High Prevalence of Uncontrolled Hypertension Among Afghan Hypertensive Patients: A Multicenter Cross-Sectional Study

Abstract

Background Despite striking advances in the management of hypertension, blood pressure (BP) control remains suboptimal worldwide. Sustainable Development Goals (SDGs) call for 80% control rates by 2030, highlighting the urgency for improvements in hypertension control. Objective We aimed to determine the prevalence of uncontrolled hypertension (≥140/90 mmHg) and assess its associated factors in Afghan hypertensive patients. Methods We conducted this multicenter cross-sectional study at three Afghan public hospitals in Afghanistan. We recruited hypertensive patients (n=950) on antihypertensive medications (AHMs) from August to December 2022. We analyzed only complete datasets (853). We employed the 14-item Hill-Bone compliance scale to assess compliance with AHMs. We performed multivariable logistic regression analyses to determine factors associated with uncontrolled hypertension. Results The mean age (±SD) of the patients was 47.5 (± 9.5) years and males constituted 50.5% (431) of the study sample. The prevalence of uncontrolled hypertension in this study was 77.3% (95% CI: 74.2–79.9%). Factors associated with uncontrolled hypertension and their adjusted OR (95% CI) were physical inactivity: 3.45 (1.87–6.35), current smoking: 3.04 (1.50–6.15), high salt intake: 3.57 (1.9–6.7), presence of comorbid medical disease: 2.22 (1.20–4.08), higher BMI: 3.32 (1.12–9.88), poor compliance to AHMs: 8.50 (4.62–15.6), and presence of depressive symptoms: 1.99 (1.2–3.27). Conclusion The prevalence of uncontrolled hypertension was high in the present study. Factors associated with uncontrolled hypertension may epitomize potential targets for public/individual health interventions in Afghanistan.

Prevalence of uncontrolled hypertension and contributing factors in Ethiopia: a systematic review and meta-analysis

“…Higher odds of uncontrolled HTN were reported in patients with diabetes mellitus (DM) and other diseases ( 56 , 63 , 65 , 66 , 71 , 77 , 78 ). A review of studies in SSA indicated a high burden of uncontrolled HTN among individuals with comorbidities ( 55 ).…”

“…This could be explained by the fact that patients with comorbidities often require multiple medications, which could increase the risk of side effects and medication non-adherence. Previous studies have revealed that poor adherence among patients with HTN is significantly associated with uncontrolled HTN ( 51 , 77 , 79 , 80 ). Moreover, limited access to quality healthcare services in developing countries can affect BP monitoring ( 55 ).…”

Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan

“…In resource-poor countries such as India, Ethiopia, and Uganda, the level of controlled BP among treated patients was 17.5% [ 7 ], 47.9% [ 8 ], and 18% [ 9 ], respectively. In Afghanistan (with its healthcare system still recovering from years of conflict), the national prevalence of uncontrolled hypertension is ~80%, warranting immediate attention [ 4 , 10 ].…”

“…The proportion of hypertensive patients with low compliance to AHMs was 37.7% in Pakistan [ 13 ], 49.6% in Iran [ 14 ], 39.5%% in Nigeria [ 15 ], 34.5% in Ethiopia [ 16 ], 67.7% in Cameron [ 17 ], 37.4% in Nepal [ 18 ], and 4%-81% in India [ 19 ]. In 2023, Baray et al showed that Afghanistan’s current proportion of hypertensive patients with low adherence to hypertension treatment is 42.1% [ 10 ]. In Afghanistan, the high prevalence of uncontrolled hypertension compounded with non-adherence to AHMs constitutes a significant public health problem.…”

“…Non-adherence to AHMs is associated with poor blood pressure control, which, in turn, potentially contributes to the development of uncontrolled hypertension. A study conducted in Afghanistan indicates that 77.3% of hypertensive patients had poor BP control [ 10 ]. The literature gap, however, does exist on the prevalence of non-adherence to AHMs and its predictors in Afghanistan.…”