Effective Management of Hypertension: A Cross-Sectional Study of Five Health Facilities

Effective Management of Hypertension: A Cross-Sectional Study of Five Health Facilities | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effective Management of Hypertension: A Cross-Sectional Study of Five Health Facilities Sara Agyemang Antwi, Jemima Aggrey Appiah, Charles Kankam Boateng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4471168/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Hypertension remains a significant global health concern due to its high incidence and association with cardiovascular diseases, stroke, and other complications. This research aimed to determine the dynamics of blood pressure control over the course of disease management, focusing on the systolic and diastolic readings at baseline and at the time of the study and on the number of years of patient management and sex. Methods A retrospective study with a multicenter approach was used. The information of a total of 373 patients was collected and analyzed using Python and SPSS. Results Overall, 72.9% of the patients were female, and 27.1% were male. The mean age was 62.57 ± 0.635 years. A regression model was used to evaluate the associations between the number of years of hypertension management, systolic anddiastolic BP at first diagnosis and current systolic and diastolic BP at R-square, (13.2% and 29.2%, respectively; p <0.01). There was a significant reduction in the systolic BP before (M = 157.01 ± 28.159) compared to after (M =138.07 ± 19.591), t (372) = 12.959, p <0.001. Similarly, the results showed a significant reduction in the diastolic BP of the patients before (M = 91.85 ± 15.934) compared to after (M =85.19 ± 12.955), t (372) = 9.062, p <0.001. There was a greater systolic BP at first diagnosis in males than in females. Conclusions The number of years of hypertension management and BP at first diagnosis may be associated with the outcome of management. Appropriate treatment combinations involving two classes of antihypertensive drugs may encourage patient adherence and yield positive outcomes. Clinical Pharmacology Hypertension calcium-channel blockers comorbidities diabetes mellitus arthritis adherence polypharmacy. Figures Figure 1 Figure 2 Figure 3 1. BACKGROUND Hypertension, a chronic medical condition characterized by elevated blood pressure levels, remains a significant global health concern due to its high prevalence and association with cardiovascular diseases, stroke, and other complications [ 1 , 2 ]. Effective management of hypertension is essential for mitigating the risk of adverse health outcomes and improving the overall quality of life of affected individuals [ 3 ]. In recent years, there has been increasing recognition of the complexity surrounding hypertension management, particularly concerning diverse prescribing patterns, varying durations of management, and the presence of comorbidities [ 4 , 5 ]. Healthcare providers face the challenge of tailoring treatment strategies to meet the unique needs of each patient while navigating through an array of available antihypertensive medications and therapeutic approaches [ 5 , 6 ]. The management of hypertension involves the prescription of various classes of antihypertensive medications, including diuretics, beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), and others [ 7 , 8 , 9 ]. Each class of medication has distinct mechanisms of action and efficacy profiles, necessitating careful consideration of individual patient characteristics and treatment goals when selecting the appropriate regimen [ 10 , 11 ]. Understanding the different prescribing patterns adopted by healthcare providers is crucial for evaluating their impact on treatment outcomes, patient adherence, and healthcare resource utilization [ 12 ]. Variations in prescribing practices may stem from factors such as clinical guidelines, physician preferences, patient demographics, and drug availability, highlighting the need for comprehensive assessment and comparison of these approaches [ 3 , 12 , 13 ]. The duration of hypertension management encompasses both short-term interventions to achieve blood pressure control and long-term strategies aimed at preventing disease progression and reducing cardiovascular risk [ 2 ]. Effective management requires a sustained commitment to treatment adherence, lifestyle modifications, and periodic monitoring to ensure that therapeutic goals are met and maintained over time [ 14 , 15 ]. Hypertension frequently coexists with various comorbidities, including diabetes mellitus, obesity, dyslipidemia, chronic kidney disease, and cardiovascular disorders, posing additional