Multicenter study of blood pressure control and its determinants in 1004 hypertensive patients followed in primary health care facilities in Settat/Morocco

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However, it is often inadequate due to environmental and/or patient-related factors. The aim of this study is to estimate the prevalence of uncontrolled blood pressure and to identify the associated risk factors in hypertensive patients followed up in health centers in Settat city. Materials and Methods A multicenter cross-sectional study was conducted from March 2023 to February 2024 in 21 primary care facilities (12 urban and 9 rural) in Settat, including 1004 hypertensive patients. Data were collected using a validated questionnaire covering medical, therapeutic and knowledge aspects of hypertension. Compliance medication was assessed by the Girerd test, and physical activity by the Global Physical Activity questionnaire recommended by the World Health Organization. Blood pressure and anthropometric measurements were taken in accordance with international standards. Results Uncontrolled blood pressure affected 57.9% (n=581) of patients. Multivariable analysis revealed a significant association with rural environment (OR = 3.13; 95% CI [2.06-4.74]), advanced age (OR = 1.39; CI95% [1.09-1.63]), low monthly income (OR = 1.37; CI95% [1.21-1.56]), high-salt diet (OR = 1.39; CI95% [1.15-1.69]) and poor compliance with medication (OR = 7.24; CI95% [5.09-10.31]). Conclusion Unsatisfactory blood pressure control in Moroccan hypertensive patients has highlighted the need to take into account the sociodemographic dimension in the management of hypertension, and the role of health centers in supplying patients with antihypertensive drugs and therapeutic and behavioral education to optimize blood pressure control. 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F1000Research 2025, 14 :1035 ( https://doi.org/10.12688/f1000research.169441.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Multicenter study of blood pressure control and its determinants in 1004 hypertensive patients followed in primary health care facilities in Settat/Morocco [version 1; peer review: awaiting peer review] MANAR AARRAD https://orcid.org/0009-0002-9116-4926 1 , Saad EL MADANI 1 , Sanaa TOUZAMI https://orcid.org/0009-0005-2877-490X 1 , El Hassan ROUSSI https://orcid.org/0000-0003-1879-0058 1 , Mohamed HILAL 1 , Fatimazahra LAAMIRI https://orcid.org/0000-0001-7181-5934 1 MANAR AARRAD https://orcid.org/0009-0002-9116-4926 1 , Saad EL MADANI 1 , [...] Sanaa TOUZAMI https://orcid.org/0009-0005-2877-490X 1 , El Hassan ROUSSI https://orcid.org/0000-0003-1879-0058 1 , Mohamed HILAL 1 , Fatimazahra LAAMIRI https://orcid.org/0000-0001-7181-5934 1 PUBLISHED 03 Oct 2025 Author details Author details 1 Health Sciences and Techniques Laboratory, Hassan First University, Higher institute of Health Sciences, Settat, Chaouia-Ouardigha, Morocco MANAR AARRAD Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Saad EL MADANI Roles: Formal Analysis Sanaa TOUZAMI Roles: Formal Analysis, Investigation El Hassan ROUSSI Roles: Methodology Mohamed HILAL Roles: Methodology Fatimazahra LAAMIRI Roles: Conceptualization, Formal Analysis, Methodology, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS AWAITING PEER REVIEW This article is included in the Global Public Health gateway. Abstract Background and Objectives Controlling blood pressure is a central objective in the management of hypertension. However, it is often inadequate due to environmental and/or patient-related factors. The aim of this study is to estimate the prevalence of uncontrolled blood pressure and to identify the associated risk factors in hypertensive patients followed up in health centers in Settat city. Materials and Methods A multicenter cross-sectional study was conducted from March 2023 to February 2024 in 21 primary care facilities (12 urban and 9 rural) in Settat, including 1004 hypertensive patients. Data were collected using a validated questionnaire covering medical, therapeutic and knowledge aspects of hypertension. Compliance medication was assessed by the Girerd test, and physical activity by the Global Physical Activity questionnaire recommended by the World Health Organization. Blood pressure and anthropometric measurements were taken in accordance with international standards. Results Uncontrolled blood pressure affected 57.9% (n=581) of patients. Multivariable analysis revealed a significant association with rural environment (OR = 3.13; 95% CI [2.06-4.74]), advanced age (OR = 1.39; CI95% [1.09-1.63]), low monthly income (OR = 