The SOCIO-Demography AND patients’ knowledge, attitudes and practice with regards to hypertension among a group of female hypertensiveS followed up in a tertiary care hospital in Sri Lanka


 Background

Hypertension is a silent killer. Differences between men and women in the pathophysiology, risks, and treatment of essential hypertension have been noted for many years. The aim of this study was to describe the socio-demography and knowledge, attitude and practice with regards to hypertension among female hypertensives.

Methodology

This was a cross sectional descriptive study conducted at Teaching Hospital Peradeniya. Data was collected by an interviewer administered structured questionnaire, and epidemiological patterns, risk factors and outcome were analyzed.

Results

113(43.4%) had at least one sibling while 102(39.1%) had at least one parent with hypertension. Mean BMI was 25.10 kg/m2 and mean waist circumference was 90.92cm. 60.3% were either overweight or obese. 67.6% had adequate amount of physical activity. History of PIH is reported in 17.69% of patients.

Conclusion

Majority of patients were currently on either ACEI or ARBs followed by diuretics. There is a delay in diagnosing hypertension and stresses the importance of early screening. Overweight and obesity is a significant problem. Majority of patients having target blood pressure control and good awareness about hypertension related complications.


Abstract Background
Hypertension is a silent killer. Differences between men and women in the pathophysiology, risks, and treatment of essential hypertension have been noted for many years. The aim of this study was to describe the socio-demography and knowledge, attitude and practice with regards to hypertension among female hypertensives.

Methodology
This was a cross sectional descriptive study conducted at Teaching Hospital Peradeniya. Data was collected by an interviewer administered structured questionnaire, and epidemiological patterns, risk factors and outcome were analyzed.
Results 113(43.4%) had at least one sibling while 102(39.1%) had at least one parent with hypertension. Mean BMI was 25.10 kg/m2 and mean waist circumference was 90.92cm. 60.3% were either overweight or obese. 67.6% had adequate amount of physical activity. History of PIH is reported in 17.69% of patients.

Conclusion
Majority of patients were currently on either ACEI or ARBs followed by diuretics.
There is a delay in diagnosing hypertension and stresses the importance of early screening. Overweight and obesity is a significant problem. Majority of patients having target blood pressure control and good awareness about hypertension related complications. 3 Background Hypertension in general is defined as systolic blood pressure above 140 mmHg and diastolic blood pressure above 90mmHg (1)(2)(3)(4) and it is a highly prevalent cardiovascular risk factor which if uncontrolled leads to devastating complications including myocardial infarction, strokes, chronic kidney disease and peripheral vascular disease (5). Prevalence of hypertension among adult females in United States is 28.1% (6) and it is more than a quarter of the entire population and it is expected to increase by 13% between 2000 and 2025(7) making it a major contributing factor for cardiovascular disease, the leading cause of mortality among females (8,9) .
Hypertension is a silent killer which usually doesn't show many specific symptoms and usually diagnosed as an incidental finding, at screening and when patients present with complications (4,10). However there could be some symptoms which suggest a possibility of hypertension but patients may have ignored resulting in a delay in the diagnosis. Therefore it is important to assess the prevalence of these symptoms in order to improve public awareness which may help in early detection.  (14,15).Differences between men and women in the pathophysiology, risks, and treatment of essential hypertension have been noted for many years. (16) The recently demonstrated relationships between estrogens and improved endothelial function suggest that hormonal changes may still be important in the mechanism of hypertension in women. In addition, there are at least two other hemodynamic, non-hormonal differences that may also account for the behaviour of hypertension between the sexes-wave reflections and heart rate.

OBJECTIVES
The aim of this study was to describe the socio-demography, various presentations and common clinical symptoms, to assess the prevalence of modifiable and non modifiable cardiovascular risk factors, current pattern of practice of prescribing antihypertensives and patients' knowledge,attitude and practice with regards to hypertension in a cohort of hypertensives.

Study Design and Setting
This was a cross sectional descriptive study conducted at the Hypertension Clinic and the Professorial Medical Wards (Wards 7 and 8) of the Teaching Hospital Peradeniya, Sri Lanka among female patients who are followed up for chronic hypertension.