challenges to effective management [ 16 ]. The presence of comorbid conditions may influence treatment decisions, medication selection, and treatment goals, requiring a comprehensive and multidisciplinary approach to patient care. Addressing the complex interplay between hypertension and comorbidities necessitates integrated management strategies that consider the unique clinical characteristics and treatment priorities of each patient [ 17 ]. In summary, effective management of hypertension requires a nuanced understanding of multiple factors, including diverse prescribing patterns, treatment durations, and comorbidities. By exploring these aspects through rigorous research and evidence-based practices, healthcare providers can enhance the quality of hypertension care and mitigate the burden of this prevalent chronic condition on individuals and healthcare systems worldwide. The quest for managing hypertension is an ongoing challenge in the medical field. This research aimed to determine the dynamics of blood pressure control over the course of treatment, focusing on systolic and diastolic readings as primary indicators of cardiovascular health. The study was predicated on the hypothesis that current systolic and diastolic pressures should be lower than those recorded at the initial diagnosis, reflecting the efficacy of the interventions applied. The second hypothesis that is closely related to the first is that as the number of years of management increases, there should be a corresponding decrease in the blood pressure reading, thus making the current systolic and diastolic measurements lower than those at the first diagnosis. To explore this phenomenon, we identified current systolic and diastolic blood pressure as dependent variables, which are influenced by various factors throughout the management period. The number of years of treatment or management was considered an independent variable, providing insight into the longitudinal impact of sustained medical intervention on blood pressure levels. Furthermore, the research investigated potential disparities in systolic and diastolic blood pressure based on the sex of the patient to determine the demographic factors influencing treatment outcomes. Additionally, we examined the correlations between current systolic and diastolic blood pressure measurements and their respective values at the first diagnosis to assess the long-term trends in blood pressure changes. Through this study, we aim to contribute valuable data to the body of knowledge on hypertension management, potentially informing future treatment protocols and improving patient care outcomes. 2. METHODS Study Design A retrospective study with a multicenter approach was used to capture diverse patient populations and healthcare settings. Quantitative data collection methods were used for comprehensive analysis. Inclusion criteria Adults aged 18 years and above were diagnosed with hypertension. Patients receiving treatment for hypertension in the selected health facilities. Exclusion criteria Patient information retrieval software or folders lacked the required information. Sampling Strategy and Site Convenience sampling was performed at five health facilities (Bomso Clinic, Rev. Walker Specialist Hospital, AAMUSTED Clinic, Anwiam District Hospital and Pramso Hospital in Ashanti Region-Ghana). Data collection and sample size The quantitative data included baseline demographic information, blood pressure measurements at baseline and at the time of data collection, management regimens, and changes in therapy. A total of 200 patient data points were collected from each health facility. However, after careful cleaning of the data gathered, we obtained a total of 373 participants. Outcome Measures Primary Outcomes: Blood pressure control rates defined by guideline-recommended targets based on the current systolic and diastolic blood pressure. Incidence of cardiovascular events (e.g., myocardial infarction, stroke) and other hypertension-related complications. Data analysis Descriptive analysis of baseline characteristics and treatment patterns. Multivariate regression modeling was used to identify independent predictors of hypertension management outcomes, adjusting for potential confounders. Ethics approval and consent to participate Ethics approval and consent to participate were obtained from the institutional review board of the Institute of Research, Innovation and Development (IRID). Approval was also obtained from the health facilities since the research relied solely on patient information (secondary data). Patient confidentiality and privacy were maintained throughout the research process. 