Factors leading to uncontrolled blood pressure in patients taking antihypertensive medication in Mafeteng, Lesotho

Abstract

In 2015, the World Health Orhanisation (WHO) stated that 1.13 billion people worldwide suffer from hypertension, with the African region having the highest prevalence of approximately 46.0%, and the American region the lowest prevalence with 35.0%. With this high prevalence of hypertension in Africa, a number of studies have revealed that there is a high prevalence of uncontrolled blood pressure (BP) in the Sub-Saharan African countries. Although treatment of hypertension is available in Lesotho, it was found to be one of the countries with a high prevalence of uncontrolled BP. The aim of this study was to determine the factors that lead to uncontrolled BP in patients taking antihypertensive medication in an outpatient setting in Mafeteng, Lesotho. In order to achieve the objectives of the study, a literature review and an empirical investigation were conducted. The literature study gave an overview of BP control around the world, factors that affect BP control and measures to improve BP control. For the empirical investigation, an observational, cross-sectional study was conducted at Mafeteng Government Hospital from October 2018 to December 2018 where 176 hypertensive patients (80.1% females) were enrolled in the study. Data was obtained through face-to-face interview using a structured questionnaire. The mean age of participants was 61.2 ±12.93 years and most of them were aged ≥60 (60.8%); the mean systolic blood pressure (SBP) was 145.2 ±23.7; and the mean diastolic blood pressure (DBP) was 88.5 ±11.9. In investigating patient-related factors leading to uncontrolled BP, it was found that about 30.1% of participants had comorbidities; 61.4% had uncontrolled BP; 90.3% adhered sub-optimally to their antihypertensive medication; 36.9% sub-optimally kept to their scheduled appointments; 65.9% consumed moderate to high amounts of salt; 86.4% followed a special diet; 85.8% engaged in physical activity; 18.2% consumed alcohol; and 18.8% were smokers. In investigating facility-related factors leading to uncontrolled BP, it was found that amongst participants with uncontrolled BP, the doctors’ adherence to the Lesotho standard treatment guidelines was questionable in 13.0% (n=108); 66.7% had not received patient education from healthcare professionals; 5.6% had not received some/all their antihypertensive medication on the day of interview; and 43.5% and 35.2% had seldom and often, respectively, experienced stock-outs of antihypertensive medication at the hospital pharmacy. In conclusion, it was found that the rate of uncontrolled BP at the study setting is high. It can be attributed to the following: sub-optimal medication adherence, sub-optimal appointment keeping, presence of comorbidities, moderate to high consumption of salt, questionable adherence to Lesotho standard treatment guidelines by doctors, lack of patient education by healthcare professionals and frequency of stock-outs of antihypertensive medication at the hospital pharmacy.