Impact of hypertension knowledge on adherence to antihypertensive therapy: a cross-sectional study in primary health care centers during the 2024 Sudan conflict

Abstract

Background: Hypertension is a global health issue, particularly in low- and middle-income countries. Effective management requires medication adherence, which is often compromised in conflict zones such as Sudan. This study examines the relationship between patients' knowledge of hypertension and their adherence to antihypertensive therapy in Sudan amidst ongoing conflict.

Methods: A cross-sectional study conducted across six primary healthcare centers in Al-Dammer, Sudan, included 389 hypertensive patients selected through convenience sampling. Data were collected using face-to-face questionnaire that assessed sociodemographics, medication adherence (GMAS), and hypertension knowledge (HKT). Analyses were conducted in SPSS, with percentages for categorical data, means ± SD for continuous data, and nonparametric tests (Shapiro-Wilk, Kruskal-Wallis) for non-normal distributions.

Results: Most participants were female (63%), and 43.7% were over 60 years old. Knowledge levels were categorized as average (57.8%), high (25.2%), and low (17%). Adherence rates were as follows: 1% poor, 2.8% low, 22.6% partial, 26.5% good, and 47% high. A positive correlation was found between knowledge and adherence (r = 0.47, p < 0.001). Major barriers to adherence included affordability (43.4%) and unavailability of medications (36.2%). While 82.3% of participants had a history of controlled hypertension, only 58.4% remained controlled at their most recent measurement, with 41.6% presenting uncontrolled blood pressure, highlighting challenges in sustained hypertension management. Improved adherence was associated with higher income, better education, and controlled blood pressure.

Conclusion: Higher hypertension knowledge was significantly associated with better adherence and improved blood pressure control. However, sustained control remains a challenge, as 41.6% of participants had uncontrolled hypertension at their last measurement. Addressing economic barriers and medication shortages through targeted interventions is essential for improving long-term hypertension management in conflict settings.

Keywords: Hypertension; Medication adherence; Patient knowledge; Primary health care centers; Sociodemographic factors; Sudan; War.

Fig. 1

Sample distribution among primary healthcare centers in Al-Dammer. This figure illustrates the distribution of hypertensive patients across six primary healthcare centers (PHCCs). The Martyr Faisal Center had the highest number of patients, accounting for 59.6% of the total sample

Fig. 2

Correlation between GMAS score and HKT score. A significant positive correlation was observed between the GMAS (General Medication Adherence Scale) score and the HKT (Hypertension Knowledge Test) score (r = 0.47; p < 0.0001), indicating that higher medication adherence is associated with better hypertension knowledge