3. RESULTS 3.1 Demographics There was a greater percentage of female hypertensive patients than male patients (72.9% and 27.1%, respectively). Additionally, the mean age was 62.57 ± 0.635 years. It was observed that, in some patients, the systolic and diastolic BP increased rather than decreased, leading to negative values for the difference in systolic and diastolic BP. (Table 1) 3.2 Association between the number of years of hypertension management and outcome (current systolic and diastolic) When regression models were estimated using Python, several regression equations were generated. Null Hypothesis: There is no association between the number of years of hypertension management and current systolic/diastolic BP. Alternate Hypothesis: There is an association between the number of years of hypertension management and current systolic/diastolic BP. Regression model 1 Y = -0.47X 1 + 0.264X 2 + 100.071 where Y = current systolic BP, X 1 = number of years of management, and X 2 = systolic BP at first diagnosis. The R-square was 13.2%, and the F-statistic was significant at p <0.001. All the coefficients are statistically significant at p <0.01. This means that we can reject the null hypothesis that there is no association between the number of years of hypertension management and management outcome, specifically, the current systolic level. Regression model 2 Y = 0.204X 1 + 0.421X 2 + 45.066 where Y = current diastolic BP, X 1 = number of years of management, and X 2 = diastolic BP at first diagnosis. The R-square was 29.2%, and the F-statistic was significant at p <0.01. However, the coefficient of the number of years of hypertension management was not statistically significant. This means that diastolic BP may not be strongly affected by the number of years of management. 3.3 Positive management outcomes (reduced current systolic and diastolic) with conventional drug therapy for hypertension A paired sample t test was performed to evaluate the impact of pharmacological management on the BP readings. The results showed a significant reduction in the systolic BP of the patients before (M = 157.01 ± 28.159) compared to after (M =138.07 ± 19.591), t (372) = 12.959, p <0.001 (two-tailed). The mean decrease in systolic BP was 18.979, Std. Error was 1.465, with a 95% confidence interval ranging from 16.099-21.858. The eta-squared value of 0.311 indicated a medium effect size. (Table 2) Similarly, the results showed a significant reduction in the diastolic BP of the patients before (M = 91.85 ± 15.934) compared to after (M =85.19 ± 12.955), t (372) = 9.062, p <0.001 (two-tailed). The mean decrease in diastolic BP was 6.66, Std. Error was 0.735, with a 95% confidence interval ranging from 5.215-8.105. The eta-squared value of 0.181 indicated a small effect size. (Table 2) It can also be inferred from the data analysis that conventional drug therapy yields a positive outcome. Additionally, there were few records (2 out of 373, 0.54%) of cardiovascular accidents (CVA), strokes (none reported) or hypertensive crises (none reported). Relationship between the BP at the first diagnosis and the current BP There was a positive correlation between the systolic level at first diagnosis and the current level, as did the diastolic level (Figure 1 & Table 3). This result was significant at p < 0.001. (Table 4). This means that patients who had higher systolic or diastolic BP readings at first diagnosis had greater current systolic or diastolic BP readings than did those who had lower values. Disparities between hypertension characteristics and management outcomes according to patient sex Independent sample t tests were performed to compare hypertension characteristics between males and females. There were significant differences (t (371) = 3.37, p < 0.01) in the systolic blood pressure at first diagnosis, with the mean BP for males (M = 165 ± 33.2) being greater than that for females (M = 154.09 ± 25.5). The magnitude of the differences in means (mean difference = 10.91 ± 3.2, 95% CI: 4.54 to 17.27) was significant. However, there were no statistically significant differences between males and females for either the current systolic BP or both the diastolic BP at first diagnosis and the current diastolic BP. This finding implies that although there was a greater percentage of females with hypertension in this dataset, males had a relatively higher systolic BP at first diagnosis than females did. (Table 4). Common first -line therapy drugs Nifedipine and amlodipine are the most common calcium channel blocker drugs (CCBs) used for initial management. (Figure 2). Angiotensin II receptor blockers (ARBs) also seem to be prescribed more than angiotensin converting enzyme