1.37; CI95% [1.21-1.56]), high-salt diet (OR = 1.39; CI95% [1.15-1.69]) and poor compliance with medication (OR = 7.24; CI95% [5.09-10.31]). Conclusion Unsatisfactory blood pressure control in Moroccan hypertensive patients has highlighted the need to take into account the sociodemographic dimension in the management of hypertension, and the role of health centers in supplying patients with antihypertensive drugs and therapeutic and behavioral education to optimize blood pressure control. READ ALL READ LESS Keywords Health centers; Hypertension; Risk factors; Uncontrolled blood pressure. Corresponding Author(s) MANAR AARRAD ( [email protected] ) Close Corresponding author: MANAR AARRAD Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 AARRAD M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: AARRAD M, EL MADANI S, TOUZAMI S et al. Multicenter study of blood pressure control and its determinants in 1004 hypertensive patients followed in primary health care facilities in Settat/Morocco [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :1035 ( https://doi.org/10.12688/f1000research.169441.1 ) First published: 03 Oct 2025, 14 :1035 ( https://doi.org/10.12688/f1000research.169441.1 ) Latest published: 02 Mar 2026, 14 :1035 ( https://doi.org/10.12688/f1000research.169441.2 )  There is a newer version of this article available. Suppress this message for one day. Introduction Hypertension is the most common chronic disease worldwide and is responsible for a number of serious and fatal cardiovascular complications. 1 The World Health Organization (WHO) estimates that 1.28 billion adults aged between 30 and 79 worldwide have hypertension, two-thirds of whom live in low- or middle-income countries. 2 The main objective of hypertension management protocols is to ensure blood pressure control (BPC) in hypertensive patients. This objective is often not achieved because of poor compliance with treatment, the adoption of unhealthy lifestyles and neglect of dietary and physical activity recommendations. In fact, the onset of hypertension may be favored by risk factors linked to the patient and/or the environment, which influence BPC. In this context, several studies have been carried out to identify the risk factors associated with uncontrolled blood pressure (UBP). Among them, an epidemiological survey which examined the evolution of hypertension over time on an international scale, the results of which indicated that advanced age, overweight/obesity, male sex, low socio-economic level, co-morbidities, sedentary lifestyle and poor adherence to pharmaceutical treatment are risk factors associated with UBP. 3 Furthermore, in Morocco, following a marked increase in the prevalence of this condition to 29%, 4 several surveys have been carried out to describe the prevalence of UBP and the risk factors associated with this burden. 5 , 6 In addition, the results of the first study carried out in Settat city, which targeted BPC in rural areas, revealed that the prevalence of UBP was 53%, associated with the following risk factors: male sex, low income, diabetes, monotherapy, poor compliance with medication and stress. 7 Furthermore, in 2022 the province’s network of primary healthcare facilities (PHCF) monitored 23,111 hypertensive patients, 51.90% of them in rural areas and 48.10% in urban areas [ 1 ]. These health facilities, which are responsible for the prevention, monitoring and management of hypertension, are part of a national health programme aimed at the primary, secondary and tertiary prevention of this disease. However, despite the colossal efforts made by the health staff responsible for managing hypertension in the health centers, the level of blood pressure control is still sub-optimal. 4 In this context, our objective is to conduct a study targeting the prevalence and risk factors associated with UBP in the Settat region. The results of this survey will provide recent data on the epidemiological situation of UBP in the region, with the aim of adapting local blood pressure management protocols and promoting BPC in Moroccan hypertensive patients. Materials and methods Type and location of study This is a cross-sectional analytical study conducted over a period of 11 months, from 01 March 2023 to 02 February 2024, in 12 urban health centers and 9 rural health districts in Settat city [ 2 ]. Study population Inclusion criteria Hypertensive patients diagnosed with essential hypertension for at least six months before the start of the study, aged 18 and over, on antihypertensive treatment and living in Settat city. Exclusion criteria Women with gestational hypertension and hypertensive patients with mental