Poorly controlled hypertension among adults treated for hypertension in Tshwane District, South Africa

BACKGROUND: Adequate control of hypertension (HTN) is essential to prevent complications such as cardiovascular and kidney diseases. Despite the use of established clinical protocols on the treatment of HTN in primary health facilities in South Africa, the HTN of many patients remains poorly controlled. The objectives of this study were to determine the prevalence of poorly controlled HTN as well as identify related associated risk factors in a sample of adult attendees in primary health care facilities. METHODS: A cross-sectional study was conducted among adult hypertension clinic attendees at primary health care facilities in Tshwane District, South Africa. Data were collected using the WHO Stepwise instrument on chronic disease risk factor surveillance and anthropometric and blood pressure (BP) measurements. Stata Version 13 was used for data analysis. RESULTS: Of the 327 patients who participated in the study, 72.2% were female and 27.8% were male. Their mean age was 56 years (SD = 10.8 years). The prevalence of uncontrolled HTN was 58%, with the mean systolic BP and diastolic BP of 142.18 and 87.43, respectively. The prevalence of poorly controlled HTN increased with age. Factors associated with poorly controlled HTN were age, gender, being unemployed, source of income, smoking, alcohol use, lack of physical activity, and skipping of medication. By multi-variate analysis, both the mean systolic and diastolic blood pressures were found to be significantly associated with poorly controlled BP. CONCLUSION: The high prevalence of poorly controlled BP among patients who are on treatment suggests the need to re-consider the appropriateness of the current integrated management and treatment of HTN used in primary health care facilities in South Africa. The results suggest that the established clinical protocols and standard treatment for HTN are not beneficial for all patients and that physicians should use the treatment response of individual patients to make clinical decisions.