Criteria for Eligibility
Female patients who were aged above 20 years and diagnosed to have hypertension where blood pressure was 140/90 mmHg or higher at diagnosis and were on antihypertensive treatment for 6 months or more and were admitted to the Medical Wards or were attending the Hypertension clinic conducted weekly were randomly recruited. The exclusion criteria were patients who had been diagnosed with hypertension within 6 months, amputees, plastered patients in whom blood pressure measurement and anthropometric measurements could not be carried out, pregnant women or those who had given birth within six months of this interview. Individuals with neurological disorders that may interfere with their understanding of the questions regarding the survey interview were also excluded.
Ethical clearance was obtained from the Ethical Review Committee of the Faculty of Medicine, University of Peradeniya, Sri Lanka.

Sample Size
All female hypertensive patients who presented to the Teaching Hospital Peradeniya from August 2015 to December 2015.

Study Instrument, Data Collection and Variables
Demographic data, details of risk factors including family history of hypertension, alcohol consumption, smoking and level of physical activity, past obstetric history including history of PIH, history of contraceptive use, dietary habits and knowledge and attitude regarding hypertension was collected using an interviewer administered questionnaire. Brief physical examination including blood pressure measurement was conducted by investigators using standard techniques (18).
Height was measured as the maximum distance from the heels to the uppermost position of the head, with the individual standing barefoot wearing light clothing and in full inspiration using Harpenden stadiometer (Chasmors Ltd., London, UK) to the nearest 0.1cm. Body weight was measured using a weighing scale to the nearest 0.1kg. Results of routine investigations were recorded.

Data Analysis Method
Data were entered in a password protected computer using Microsoft Excel and it was analyzed using SPSS 20.  (Table 3). Majority was currently not on any contraceptives and 74% had never used any contraceptive (Table 4).

Results
Data regarding initially started drugs were available only in 159 patients. ACEI and ARBs were the most frequently used as initial antihypertensives. Majority of the patients were currently on either ACEI or ARBs followed by diuretics (Table 5).Most patients were on multiple drugs rather than a single drug (  (Table 7).

Discussion
Hypertension in female is a major concern world wide as it remains the major risk factor contributing for the most prevalent cause of death in female i.e. cardiovascular disease. About 31.5% of female deaths in the world are due to cardiovascular diseases including ischaemic heart disease and strokes (19  As hypertension is one of the most prevalent chronic conditions which require a long term and frequently lifelong treatment, antihypertensives use a major fraction of both the government and private health budgets (36). Therefore the selection of the best suitable antihypertensives according to latest guidelines should be a concern to achieve the treatment goals and to optimize the health budget. Majority (57.2%) of the subjects was started on either ACEI or ARBs at the beginning and 86.92% were currently of them followed by diuretics (40%) and CCBs (32.31% were aware that they were on antihypertensives and 75% revealed that they take their medications regularly. Among the 25% who do not take medications regularly, 62.5% disclosed that they forget to take them, 10.71% didn't like the side effects and 7.14% take them only when they get symptoms. Compliance of the patients should be increased by stressing out the importance of taking them and allocating a specific time to take medications in order to prevent missing the doses. 59.5% of the patents were aware that they were on lipid lowering drugs, 14.05% that they weren't and 26.45% were uncertain. 38.84% were aware that they were taking Aspirin and 38.02% were aware that they weren't. 81.4% were aware of the major complications of hypertension and 79.75% revealed that they were informed of them by a doctor or a nurse. 73.14% revealed that they were advised to change their life style in order to control their blood cholesterol level and blood pressure by a health care professional however public education can still be improved.

Consent for publication
Consent for publication was taken from all the participant prior to data collection and from all the authors of the study.

Availability of data and material
The data of the study is available with the authors of the study, and is secured with password protection for which only the authors have access to.

Competing interest
We declare that we have no competing interests.

Financial Disclosure:
The authors report no specific funding in relation to this research to disclose