inhibitors (ACEIs). The term “polypharmacy”, which connotes the pattern of multiple prescriptions for hypertension management, did not seem to be evident, as the mean number of drugs per patient was 1.49 ± 0.031. (Table 1). Prevalent comorbidities Type 2 diabetes mellitus was the most prevalent comorbidity and was reported by many the respondents. (Figure 3). Notable comorbidities reported by patients were arthritis; peripheral neuropathy; and musculoskeletal conditions such as myalgia, lumbago, spondylosis, musculoskeletal pains, and mastalgia, among others. The group called “Others” included individuals with erectile dysfunction, chronic kidney disease, cellulitis, and cardiovascular accidents, among others. 4. DISCUSSION Hypertension has been reported in other studies to be prevalent among people aged 65years and above [18]; in this study, the mean age (approx. 63years) of hypertensive patients was similar. The high incidence of hypertension in females in this study may be due to weight gain associated with pregnancy [19] and contraceptive use [20]. Weight gain has been linked to an increased chance of developing preeclampsia, a condition characterized by elevated blood pressure [19]. Some of these conditions can persist after childbirth [21]. Additionally, female sex is more strongly correlated with early-onset hypertension and hypertension in general with sex-specific genetic risk factors than male sex is according to a study performed in the Finnish population [22]. The regression model generated postulates a negative albeit possible association between the number of years of hypertension management and the systolic BP reading, which is acceptable. Generally, a positive management outcome, which is evidenced by a decrease in BP from the baseline of diagnosis, is expected after years of management, provided there is adherence to therapy and other modifications [23]. Patients who accept pharmacological treatment usually achieve positive outcomes within some years [24,25,26]. This was further confirmed in the present study, as reductions in both systolic and diastolic BP were observed. Notably, two classes of antihypertensives are used for management [18]. Both calcium channel blockers (CCBs) and angiotensin receptor blockers (ARBs) are predominant [12,18]. The combination of CCBs and ARBs is cost-saving [11]. Additionally, single-pill, fixed-dose combination treatment improved adherence and prevented or reduced the occurrence of resistant hypertension [27]. According to one study, CCBs are superior for the prevention of stroke [2]. This could be an informative factor for its preferred use. Ashdad reported that prescribing patterns may not occur according to guidelines in low- and middle-income countries (LMICs) [12], and this could be true, as a few discrepancies were observed in the dataset; however, because the average number of antihypertensive drugs per patient was approximately two (2), it can be said that prescribing patterns are good to some extent. In this study, males were observed to have a greater systolic BP than females because males are more likely to defer hospital attendance and therapy. Some studies report that women have better reporting patterns of health conditions than men [28,29,30]. In view of this, the delay in seeking medical care could be the contributing factor to higher systolic BP readings at first diagnosis. Among the 1000 patients with hypertensive crisis, 63 (6.3%) were included in one African study, and these patients were predominantly female [31]; however, in our study, none were reported. This is likely due to the small sample size. Diabetes is undoubtedly a well-known comorbidity of hypertension, so proper control of one of these conditions is believed to lead to improvement in the other. It is not surprising that this was the highest reported comorbidity in this study. One other comorbid condition is arthritis [16]. Limitations and Challenges There was difficulty in controlling for confounding variables and external factors influencing treatment outcomes, one of which was the lack of knowledge on the concomitant use of herbal medicines and conventional antihypertensive agents. Additionally, there are generalizability limitations due to variations in healthcare systems, patient populations, and treatment practices across different settings. Recommendations Collaboration with healthcare stakeholders and policy makers to encourage prescribers to continue to desist from polypharmacy, as this collaboration will improve concordance between health practitioners and patients. 