Evaluating Risk Profiles and Treatment Modalities for Hypertension: Factors Associated with Uncontrolled Blood Pressure at a Primary Health Center
TL;DR
Inadequate therapy, family history, risk classification, and age are significant factors associated with uncontrolled hypertension, and salt restriction was associated with lower odds of uncontrolled hypertension.
Abstract
Background: Hypertension remains a significant global health challenge, with approximately 31.1% adults worldwide suffering from it. In Indonesia, community health centers are at the forefront in controlling hypertension. However, the prevalence of hypertension in Indonesia remains high. Identification of risk factors and treatment-related issues is needed to predict uncontrolled hypertension. This study aimed to evaluate the relationships between various risk factors, adherence to therapeutic evaluation guidelines, and hypertension control status. Furthermore, this study examines factors associated with uncontrolled hypertension among patients at community health centers. Methods: A cross-sectional analytic study involved 295 adult hypertensive patients from community health centers. Data included demographic characteristics, cardiovascular risk factors, lifestyle factors, hypertension risk classification, and therapy evaluation adherence based on established guidelines. Inadequate therapeutic evaluations include withholding combination therapy. Bivariate analyses (Pearson Chi-square and Mann-Whitney) were performed, followed by multivariate binary logistic regression to identify significant odds ratios. Results: The prevalence of uncontrolled hypertension was 64.7%. In multivariate analysis, factors that increased the odds of uncontrolled hypertension were older age (aOR 1.082; 95% CI 1.042-1.124; p<0.001), higher hypertension risk classification (aOR 2.156; 95% CI 1.142-4.069; p=0.018), hypertension family history (aOR 2.925; 95% CI 1.409-6.072; p=0.004), and especially inadequate therapy (aOR 4.902; 95% CI 2.353-10.212; p<0.001). Conversely, salt restriction (aOR 0.352; 95% CI 0.179-0.694; p=0.002) was protective against uncontrolled hypertension. Other clinical factors (hypercholesterolemia, hyperuricemia, and diabetes mellitus) were not significant in the model. Conclusion: Inadequate therapy, family history, risk classification, and age are significant factors associated with uncontrolled hypertension. Salt restriction was associated with lower odds of uncontrolled hypertension. Treatment concordance has the highest odds ratio. This demonstrates that the importance of community health centers extends beyond lifestyle change agents; guideline-based therapy monitoring is also crucial.