disorders. Sampling method and sample size The sampling adopted in this study is probabilistic. The survey was carried out among all hypertensive patients followed up in the PHCFs of the province of Settat as part of medical-nursing follow-up. Based on the Lorenz formula developed by Cochrane 8 and Ardilly 9 : N = t 2 × p ( 1 – p ) / m 2 where t = 1.96 and based on a provincial prevalence of 3.66% ** and a precision of 5%, a minimum population of 357 is required. However, in order to improve the representativeness of the sample and enable more robust comparisons, 1,004 hypertensive patients were included in the study. Data collection tools Structured questionnaire Data were collected by face-to-face interviews with patients using a structured questionnaire based on the scientific literature and validated by experts in public health and cardiology. We contacted doctors and teacher-researchers who are members of the care and health of the population and the environment research team of the Health Sciences and Technologies laboratory at the Higher Institute of Health Sciences at Hassan First University. To test the clarity and ease of understanding of the questionnaire, a pre-test was carried out with a representative sample of the target population consisting of 30 people 10 excluded from the final study sample. The survey explored several aspects, including: Socio-demographic and economic data Age, sex, marital status, level of education, professional status and the presence of medical cover. For monthly household income, we used the classification proposed by the High Commission for Planning (HCP). 11 Patients’ knowledge of hypertension This section was devoted to assessing patients’ knowledge of the signs of hypertension, the hygiene and dietary measures essential to its management, and its major complications. Clinical and therapeutic characteristics of patients Duration of hypertension and circumstances of diagnosis, family history and comorbidities. We assessed patients’ behavior and lifestyle, looking for tobacco and alcohol consumption, the presence of stress, whether they followed a low-salt diet, and whether they had self-measured blood pressure at home. carrying out the biological tests requested The check-up was considered ‘completed’ if it had been carried out within 3 months or less of the date of our interview. This deadline was chosen because it generally corresponds to the period recommended by doctors for follow-up appointments. Accessibility and care offered by PHCFs This section aimed to determine whether patients had benefited from therapeutic education within the PHCFs, particularly with regard to the definition of hypertension and its potential complications. We also explored the geographical accessibility of the various PHCFs, the availability of different antihypertensive drugs, the frequency of follow-up consultations and, finally, we assessed patients’ general satisfaction with the services offered in these health centers. Physical activity measurement The level of physical activity (PA) was determined using the Global Physical Activity Questionnaire (GPAQ), recommended by the WHO for population surveys. This tool includes 16 questions covering the following areas: activities at work, travel activities and leisure activities. The aim is to determine the PA profile of patients according to these three levels: low, medium and high. 12 Assessing compliance with medication Adherence to medication was assessed using the validated Girerd test, commonly used in primary care to measure adherence to treatment in chronic patients. This questionnaire consists of 6 closed questions on the likely difficulties associated with taking antihypertensive medication. Responses are dichotomous (‘Yes’ or ‘No’); a positive response to one or two questions indicates a minor adherence problem, while three or more positive responses indicate poor adherence. 13 Anthropometric measurements Weights were measured using an electronic scale accurate to 100g, and patients’ barefoot heights were measured using a wall-mounted scale accurate to one tenth of a centimeter. Waist and hip circumferences were measured using a tape measure graduated in millimeters. Patients’ nutritional status was assessed by calculating their body mass index (BMI) according to the WHO classification. 