Abstract P371: Raising Awareness Leads to High Provider Visits and Blood Pressure Reduction Among Hypertensive Patients in Bangladesh - A Population-Based Cohort Study
Background: Low patient awareness is associated with uncontrolled blood pressure (BP) which is a leading cause of stroke, myocardial infarction, and chronic kidney diseases in low resource settings.
Objective: Effect of raising awareness and advising for seeking treatment on provider visit and BP.
Methods: We conducted a population-based study on 1678 randomly selected individuals aged ≥20 years from rural Matlab (n=853), Chandpur and urban Kamalapur (n=825), Dhaka in Bangladesh. Hypertensive individuals (BP ≥ 140/90 mmHg or self reported hypertension under medication) were informed about their BP status, explained about possible health risks if left untreated, and advised to visit a qualified health care provider. Information on provider visit was collected and BP was measured after 6 months of initial survey. Changes in BP from baseline to follow-up and the proportion of BP control achievement (BP<140/90 mmHg) were compared by provider type and area of residence.
Results: A total of 287 individuals (17.1%) were identified as hypertensive with significantly higher prevalence in urban than rural population [23.6 % (195 of 825) vs 10.8% (92 of 853); p<0.001]. About half of the hypertensive individuals were unaware which was higher among males than females [59% (68 of 115) vs 45% (77 of 172), P=0.007]. A 245(85.4%) hypertensive patients were followed. Almost all of them (n=240) visited a health care provider, 67% (164 of 245) visited medically qualified practitioners and the remaining visited village pharmacy or other local agents. In urban area more medically qualified practitioners were visited than in rural area [77.4% (127 of 164) vs 45.7% (37 of 81), P<0.000]. The overall mean systolic blood pressure (SBP) was reduced by 3.3±20.7 mmHg (p<0.01) and mean diastolic blood pressure (DBP) by 2.0± 13.0 mmHg (p<0.02). Those who received treatment from medically qualified practitioners had significant SBP (-3.9±22.4 mmHg p<0.03) and DBP (-2.7±14.1 mmHg p<0.02) reduction. Those received treatment from village pharmacy or other local agents showed a non-significant reduction in both SBP (-2.3 ±17.3 mmHg; P=0.26) and DBP (-0.03 ± 10.6 mmHg p=0.98). Half of the hypertensive patients [51.2% (84 of 164) in urban and 48.1% (39 of 81) in rural] achieved BP control goal with no difference between area of residence or provider type.
Conclusion: Raising awareness and advice given to seek care leads to high provider visits and blood pressure reduction in both rural and urban settings in Bangladesh irrespective of provider type. Findings need a longer-term follow up and further detail investigations to make sound sustainable recommendation.
- © 2013 by American Heart Association, Inc.