCs are effective in improving blood pressure control and increasing treatment adherence. Therefore, the expansion of FHC-based screening and awareness programmes should be considered an integral component of national strategies to combat hypertension.
Nevertheless, given the limitation of the short follow-up period in this study, there is a clear need for longer-term intervention and follow-up studies. Such studies are important for assessing the sustainability of the observed effects and for contributing to the development of targeted public health strategies for high-risk groups.
Supplementary Information
Acknowledgements
We are grateful to the individuals who volunteered to participate in this study.
Use of AI-assisted tools
AI-assisted tools were used solely for translation and language editing; no scientific content was generated by these tools. All authors reviewed and approved the final manuscript and take full responsibility for the content.
Abbreviations
- FHCs
Family Health Centers
- STROBE
Strengthening the Reporting of Observational Studies in Epidemiology
- MASES-SF
Medication Adherence Self-Efficacy Scale–Short Form
Authors’ contributions
Conceptualization: HO, SG and ADA: Data collection or processing: ADA and HO; Analysis: HO, SG and ADA; Writing—original draft: HO, SG and ADA; Supervision SG and HO. All authors read and approved the final manuscript.
Funding
Not applicable.
Data availability
The data are available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
Ethical approval for the study was obtained from the Clinical Research Ethics Committee of the Akdeniz University Faculty of Medicine (03.10.2024/633), and institutional permission was obtained from the Antalya Provincial Health Directorate (25.10.2024/257673890). In addition, written and verbal informed consent was obtained from all participants. The study was conducted in accordance with the principles of the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data are available from the corresponding author upon reasonable request.