5. CONCLUSIONS It was concluded that the number of years of hypertension management is associated with the outcome of hypertension management, as is the number of blood pressure readings at first diagnosis. Appropriate treatment combinations involving two classes of antihypertensive drugs may encourage patient adherence and yield positive outcomes. Abbreviations ACEIs – angiotensin-converting enzyme inhibitors ARBs – Angiotensin receptor blockers BP – Blood pressure CCBs – Calcium channel blockers RTI – Respiratory tract infections Declarations Ethics Approval and Consent to participate - Ethics approval was obtained from the Institute of Research, Innovation and Development (IRID) at Kumasi Technical University. Reference number: IRID/EC2024/HS0003 Consent for publication – Not applicable. Availability of data and materials – Data are available from the author upon request. Competing interests – None declared. Funding - No external funding Author contributions – SAA was responsible for the research idea and supervision of the data collection and was a major contributor to the writing of the manuscript. JAA was responsible for shaping the research idea, formulating the research questions, and writing the manuscript. CKB was responsible for the analysis of the data. All the authors read and approved the final manuscript. Acknowledgments – We would like to thank all the data collectors, namely, Theophilus Hodalor, Evans Akonnor, Samuel Opoku, Abigail Torsah, Nana Kwame Owusu-Ansah and Anita Opoku, for their hard work. Additionally, the Dean of Health Sciences, Prof. Samuel Osei-Djarbeng and Prof. Emmanuel Omari-Siaw (Head of Department, Pharmaceutical Sciences) deserve special mention for their support and experienced contributions during manuscript preparation. References Carey RM, Wright Jr JT, Taler SJ, Whelton PK. Guideline-driven management of hypertension: an evidence-based update. Circulation research. 2021 Apr 2;128(7):827-46. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, Chalmers J, Rodgers A, Rahimi K. 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Tables Table 1 Descriptive statistics of the scale variables Descriptive Statistics Minimum Maximum Mean Age 34 94 62.57 ± 0.635 Number of years of High BP Management 1 31 7.23 ± 0.279 Systolic BP on First Diagnosis 93 322 157.05 ± 1.458 Current systolic BP 84 218 138.07 ± 1.014 Difference in Systolics -51 191 18.98 ± 1.465 Diastolic BP on First Diagnosis 10 150 91.85 ± 0.825 Current diastolic BP 50 151 85.19 ± 0.671 Difference in Diastolics -76 50 6.66 ± 0.735 Number of BP drugs per patient 1 4 1.49 ± 0.031 Total Number 373 Table 2 Differences in the mean BP readings at first diagnosis and at the time of diagnosis. Paired Sample T test Paired Samples Statistics Mean N SD Std. Error Mean Pair 1 Systolic BP on first diagnosis 157.05 373 28.159 1.458 Current systolic BP 138.07 373 19.591 1.014 Pair 2 Diastolic BP on first diagnosis 91.85 373 15.934 0.825 Current diastolic 85.19 373 12.955 0.671 Paired Differences Mean SD Std. Error Mean 95% Confidence Interval of the Difference Lower Upper t df Sig. Pair 1 Systolic BP on first diagnosis - Current systolic BP 18.979 28.285 1.465 16.099 21.858 12.959 372 0.000 Pair 2 Diastolic BP on first diagnosis - Current diastolic 6.66 14.193 0.735 5.215 8.105 9.062 372 0.000 Table 3 Correlations among different variables in the dataset. Correlations Number of years of Management Systolic on first diagnosis Current systolic Diastolic on first diagnosis Current diastolic Age Number of years of Management 0.29 -0.02 0.19 0.18 0.21 Systolic on first diagnosis 0.34 0.39 0.34 0.07 Current systolic 0.24 0.54 -0.04 Diastolic on first diagnosis 0.53 -0.15 Current diastolic -0.1 Table 4 Differences in the mean systolic BP at first diagnosis according to sex. Independent Sample T test Sex N Mean Systolic on first diagnosis Male 101 165 ± 33.201 Female 272 154.09 ± 25.483 F (equal variances assumed) 4.259 p value 0.04 t 3.37 df 371 sig. 0.001 Mean difference 10.908 ± 3.236 95% Confidence interval of difference 4.544-17.272 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4471168","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":306275469,"identity":"69908aae-0b1f-4894-9e94-1f674b5064b2","order_by":0,"name":"Sara Agyemang Antwi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYHADxsaHDRCWARAfIKyBh4Gx2bABrJp4LQxskkRpkW8/+/ADQ41dnr1EclvljD9/EhvYm7dJMPy6g1OLwZl0YwmGY8nFPBKJbTc3thkkNvAcK5Ng7HuGWwtDGoMEAxtzYo80UMvDBqAWiRwzCcaew7gd1v+M+QfDv3qwlsIHf4Ba5N/g18JwI41NgrHtMFgL4wY2kC08ZhIMP3BrMbjxjM0ise94Ys/9h82SM9uMjdt40ootEhvwOSyN+caHb9WJ7T3HH37s+SMn289+eOOND3/wOAwEEpA5bCAisQ2/DmzgD+laRsEoGAWjYNgCALXDWJ+dnCtfAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0009-0006-1913-705X","institution":"Kumasi Technical