The Relationship between Health Literacy and Hypertension Control: A Cross-Sectional Study
Abstract
Background: Uncontrolled hypertension is a major public health problem among patients in developed and developing countries. The present study was conducted to investigate the prevalence and causes of uncontrolled hypertension to facilitate the design of more effective methods of hypertension control.
Methods: This cross-sectional study was conducted on 303 adults with hypertension. The Standard Health Literacy Questionnaire was used to collect data. Uncontrolled hypertension was ascertained based on the WHO definition. A multiple logistic regression model was used at a 95% confidence level. Variables considered were confounders including age, sex, marital status, family size, income (monthly mean), smoking (past or current), education level, and physical activity (times in a week).
Results: The mean (SD) age of the participants (n=303) was 59.3(12.7) years, and 57.4% were men. The prevalence of uncontrolled hypertension was 50.5%. The mean score of health literacy among patients with controlled hypertension was higher than that among patients with uncontrolled hypertension (64.83±23.72 vs 46.28±22.19; P<0.001). The odds of uncontrolled hypertension decreased by 3% in the patients (OR: 0.97; P=0.06). Adherence to treatment (OR: 0.13; P<0.001), salt consumption per package purchased per month (OR: 4.40; P=0.001), increased physical activity per hour per week (OR: 0.56; P<0.001), current or passive cigarette smoking (OR: 4.59; P=0.010), a positive history of chronic diseases (OR: 2.62; P=0.027), and increased family size (per 1 child) (OR: 0.57; P<0.001) were associated with uncontrolled hypertension.
Conclusion: The results showed a borderline association between increased health literacy and hypertension control. Additionally, increased salt consumption, reduced physical activity, small family size, and underlying diseases (eg, diabetes, chronic heart disease, and renal disease) could increase the odds of uncontrolled hypertension in Iranian society.
2. Arabzadeh S, Sadeghi M, Rabiei K, Sarrafzadegan N, Taheri L, Golshahi J. Determinants of uncontrolled hypertension in an Iranian population. ARYA Atheroscler 2014;10:25-31.
3. Abd El-Aty MA, Meky FA, Morsi MM, Al-Lawati JA, El Sayed MK. Hypertension in the adult Omani population: predictors for unawareness and uncontrolled hypertension. J Egypt Public Health Assoc 2015;90:125-132.
4. WHO. Hypertention: Key facts. https://www.who.int/health-topics/hypertension (25 August 2021).
5. CDC. Facts About Hypertension. https://www.cdc.gov/bloodpressure/facts.htm (14 October 2022).
6. Rezaei S, Mahmoudi Z, Sheidaei A, Aryan Z, Mahmoudi N, Gohari K, Yoosefi M, Hajipour MJ, Dilmaghani-Marand A, Soleimanzadehkhayat M, Gholami A, Mirab Samiee S, Moradi G, Larijani B, Farzadfar F. Salt intake among Iranian population: the first national report on salt intake in Iran. J Hypertens 2018;36:2380-2389.
7. Sakboonyarat B, Rangsin R, Kantiwong A, Mungthin M. Prevalence and associated factors of uncontrolled hypertension among hypertensive patients: a nation-wide survey in Thailand. BMC Res Notes 2019;12:380.
8. Hajjar I, Kotchen JM, Kotchen TA. Hypertension: trends in prevalence, incidence, and control. Annu Rev Public Health 2006;27:465-490.
9. Lima NK, Moriguti JC, Ferriolli E. Uncontrolled hypertension in older patients: markers and associated factors to masked and white-coat effect. J Geriatr Cardiol 2016;13:672-678.
10. Jafar TH, Gandhi M, Jehan I, Naheed A, de Silva HA, Shahab H, Alam D, Luke N, Wee Lim C; COBRA-BPS Study Group. Determinants of Uncontrolled Hypertension in Rural Communities in South Asia-Bangladesh, Pakistan, and Sri Lanka. Am J Hypertens 2018;31:1205-1214.
11. Masilela C, Pearce B, Ongole JJ, Adeniyi OV, Benjeddou M. Cross-sectional study of prevalence and determinants of uncontrolled hypertension among South African adult residents of Mkhondo municipality. BMC Public Health 2020;20:1069.
12. Tavousi M, Haeri-Mehrizi A, Rakhshani F, Rafiefar S, Soleymanian A, Sarbandi F, Ardestani M, Ghanbari S, Montazeri A. Development and validation of a short and easy-to-use instrument for measuring health literacy: the Health Literacy Instrument for Adults (HELIA). BMC Public Health 2020;20:656.
13. Amare F, Hagos B, Sisay M, Molla B. Uncontrolled hypertension in Ethiopia: a systematic review and meta-analysis of institution-based observational studies. BMC Cardiovasc Disord 2020;20:129.
