Prevalence and Determinants of Uncontrolled Blood Pressure among Hypertensive Patients at Governmental Primary Health Centers in the Gaza Strip

Aya Riziq Ibrahim Alboraey
آية رزق ابراهيم البرعي
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Al-Quds University
Introduction: Hypertension is a leading cause of premature death worldwide and the burden of hypertension is higher in low- and middle-income countries, where two-thirds of cases are reported, primarily due to increased risk factors. Globally, the magnitude of uncontrolled blood pressure is becoming of public health importance in developing countries. Aim: The overall aim of this study was to assess the prevalence and determinants of uncontrolled blood pressure among hypertensive patients at governmental primary health centers in the Gaza Strip. Methods: This study is a mixed methods study that involves both collecting quantitative and qualitative data. The quantitative data is a descriptive-analytical cross-sectional design. The quantitative data were collected from patients who utilize the health services within the study settings. In total, 400 patients participated in the study (213 males and 187 females who utilized the health services among governmental primary health centers in the Gaza Strip. The qualitative data were collected through in-depth interviews with healthcare providers and health experts from the Ministry of Health in the Gaza Strip. Analysis of quantitative data was conducted using the SPSS program, the analysis involved conducting frequency distribution, cross-tabulation, general scores, mean percentages, chi-square, and logistic regression tests were used. For qualitative data, an open coding thematic analysis method was used. Findings: The results of the study showed that about one-third of the study participants have uncontrolled blood pressure (36.3%). The percentage of uncontrolled blood pressure was higher among male participants (55.8%) compared to female participants (44.2%). The findings of the study have shown that there was a significant association between uncontrolled blood pressure and demographic and socioeconomic factors such as having a high BMI (Body Mass Index) (25-29.9) and (≥30). Disease-related factors have a significant association with uncontrolled BP such as shorter duration of high blood pressure and participants who missed taking their medication over the past two weeks for any reason. Low general psychological health has a significant association with uncontrolled blood pressure. Additionally, not having enough knowledge about hypertension is significantly associated with uncontrolled blood pressure. Conclusion: Uncontrolled blood pressure is a real problem for hypertensive patients in the Gaza Strip, More studies are needed to evaluate the determinants of controlling status of blood pressure on a larger, more diverse, and representative group of participants. There is a need to develop unified national guidelines for the treatment of hypertension. The guidelines should include a description of the treatment modalities, including lifestyle modification as part of the treatment plan by the health care providers. Additionally, patients particularly those who have uncontrolled BP, it is highly recommended that the MoH (Ministry of Health) develop follow-up management plans for them to ensure a higher level of compliance. The management plan should include a multi-disciplinary team that involves physicians, nurses, nutritionists, and psychologists. Finally, more studies are needed to evaluate the determinants of controlling status of blood pressure on a larger, more diverse, and representative group of participants.