University","correspondingAuthor":true,"prefix":"","firstName":"Sara","middleName":"Agyemang","lastName":"Antwi","suffix":""},{"id":306276161,"identity":"ede00500-9ee0-4998-8916-e3d66ba82f74","order_by":1,"name":"Jemima Aggrey Appiah","email":"","orcid":"https://orcid.org/0009-0008-3526-5152","institution":"Kumasi Technical University","correspondingAuthor":false,"prefix":"","firstName":"Jemima","middleName":"Aggrey","lastName":"Appiah","suffix":""},{"id":306276162,"identity":"8ab4de80-c72c-4400-89f0-dce747b8ec9b","order_by":2,"name":"Charles Kankam Boateng","email":"","orcid":"https://orcid.org/0009-0003-6529-2286","institution":"Intermaths students Association, Erasmus Students Association","correspondingAuthor":false,"prefix":"","firstName":"Charles","middleName":"Kankam","lastName":"Boateng","suffix":""}],"badges":[],"createdAt":"2024-05-24 08:41:28","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4471168/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4471168/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57380027,"identity":"e578bf07-ae65-49f6-862f-4ee593abd8e0","added_by":"auto","created_at":"2024-05-30 01:16:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54712,"visible":true,"origin":"","legend":"\u003cp\u003eA scatter plot displaying associations between the readings at first diagnosis andthe current data.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4471168/v1/09f9bba64eef65864817abc3.png"},{"id":57380025,"identity":"0d912957-b0ec-4d82-b710-e720120aba1d","added_by":"auto","created_at":"2024-05-30 01:16:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30505,"visible":true,"origin":"","legend":"\u003cp\u003ePareto plots of the common types of antihypertensive agents used as first-line therapy.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4471168/v1/18289d9a9047b1550fd25ac5.png"},{"id":57380028,"identity":"e7a15656-ba8a-4633-941d-4610072968b8","added_by":"auto","created_at":"2024-05-30 01:16:46","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":29564,"visible":true,"origin":"","legend":"\u003cp\u003ePareto plots of the comorbidities reported by hypertensive patients.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4471168/v1/8d004289e9ee3f200be8fb6c.png"},{"id":57380566,"identity":"b222c62b-c73d-4cea-98b1-db117c19ef16","added_by":"auto","created_at":"2024-05-30 01:24:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":639532,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4471168/v1/97da0613-547c-49aa-b77e-170a017b33e2.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eEffective Management of Hypertension: A Cross-Sectional Study of Five Health Facilities\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1. BACKGROUND","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHypertension, a chronic medical condition characterized by elevated blood pressure levels, remains a significant global health concern due to its high prevalence and association with cardiovascular diseases, stroke, and other complications [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Effective management of hypertension is essential for mitigating the risk of adverse health outcomes and improving the overall quality of life of affected individuals [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn recent years, there has been increasing recognition of the complexity surrounding hypertension management, particularly concerning diverse prescribing patterns, varying durations of management, and the presence of comorbidities [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Healthcare providers face the challenge of tailoring treatment strategies to meet the unique needs of each patient while navigating through an array of available antihypertensive medications and therapeutic approaches [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe management of hypertension involves the prescription of various classes of antihypertensive medications, including diuretics, beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), and others [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Each class of medication has distinct mechanisms of action and efficacy profiles, necessitating careful consideration of individual patient characteristics and treatment goals when selecting the appropriate regimen [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eUnderstanding the different prescribing patterns adopted by healthcare providers is crucial for evaluating their impact on treatment outcomes, patient adherence, and healthcare resource utilization [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Variations in prescribing practices may stem from factors such as clinical guidelines, physician preferences, patient