14 Abdominal obesity (AO) was defined as a waist circumference greater than 88 cm in women and greater than 102 cm in men. 15 The waist to hip ratio (WHR) was considered normal if it was <0.85 in women and <0.90 in men. 16 By combining BMI and OA parameters, we classified hypertensive patients into two levels of cardiovascular risk: low or high. 17 Blood pressure measurements To measure blood pressure, we followed the recommendations of the European Society of Cardiology: After 15 minutes’ rest, patients were placed in a seated position, with their backs resting against a chair, their arms at heart level and their feet flat on the floor, without crossing them. Patients were asked to remain calm and avoid talking during the measurement. Blood pressure was measured using an electronic blood pressure monitor (Microlife BP A2 Basic), fitted with a cuff suitable for adults and obese people. Two measurements were taken 2 minutes apart on the arm with the higher values, and the blood pressure was taken as the mean of the two values. To meet the objectives of the study, patients were classified in the ‘uncontrolled hypertension’ group if their systolic blood pressure (SBP) was greater than or equal to 140 mmHg and/or if their diastolic blood pressure (DBP) was greater than or equal to 90 mmHg. 17 We then explored and compared the demographic characteristics, clinical and therapeutic data, behavior and lifestyle of patients in the two groups. Statistical analysis The data were entered and analyzed using SPSS software (version 27). The normality of quantitative variables was verified using the Kolmogorov-Smirnov test. Variables with a normal distribution were expressed as mean ± standard deviation and compared using Student’s t test, while qualitative variables were analyzed in terms of numbers and percentages using the Chi-2 test or Fisher’s exact test. Risk factors for UBP were identified using univariable logistic regression, followed by multivariable analysis for significant variables (p<0.05), with a threshold of 5% for final variable selection. Ethical considerations This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Biomedical Ethics Committee of the Faculty of Medicine and Pharmacy of Casablanca, Hassan First University under reference number 04/2023. Authorization to access and analyze patients’ medical records was also granted by the regional health authorities of the city of Settat. All data were anonymized prior to analysis to ensure confidentiality and respect for the privacy of participants. The patients surveyed were asked to give their verbal consent to participate in the study. Results and discussion Results The mean age was 60.08 (±12.85) with extremes ranging from 29 to 99 years and a marked predominance of women representing 75.1% (745) of the sample. 60.15% of participants were from urban areas. The majority of participants were married 71.30% (716), while 54.10% (543) of patients were illiterate, and 87.1% (874) were unemployed. A minority of patients (2.1%, 21) had no medical cover. More than half of the participants (51.90%, 521) reported receiving more than 2,000 dirhams per month (DHS/month). The distribution of patients according to their socio-demographic characteristics and blood pressure control status ( Table 1 ) revealed a significantly higher proportion of uncontrolled hypertension among patients living in urban areas, women, elderly subjects and those with a low socioeconomic level. Table 1. Distribution of hypertensive patients by socio-demographic characteristics and blood pressure control. Socio-demographic characteristics Hypertensive patients N=1004 p Controlled hypertension group n (%) 423 (42.1) (BP 140/90 mm Hg) Gender <0.001 ** Female 345 (81.60) 409 (70.40) Male 78 (18.40) 172 (29.60) Age group (years) <0.001 ** <40 32 (7.60) 34 (5.90) 40-50 93(22) 74 (12.70) 50-60 107 (25.30) 132 (22.70) 60 et plus 191 (45.20) 341 (58.70) Residence 0.01 * Urban 235 (55.60) 369 (63.50) Rural 188 (44.40) 212 (36.50) Marital status 0.1 Single 28 (6.60) 25 (4.30) Married 309 (73) 407 (70.10) Divorced 17 (4) 24 (4.10) Widowed 69 (16.30) 125 (21.50) Level of education 0.4 Illiterate 236 (55.80) 307 (52.80) Koranic 49 (11.60) 78 (13.40) Primary 80 (18.90) 110 (18.90) Secondary 45 (10.60) 76 (13.10) University 13 (3.10) 10 (1.70) Occupation 0.3 With 49 (11.60) 81 (13.90) Without 374 (88.40) 500 (86.10) Medical cover 0.1 Without 8 (1.90) 13 (2.20) Private insurance 17 (4) 16 (2.80) AMO 114 (27) 122 (21) CNSS 83 (19.60) 112 (19.30) CNOPS 39 (9.20) 73 (12.60) RAMED 162 (38.30) 245 (42.20) Monthly income (DH/Mois) <0.001 ** 5000 23 (5.40) 45 (7.70) * Student's t test. ** Chi-2 test of independence. A p-value of less than 0.05 is considered. Most patients had a good understanding of the various aspects of hypertension. In fact, 94.30% (947) knew the signs of hypertension, 98% (984) were able to cite the essential dietary hygiene measures, and 82.40% (827) had knowledge of the potential