14. Azizi F, Ghanbarian A, Madjid M, Rahmani M. Distribution of blood pressure and prevalence of hypertension in Tehran adult population: Tehran Lipid and Glucose Study (TLGS), 1999-2000. J Hum Hypertens 2002;16:305-312.
15. Najafipour H, Nasri HR, Rostamzadeh F, Amirzadeh R, Shadkam M, Mirzazadeh A. Prevalence and incidence of pre-hypertension and hypertension (awareness/control) in Iran: findings from Kerman coronary artery diseases risk factors study 2 (KERCADRS). J Hum Hypertens 2022;36:461-472.
16. Rabizadeh S, Gholami B, Mahmoudzadeh Kani S, Rajab A, Farrokhpour H, Esteghamati A, Nakhjavani M. Uncontrolled hypertension in patients with type 2 diabetes: What are the correlates? J Clin Hypertens (Greenwich) 2021;23:1776-1785.
17. Pakzad B, Akbari M, Baberi F. Prevalence, Awareness, Treatment, and Control of Hypertension in an Isfahan State Institution Sample. J Tehran Heart Cent 2018;13:65-72.
18. Hyman DJ, Pavlik VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med 2001;345:479-486.
19. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation 2016;134:441-450.
20. Derex L. Prise en charge en phase aiguë de l'accident vasculaire cérébral chez le sujet âgé [Acute stroke management in elderly patients]. Rev Prat 2012;62:1225-1228.
21. Animut Y, Assefa AT, Lemma DG. Blood pressure control status and associated factors among adult hypertensive patients on outpatient follow-up at University of Gondar Referral Hospital, northwest Ethiopia: a retrospective follow-up study. Integr Blood Press Control 2018;11:37-46.
22. Huang YM, Shiyanbola OO, Smith PD. Association of health literacy and medication self-efficacy with medication adherence and diabetes control. Patient Prefer Adherence 2018;12:793-802.
23. Lor M, Koleck TA, Bakken S, Yoon S, Dunn Navarra AM. Association Between Health Literacy and Medication Adherence Among Hispanics with Hypertension. J Racial Ethn Health Disparities 2019;6:517-524.
24. Yasuda S, Miyamoto Y, Ogawa H. Current Status of Cardiovascular Medicine in the Aging Society of Japan. Circulation 2018;138:965-967.
25. Kobayashi LC, Wardle J, von Wagner C. Limited health literacy is a barrier to colorectal cancer screening in England: evidence from the English Longitudinal Study of Ageing. Prev Med 2014;61:100-105.
26. Charansonney OL. Physical activity and aging: a life-long story. Discov Med 2011;12:177-185.
27. Petersen J, Malyutina S, Ryabikov A, Kontsevaya A, Kudryavtsev AV, Eggen AE, McKee M, Cook S, Hopstock LA, Schirmer H, Leon DA. Uncontrolled and apparent treatment resistant hypertension: a cross-sectional study of Russian and Norwegian 40-69 year olds. BMC Cardiovasc Disord 2020;20:135.
28. Zhang L, Zhao F, Zhang P, Gao J, Liu C, He FJ, Lin CP. A pilot study to validate a standardized one-week salt estimation method evaluating salt intake and its sources for family members in China. Nutrients 2015;7:751-763.
29. Meneton P, Jeunemaitre X, de Wardener HE, MacGregor GA. Links between dietary salt intake, renal salt handling, blood pressure, and cardiovascular diseases. Physiol Rev 2005;85:679-715.
30. Ha SK. Dietary salt intake and hypertension. Electrolyte Blood Press 2014;12:7-18.
31. Luehrs RE, Zhang D, Pierce GL, Jacobs DR Jr, Kalhan R, Whitaker KM. Cigarette Smoking and Longitudinal Associations With Blood Pressure: The CARDIA Study. J Am Heart Assoc 2021;10:e019566.
32. Virdis A, Giannarelli C, Neves MF, Taddei S, Ghiadoni L. Cigarette smoking and hypertension. Curr Pharm Des 2010;16:2518-2525.
33. Ridao N, Luño J, García de Vinuesa S, Gómez F, Tejedor A, Valderrábano F. Prevalence of hypertension in renal disease. Nephrol Dial Transplant 2001;16 Suppl 1:70-73.
34. Park JK, Kim CB, Kim KS, Kang MG, Jee SH. Meta-analysis of hypertension as a risk factor of cerebrovascular disorders in Koreans. J Korean Med Sci 2001;16:2-8.
| Files | ||
| Issue | Vol 17 No 4 (2022): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v17i4.11614 | |
| Keywords | ||
| Uncontrolled blood pressure Health literacy Cross-Sectional Studies Iran | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