demographics, and drug availability, highlighting the need for comprehensive assessment and comparison of these approaches [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe duration of hypertension management encompasses both short-term interventions to achieve blood pressure control and long-term strategies aimed at preventing disease progression and reducing cardiovascular risk [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Effective management requires a sustained commitment to treatment adherence, lifestyle modifications, and periodic monitoring to ensure that therapeutic goals are met and maintained over time [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHypertension frequently coexists with various comorbidities, including diabetes mellitus, obesity, dyslipidemia, chronic kidney disease, and cardiovascular disorders, posing additional challenges to effective management [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The presence of comorbid conditions may influence treatment decisions, medication selection, and treatment goals, requiring a comprehensive and multidisciplinary approach to patient care.\u003c/p\u003e\u003cp\u003eAddressing the complex interplay between hypertension and comorbidities necessitates integrated management strategies that consider the unique clinical characteristics and treatment priorities of each patient [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn summary, effective management of hypertension requires a nuanced understanding of multiple factors, including diverse prescribing patterns, treatment durations, and comorbidities. By exploring these aspects through rigorous research and evidence-based practices, healthcare providers can enhance the quality of hypertension care and mitigate the burden of this prevalent chronic condition on individuals and healthcare systems worldwide.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe quest for managing hypertension is an ongoing challenge in the medical field. This research aimed to determine the dynamics of blood pressure control over the course of treatment, focusing on systolic and diastolic readings as primary indicators of cardiovascular health. The study was predicated on the hypothesis that current systolic and diastolic pressures should be lower than those recorded at the initial diagnosis, reflecting the efficacy of the interventions applied. The second hypothesis that is closely related to the first is that as the number of years of management increases, there should be a corresponding decrease in the blood pressure reading, thus making the current systolic and diastolic measurements lower than those at the first diagnosis.\u003c/p\u003e \u003cp\u003eTo explore this phenomenon, we identified current systolic and diastolic blood pressure as dependent variables, which are influenced by various factors throughout the management period. The number of years of treatment or management was considered an independent variable, providing insight into the longitudinal impact of sustained medical intervention on blood pressure levels.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFurthermore, the research investigated potential disparities in systolic and diastolic blood pressure based on the sex of the patient to determine the demographic factors influencing treatment outcomes. Additionally, we examined the correlations between current systolic and diastolic blood pressure measurements and their respective values at the first diagnosis to assess the long-term trends in blood pressure changes. Through this study, we aim to contribute valuable data to the body of knowledge on hypertension management, potentially informing future treatment protocols and improving patient care outcomes.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cp\u003e\u003cem\u003eStudy Design\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective\u0026nbsp;study with a multicenter approach\u0026nbsp;was used\u0026nbsp;to capture diverse patient populations and healthcare settings. Quantitative data collection methods were used for comprehensive analysis.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInclusion\u0026nbsp;\u003c/em\u003e\u003cem\u003ecriteria\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAdults aged 18 years and above\u0026nbsp;were\u0026nbsp;diagnosed with hypertension.\u003c/p\u003e\n\u003cp\u003ePatients receiving treatment for hypertension in the selected health facilities.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eExclusion\u0026nbsp;\u003c/em\u003e\u003cem\u003ecriteria\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePatient\u0026nbsp;information retrieval software or folders\u0026nbsp;lacked the required information.