In Iran, HTN has been the second leading cause of morbidity and mortality since 1990 (19, 20). In this country, the prevalence of HTN has been estimated to range from 27.7% (21) to 42.7% (22). Effective control of people with HTN requires improving awareness among health professionals and the general public.
Unlike other studies, the patients were more aware of their disease in the present investigation (80.3%) (23). In addition, 78% of the hypertensive patients and 97% of those who were aware of their disease were treated. In other studies, these measures were found to be 40.9% (24) and 51.9% (25), respectively.
In the current research, BP was controlled in 53.6% of all patients and in 68.7% of those taking drugs. These values were similar to those of the study by Gandomkar et al. (69.1%) (14), but higher than those obtained by Li (23). Similar results were also obtained in a survey performed on the people aged 65–94 years in Germany. In that study, 80.2% of the patients knew that they had HTN and 74.4% of the patients and 92.8% of the informed individuals took antihypertensive drugs (26). The higher awareness in the present study might result from a better access to health care. Besides, the better treatment and control of the disease in this study compared to other studies might be due to the fact that a larger number of people followed the treatment plan because of the larger population that was aware of their disease. In one study, poor treatment status was mentioned due to lower SES, lower health literacy, and misconceptions about treatment (27). Given that about half of the patients had abnormal or uncontrolled BP, it could be justified that poor control of the disease was related to individual factors (asymptomatic disease and misconceptions) as well as health system factors (lack of antihypertensive drugs, long distance to medical centers, high cost of medicine, and shortage of skills and resources) (28).
In the present study, 19.2% of the patients were unaware of their status. Among the hypertensive patients who were aware of their disease and were taking medications, 66.72% had their disease controlled, but 30.32% had abnormal BP. Among those who did not take medications despite being aware of the disease, 2.94% had abnormal BP, which was on the contrary to the results of other investigations. Identifying the information of each of these subgroups might help researchers make better decisions to find the reason for not taking medications or controlling the disease and to find a solution for it.
The present study results showed that awareness, treatment, and control of HTN were higher among females and older individuals. These findings were consistent with those of other studies (22, 29), and might be due to the fact that these groups often refer to health centers to receive services (30).
In the present survey, education level was inversely associated with awareness, which was in line with the findings of the research by Malekzadeh (22). However, another study demonstrated that literacy was associated with better treatment (31). The inverse relationship might be due to the lower utilization of health services by the highly educated groups (32).
In the current study, physical activity was associated with awareness and control, while Rajati reported that it was only associated with treatment (33). In addition, higher BMI was directly related to all three outcomes. The higher level of awareness in obese people might result from receiving more attention from the health system (34).
In agreement with the current study findings, Zhang indicated that better disease control was inversely related to high cholesterol level (35). In addition, the present study findings revealed that the individuals who drank alcohol had lower awareness about their status, which was in line with the results obtained by Lv et al. (36).
The results of a previous research indicated that the patients with diabetes had higher awareness (35), which was consistent with the results of the current study. This study also showed that the individuals with a history of cardiovascular disease had higher awareness and better treatment and control, which was in agreement with the results of the study performed by Gandmakar et al. (31). Having other chronic diseases was associated with higher awareness and better control, too. In one study, people with diabetes, obesity, heart disease, and stroke were more likely to see a doctor and have their BP checked (26). In the present study, the patients who had a history of cardiovascular disease in their first- and second-degree relatives had higher awareness and better control. Nonetheless, the awareness and control levels were 50% lower among the individuals with a family history of chronic diseases in comparison to those without this condition. The findings of two prior studies showed that the people with a family history of HTN had a higher level of awareness (25, 37). This might imply that a family history of HTN might encourage people to check their BP. Physicians might also pay more attention to this group because they are at a higher risk for heart diseases (38).
This study had a few limitations. First, the cross-sectional design of the study made it difficult to rule out the inverse causation of variables. HTN risk factors such as stress and dietary habits have not been analyzed. Despite these limitations, the strong points of the study included its large sample size and precise collection of data regarding the potentially relevant demographic and lifestyle factors. Also, the relationship between family history of various diseases has been investigated while it has been less seen in other studies.