Awareness and control of hypertension in Bangladesh: follow-up of a hypertensive cohort

Abstract

Objectives: To assess the effect of awareness and advice to seek care on blood pressure (BP) control among patients with hypertension in Bangladesh.

Design: Longitudinal study.

Setting: The study was carried out in icddr,b surveillance sites at rural Matlab in Chandpur district and semi-urban Kamalapur in Dhaka, Bangladesh.

Participants: Randomly selected men and non-pregnant women aged 20 years or older without any acute illness or history of any vascular events such as stroke or acute myocardial infarction.

Main outcome measure: Hypertension was defined as systolic BP (SBP) ≥140 and/or diastolic BP (DBP) ≥90 mm Hg or as self-reported hypertension under medication. We advised patients to seek care from a qualified provider and to adopt a healthy lifestyle. We compared changes in BP from baseline to follow-up at around 6 months.

Results: Overall, 17.1% (n=287) of participants had hypertension at baseline with significantly higher prevalence in the semi-urban than in the rural population (23.6% vs 10.8%; p<0.001); half were unaware of their condition. At follow-up, 83% (n=204) reported a visit to any healthcare provider. In the semi-urban area, a higher proportion of patients visited medically qualified practitioners than in the rural area (76.7% vs 36.6%, p<0.000). SBP (-3.3±20.7 mm Hg; p<0.01) and DBP (-2.0±13.0 mm Hg; p<0.02) were lower at follow-up. Those who visited medically qualified practitioners had significant SBP (-3.9±22.4 mm Hg; p<0.03) and DBP (-2.7±14.1 mm Hg; p<0.02) reduction. BP reduction did not reach statistical significance among those visiting a pharmacist or their village doctors. Overall, half of the patients with hypertension achieved the BP control goal (BP<140/90 mm Hg).

Conclusions: Awareness and simple health messages increase provider visit, reduce blood pressure and improve BP control in hypertensive Bangladeshis. Longer-term follow-up is required to verify the sustainability.

Keywords: EPIDEMIOLOGY; PRIMARY CARE; PUBLIC HEALTH.

Figure 1

Study enrolment and follow-up flow diagram. BP, blood pressure.

Figure 2

Distribution of awareness and control of blood pressure among patients with hypertension at baseline and at follow-up by area of residence in Bangladesh. HTN, hypertension.

Figure 3

Pattern of health care provider visits and medication use in urban Dhaka and rural Matlab, Bangladesh. (A) Distribution of provider visits by area and economic strata. (B) Pattern of medication use by area and provider type. *Professionals included MBBS/MD or higher educated health care providers. Drug sellers included pharmacists, village doctors or owners of small drug outlets with or without diplomas or certificates for medical practice. BB, β-blockers; CCB, calcium channel blockers; ARB, angiotensin receptor blockers.

Figure 4

Change in systolic and diastolic blood pressure between baseline and follow-up by provider type. *Professionals included MBBS/MD or higher educated health care providers. Drug sellers included pharmacists, village doctors or owners of small drug outlets with or without any diplomas or certificates for medical practice. DBP, diastolic blood pressure; SBP, systolic BP.