complications of hypertension. The study of clinical and therapeutic data revealed that 68.60% (689) of patients had been hypertensive for 5 years or more, 57.80% (580) had a family history of hypertension, and 67.30% (676) were at cardiovascular risk. The nutritional status of the participants was in favor of overweight/obesity in 59.10% (594). With regard to the type of antihypertensive medication used, almost all patients 81.50% (818) were on monotherapy. The distribution of patients according to their clinical and therapeutic characteristics and blood pressure control status ( Table 2 ) showed a significantly higher proportion of uncontrolled hypertension in patients with a long history of the disease, diabetics, overweight subjects and those with associated heart disease. Table 2. Distribution of hypertensive patients according to clinical and therapeutic characteristics and blood pressure control. Clinical and therapeutic characteristics Hypertensive patients N=1004 p Controlled hypertension group n (%) 423 (42.1) (BP 140/90 mm Hg) Duration of illness (year) <0.001 * 10 91 (21.5) 206 (35.50) Family history 0.08 Yes 231 (54.60) 349 (60.10) No 192 (54.40) 232 (39.90) Diabetes <0.001 * Yes 165 (39) 323 (55.60) No 258 (61) 258 (44.40) Heart disease 0.32 Yes 67 (15.80) 106 (18.20) No 356 (84.20) 475 (81.80) Kidney disease 0.14 Yes 12 (2.80) 27 (4.60) No 411 (97.20) 554 (95.40) Dyslipidemia 0.04 * Yes 52 (12.30) 99 (17) No 371 (87.70) 482 (83) BMI <0.001 ** Normal 210 (49.60) 193 (33.20) Overweight 151 (35.70) 263 (45.30) Obese I 53 (12.50) 99 (17) Obese II 3 (0.70) 20 (3.40) Obese III 3 (0.70 2 (0.30) Underweight 3 (0.70) 4 (0.70) Cardiovascular risk <0.001 * Yes 249 (58.90) 427 (73.50) No 174 (41.10) 154 (26.50) Type of therapy 0.74 Monotherapy 349 (82.50) 469 (80.70) Dual therapy 70 (16.50) 107 (18.40) Triple therapy 4 (0.90) 5 (0.90) * Test de Khi2. ** Test exact de Fisher. The study of patients’ lifestyles revealed that only 4.4% (44) smoked and 1.4% 14 drank alcohol, with the total absence of these two habits among the women surveyed. 74.40% (747) of participants reported stress, and 49.60% (498) did not follow a low-salt diet. Physical activity was lower than recommended in 46.40% (466) of participants, with a predominance of women in 73.61% (343). Almost all patients (908) did not have their blood pressure measured at home. The biological tests requested were not carried out by 68.80% (691) of participants, while more than half 59.60% (598) showed good adherence to treatment. 51.70% (519) of patients returned for a follow-up visit after 6 months ( Table 3 ). Table 3. Distribution of participants according to behavioral characteristics, lifestyle and blood pressure control. Behavioral characteristics and lifestyle Hypertensive patients N=1004 p Controlled hypertension group n (%) 423 (42.1) (BP 140/90 mm Hg) Stop smoking <0.001 * Yes 37 (8.7) 115 (19.80) No 386 (91.30) 466 (80.20) Tobacco consumption 0.02 * Yes 11 (2.60) 33 (5.70) No 412 (97.40) 548 (94.30) Alcohol consumption <0.001 ** Yes 0 (0) 14 (2.41) No 423 (100) 567 (97.59) Self-measurement of blood pressure 0.60 Yes 38 (9) 58 (10) No 385 (91) 325 (90) Low-salt diet <0.001 * Yes 259 (61.20) 247 (42.50) No 164 (38.80) 334 (57.50) Biological monitoring 0.05 Yes 146 (34.50) 167 (28.70) No 277 (65.50) 414 (71.30) Physical activity profile <0.001 * Low 149 (35.20) 317 (54.60) Moderate 248 (58.60) 251 (43.20) High 26 (6.10) 13 (2.20) Medication compliance <0.001 * Yes 360 (85.11) 238 (40.96) No 63 (14.89) 343 (59.04) Stress <0.001 * Yes 291 (68.80) 456 (78.50) No 132 (31.20) 125 (21.50) * Test de Khi2. ** Test exact de Fisher. Regarding accessibility and services offered at the PHCF, 54.10% (543) of patients confirmed that they needed 30 min to 1 hour to get to their follow-up center. 87.20% (875) of participants stated that they did not receive information on hypertension, while 56.20% (564) did not receive education on its complications. More than half of the respondents (59%, 592) expressed reluctance to discuss personal problems relating to hypertension with their doctor. The availability of antihypertensive in the PHCF was judged differently by hypertensive patients, 21% (211) said they had never found their medication, 55.80% (560) said they rarely found it, while 22.70% (228) often found it and 0.5% 5 said they always found their medication available. Regarding patients’ satisfaction with the hypertension management services offered in the PHCF, 18.80% (189) were dissatisfied, 45.50% (457) were not very satisfied, 30.10% (302) were satisfied and only 5.6% (56) were very satisfied. At the bivariable analysis stage, we retained sixteen variables significantly associated with UBP. Multivariable analysis of the previously selected variables revealed the following associated factors: rural residence (OR = 3.13; 95% CI = [2.06-4.74]); advanced age (OR= 1.39; 95% CI = [1. 