Prevalence and determinants of undiagnosed hypertension among adult residents of Mbarara City, Uganda

Abstract

Background: Most cardiovascular illnesses acquired in adult life are related to hypertension, yet many individuals do not seek medical check-up for it until the symptomatic stage. The purpose of this study was to estimate the prevalence of undiagnosed hypertension and identify its associated factors among adult residents of Mbarara City. Methods: This was a cross-sectional household-based community survey. Participants were adult persons aged at least 18 years. Blood pressure (BP) was measured three times at 5 minute intervals, and an average of the last two readings was taken as the individual’s actual BP. Undiagnosed hypertension (UDH) was defined as elevated BP at an average of systolic BP ≥135 mmHg and/or diastolic BP ≥85 mmHg if the affected individual admitted that he/she was not aware of his/her hypertensive status prior the survey. A total of 482 participants were enrolled in the study, selected across all the 6 divisions of the city. Statistical analysis was done by generating descriptive statistics and performing logistic regression in Stata 14 at α ≤ 0.05 for significance. Results: Overall, 482 participants were enrolled. The prevalence of hypertension at the 135/85 mmHg threshold was 202/482 (41.9%, 95% CI: 37.4-46.5%) [and 150/482 (31.1%, 95% CI: 27.0-35.5%) at 140/90 mmHg threshold]. Prevalence of UDH was 134/202 (66.3% (95% CI: 59.4-72.8%); and the associated factors were BP measurement at last health facility visit (OR = 0.12, 95% CI: 0.05-0.28), magnitude of hypertension related health education received at last health facility visit (OR = 0.71, 95% CI: 0.64-0.79), and one’s perceived self-susceptibility to hypertension (OR = 0.97, 95% CI: 0.95-0.98). Thirty-eight of the 134 participants with UDH (28.4%, 95% CI: 20.9-36.8%) was the estimated proportion of UDH attributable to missed opportunities by healthcare providers. Conclusion: A high proportion of hypertensive individuals live with the condition unknowingly, making an important public health challenge in Mbarara City. Over one quarter of this can be attributed to lack of routine measurement of all patients’ blood pressures by healthcare providers. There is urgent need to plan and enforce routine measurement of blood pressure and offering an appropriate minimum health education package for all patients presenting at all health facilities.