Factors Affecting Blood Pressure Control among Hypertensive Patients Attending Primary Healthcare Facilities in Western Jamaica

ABSTRACT Objective: To identify patient-related factors that act as barriers to hypertension control. Methods: A cross-sectional study of 365 patients who were diagnosed with primary hypertension and attended primary healthcare facilities in western Jamaica was carried out. A pretested questionnaire was administered, and the patients ' blood pressure and body mass index were taken and calculated. Inferential statistics were used to interpret the data. Chi-square and Fischer's exact tests were used to analyse the differences in dichotomous variables. A p-value of ≤ 0.05 was regarded as statistically significant. Two focus group discussions and 10 in-depth interviews provided qualitative data. Results: Of the 365 participants, only 30.1% had blood pressure readings within normal limits. The blood pressure was statistically significantly higher in those who last smoked under one year (p = 0.018), those who consumed alcohol (p = 0.021), those who reported high stress levels (p = 0.020) and those with a weak support system (p = 0.012; Spearman's rank correlation coefficient = 0.131). Knowledge deficit was also statistically significant where 55.1% believed that hypertension could be cured or were unsure and 27.5% denied personal responsibility in achieving control. Patients who had been diagnosed 11 years or more were more likely to be uncontrolled (p = 0.010). Medication adherence (p = 0.056), alternative medicine (p = 0.476), diet (p = 0.108), exercise (p = 0.568) and obesity (p = 0.941) showed no statistically significant relationship. Conclusion: Smoking, alcohol consumption, stress, level of awareness and support system were significant modifiable determinants of blood pressure control. Clinicians often place much emphasis on medication adherence, diet and exercise. However, these modifiable contributing factors are often overlooked in the management of hypertension. Addressing these issues could result in a significant improvement in blood pressure control.