09-1.63]); low monthly income (OR = 1.37; 95% CI = [1.21-1.56]); high BMI (OR = 1.39; 95% CI = [1.15-1.69]) and poor adherence to medication (OR = 7.24; 95% CI = [5.09-10.31]) ( Table 4 ). Table 4. Multivariable analysis (odds ratio, p-value) of uncontrolled blood pressure in hypertensive patients followed at PHCF in Settat- Morocco. Variables Risk factors associated with uncontrolled blood pressure in hypertensive patients Bivariable analysis Multivariable analysis AOR 95% CI P-value AOR 95% CI P-value Rural residence 1.39 (1.08-1.79) 0.01 3.13 (2.06-4.74) 0.001 Male sex 1.16 (1.08-1.24) <0.001 1.39 (0.79-2.44) 0.24 Advanced age 1.07 (0.87-1.26) <0.001 1.34 (1.09-1.63) 0.004 Low monthly income 1.10 (0.79-1.23) <0.001 1.37 (1.21-1.56) 0.001 Length of illness 1.03 (0.80-1.31) <0.001 1.06 (0.86-1.29) 0.60 Diabetes 0.70 (0.61-080) <0.001 1.30 (0.94-1.80) 1.11 Dyslipidemia 0.72 (0.53-0.99) 0.04 1.04 (0.65-1.66) 0.85 High BMI 1.14 (0.91-1.85) <0.001 1.39 (1.15-1.69) 0.001 High-salt diet 1.44 (1.27-1.62) <0.001 0.41 (0.29-0.58) 0.001 Stop Smoking 0.43 (0.31-0.62) <0.001 1.12 (0.58-2.18) 0.72 Tobacco consumption 0.45 (0.23-0.90) 0.02 0.96 (0.37-2.67) 0.99 Stress 1.45 (1.17-1.79) <0.001 1.60 (1.09-2.35) 0.02 Poor medication compliance 2.07 (1.87-2.30) <0.001 7.24 (5.09-10.31) 0.001 Low physical activity 0.95 (0.25-1.12) <0.001 0.77 (0.63-0.92) 0.006 Discussion Blood pressure control is the main objective of hypertension management protocols. However, this objective is hampered by several environmental and/or patient-related risk factors. Our study targeted hypertensive patients followed in urban and rural health centers in Settat city to determine the prevalence of UBP and to identify associated risk factors. The results revealed that the level of BPC was unsatisfactory in more than half of the hypertensive population studied (57.90% (581)). This finding was confirmed by several studies conducted in different regions of Morocco, such as Meknes, 6 Marrakech 18 and Rabat 19 who reported an UBP level of 73%, 73.50% and 76.70% respectively. In the same context, the results of multivariable logistic regression showed that living in a rural area was a factor associated with UBP in this population, which was in line with the results of a study also conducted in Africa. 20 the place of residence in Morocco is a challenge in terms of equal access to healthcare, particularly in rural areas, which are characterized by their disparity, the presence of isolated areas and the inadequacy of local health structures, leading to an inequity in health human resources and drug supplies in these areas, 21 these factors may explain the UBP observed in this population. In addition, monthly income was another socio-demographic factor mentioned during our survey, which was corroborated by other studies carried out in Morocco. 6 – 7 In this respect, the HCP stated that the average income in 2019 was 2083 DHS/Month in urban areas and 1297 DHS/Month in rural areas, which represents a significant disparity (0.45) between the two areas according to the GINI index. 11 During our survey, we found that 48.11% received less than 2,000 DHS/month, which means a remarkable poverty rate among this population. 11 The level of monthly income has an impact on people’s consumption and purchasing power 21 This may hinder the availability of antihypertensive treatment, the frequency of medical check-ups and the performance of the biological and complementary tests requested of patients, which may consequently influence their level of blood pressure control. In this sense, it will be imperative to take into account the socio-economic and demographic dimension when drawing up protocols for the management of hypertension. In addition, advanced age was identified as a factor associated with UBP, a finding consistent with the results of other studies., 22 – 24 which may be linked to the particular nature of this period of life, characterized by the phenomenon of ageing often marked by arterial rigidity and the presence of co-morbidities in the elderly, which can complicate the management of their hypertension. 25 In addition, analysis of the participants’ nutritional status revealed that overweight/obesity was a risk factor associated with UBP, which was in line with the results of several studies, 6 , 26 , 27 In this context, WHO has confirmed that an increase in BMI is a major risk factor for non-communicable diseases such as hypertension and diabetes, with an increased risk of developing cardiovascular risks such as stroke. 