Therapeutic inertia and blood pressure control status Among adult hypertensive patients on follow up at Ambulatory cardiac clinic of jimma medical center, Southwest Ethiopia: prospective observational study

Abstract

Background: Hypertension is a major global public health problem and is a leading cause of death and disability in developing countries. Hypertension control is poor everywhere, including in Ethiopia. The reasons for poor control of blood pressure may arise from therapeutic inertia, patient related risk factors, and medication nonadherence or unhealthy diet. Objectives: This study aimed to assess the burden of therapeutic inertia and blood pressure control rate among adult hypertensive patients on follow-up at the Ambulatory Cardiac Clinic of Jimma Medical Center, Southwest Ethiopia. Methodology: A hospital-based prospective observational study was conducted among adult hypertensive patients who had regular follow-ups at the Ambulatory Cardiac Clinic of Jimma Medical Center from 22 September to 22 December 2022. Hypertensive patients who fulfilled the inclusion criteria were selected in the first month of the data collection period and consequently followed up for the next three months. Patients’ specific data were collected using a structured data collection tool. Blood pressure control status evaluated by Eighth Joint National Committee Guideline. Data were analyzed using the statistical software program SPSS version 27.0. Factors associated with blood pressure control were identified using binary and multivariate logistic regression analyses. Result: From a total of 360 participants, more than half (57.8%) of the participants were male. The mean age of participants was 54 ± 13.523 years. The rate of blood pressure control was 36.9%. The mean therapeutic inertia score was -0.158 ± 0.518, with nearly one-half, 177 (49.2%) participants having therapeutic inertia, and participants’ medication adherence rate was 47.2%. In multivariable logistic regression analysis, age ≥ 60 years (AOR) = 2.29, 95% CI: 1.33-3.93, p = 0.003), participants from rural areas (AOR = 2.04, 95% CI = 1.18-3.52, P = 0.010), not salt reducing (AOR = 2.83, 95% CI = 1.67-4.78, P = <0.001), chewing khat (AOR = 2.94, 95% CI = 1.68-5.14, P = <.001), drinking coffee all the time (AOR = 3.07, 95% CI = 1.46-6.45, P = 0.003), drinking coffee most of the time (AOR = 2.44, 95% CI = 1.19-5.00, P = 0.015), treatment duration < 1 year (AOR = 2.76, 95% CI = 1.09-6.94, P = 0.032), DM (AOR = 3.62, 95% CI = 1.67-7.85, P = 0.001), medication nonadherence (AOR = 2.87, 95% CI = 1.69-4.87, p = <0.001), participants with therapeutic inertia score of -1< 0 (AOR = 4.32, 95% CI = 2.17-8.60, P = <0.001) were independent variables that were statistically associated with uncontrolled blood pressure. Conclusion: The rate of controlled blood pressure was low. Older age, participants from rural areas, not salt reduction, coffee drinking, chewing khat, treatment duration of < 1 year, comorbi dityes, therapeutic inertia, and participants’ nonadherence to medications were independent predictors of blood pressure control. Therefore, clinicians should adhere to guidelines to reduce TI and give health education on salt-eating, khat-chewing, coffee-drinking, treatment duration, residency, comorbid conditions, and for older patients. Additionally, clinicians should provide effective education to patients on medication adherence.