14 Finally, poor adherence to prescribed treatment was associated with UBP. This finding was confirmed by two other studies. 28 , 29 Poor compliance with medication can be explained by the unavailability of antihypertensive drugs in health centers, the decline in patients’ incomes and poverty, and the advanced age of participants. This means that health centers must be provided with sufficient antihypertensive drugs on a regular basis to ensure that patients are always supplied, and this action must be reinforced by the promotion of therapeutic education, stressing the danger of forgetting or stopping treatment on blood pressure control and the general state of health of hypertensive patients. Contributions to the literature ➢ This study aimed to determine the prevalence of uncontrolled blood pressure in this region, to address the lack of public health data or studies targeting this burden. ➢ The importance to take into account socio-demographic factors such as residence area when developing protocols for the management of hypertension. ➢ Highlighting the important role of primary healthcare facilities in blood pressure control, particularly by providing patients with antihypertensive drugs. ➢ The importance of educating hypertensive patients about the impact of lifestyle on blood pressure control. Conclusion This study, carried out in the province of Settat in Morocco, aimed to estimate the prevalence of uncontrolled blood pressure and to identify the associated risk factors. The results highlighted a number of factors significantly associated with UBP, including rural residence, low socio-economic status, advanced age, high body mass index and poor compliance with treatment. These findings underline the need to adapt hypertension management protocols to take account of socio-economic and demographic factors. It is also crucial to improve the regular supply of antihypertensive drugs in healthcare centers, to promote compliance with medication, and to set up therapeutic education programmes focusing on hygienic and dietary measures, in order to achieve lasting improvements in blood pressure control in the hypertensive population. Availability of data and materials The data used in this study comes from the medical records of patients treated in primary healthcare facilities in the province of Settat. For ethical and confidentiality reasons, this data cannot be shared publicly. The approval of the Ethics Committee and regional health authorities was obtained, with the explicit condition that the data not be made public. Any interested researcher may submit a reasoned request to the corresponding author and the Biomedical Ethics Committee of the Faculty of Medicine and Pharmacy of Casablanca, and access may be granted under certain conditions that guarantee the protection of patient privacy. Acknowledgements We would like to thank the nursing and administrative staff at the Settat health Delegation. References 1. Unger T, Borghi C, Charchar F, et al. : 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. juin 2020 [cité 22 sept 2023]; 75 (6): 1334–1357. Publisher Full Text 2. Hypertension: [cité 15 août 2023]. Reference Source 3. Zhou B, Perel P, Mensah GA, et al. : Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat. Rev. 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PubMed Abstract | Publisher Full Text | Free Full Text Footnotes 1 Health and Social Protection Delegation for the Province of Settat / Chronic disease monitoring service. 2 http://cartesanitaire.sante.gov.ma/dashboard/pages2/etab_ressp_2024.html . Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 03 Oct 2025 ADD YOUR COMMENT Comment Author details Author details 1 Health Sciences and Techniques Laboratory, Hassan First University, Higher institute of Health Sciences, Settat, Chaouia-Ouardigha, Morocco MANAR AARRAD Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Saad EL MADANI Roles: Formal Analysis Sanaa TOUZAMI Roles: Formal Analysis, Investigation El Hassan ROUSSI Roles: Methodology Mohamed HILAL Roles: Methodology Fatimazahra LAAMIRI Roles: Conceptualization, Formal Analysis, Methodology, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 02 Mar 2026, 14:1035 https://doi.org/10.12688/f1000research.169441.2 version 1 Published: 03 Oct 2025, 14:1035 https://doi.org/10.12688/f1000research.169441.1 Copyright © 2025 AARRAD M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article AARRAD M, EL MADANI S, TOUZAMI S et al. 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