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSampling Strategy and Site\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eConvenience sampling\u0026nbsp;was performed\u0026nbsp;at five health facilities (Bomso\u0026nbsp;Clinic, Rev. Walker Specialist Hospital, AAMUSTED\u0026nbsp;Clinic, Anwiam District Hospital and Pramso Hospital in Ashanti Region-Ghana).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData\u0026nbsp;\u003c/em\u003e\u003cem\u003ecollection\u003c/em\u003e\u003cem\u003e\u0026nbsp;and\u0026nbsp;\u003c/em\u003e\u003cem\u003esample\u003c/em\u003e\u003cem\u003e\u0026nbsp;size\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe quantitative\u0026nbsp;data included baseline demographic information, blood pressure measurements at baseline and at the time of data collection, management regimens, and changes in therapy. A total of 200 patient\u0026nbsp;data points were\u0026nbsp;collected from each health facility. However, after careful cleaning of the data gathered, we\u0026nbsp;obtained a total of 373 participants.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOutcome Measures\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePrimary Outcomes: Blood pressure control rates defined by guideline-recommended targets based on the current systolic and diastolic blood pressure.\u003c/p\u003e\n\u003cp\u003eIncidence of cardiovascular events (e.g., myocardial infarction, stroke) and other hypertension-related complications.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData\u0026nbsp;\u003c/em\u003e\u003cem\u003eanalysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive analysis of baseline characteristics and treatment patterns. Multivariate\u0026nbsp;regression\u0026nbsp;modeling was used\u0026nbsp;to identify independent predictors of hypertension management outcomes, adjusting for potential confounders.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics\u0026nbsp;\u003c/em\u003e\u003cem\u003eapproval\u003c/em\u003e\u003cem\u003e\u0026nbsp;and\u0026nbsp;\u003c/em\u003e\u003cem\u003econsent\u003c/em\u003e\u003cem\u003e\u0026nbsp;to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEthics\u0026nbsp;approval\u0026nbsp;and\u0026nbsp;consent\u0026nbsp;to participate\u0026nbsp;were\u0026nbsp;obtained from\u0026nbsp;the\u0026nbsp;institutional review board\u0026nbsp;of the\u0026nbsp;Institute of Research, Innovation and Development (IRID). Approval was also obtained from the health facilities since the research relied solely on patient information (secondary data). Patient confidentiality and privacy\u0026nbsp;were\u0026nbsp;maintained\u0026nbsp;throughout the research process.\u003c/p\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003e3.1 \u003cstrong\u003eDemographics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was a greater percentage of female hypertensive patients\u0026nbsp;than male patients (72.9% and 27.1%,\u0026nbsp;respectively). Additionally, the mean age was\u0026nbsp;62.57 ± 0.635 years. It was observed that,\u0026nbsp;in\u0026nbsp;some patients,\u0026nbsp;the systolic and diastolic BP\u0026nbsp;increased\u0026nbsp;rather than\u0026nbsp;decreased,\u0026nbsp;leading to negative values for the difference in\u0026nbsp;systolic\u0026nbsp;and\u0026nbsp;diastolic BP. (Table 1)\u003c/p\u003e\n\u003cp\u003e3.2 \u003cstrong\u003eAssociation between\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ethe\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003enumber of years of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ehypertension management\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and outcome (current systolic and diastolic)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen regression models were estimated using Python,\u0026nbsp;several regression\u0026nbsp;equations were generated.\u003c/p\u003e\n\u003cp\u003eNull Hypothesis: There is no association between the number of years of\u0026nbsp;hypertension\u0026nbsp;management and current systolic/diastolic BP.\u003c/p\u003e\n\u003cp\u003eAlternate Hypothesis: There is an association between the number of years of\u0026nbsp;hypertension\u0026nbsp;management and current systolic/diastolic BP.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRegression model 1\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eY = -0.47X\u003csub\u003e1\u003c/sub\u003e + 0.264X\u003csub\u003e2\u003c/sub\u003e + 100.071\u003c/p\u003e\n\u003cp\u003ewhere\u0026nbsp;Y = current systolic\u0026nbsp;BP, X\u003csub\u003e1\u0026nbsp;\u003c/sub\u003e= number of years of management,\u0026nbsp;and\u0026nbsp;X\u003csub\u003e2\u0026nbsp;\u003c/sub\u003e= systolic BP\u0026nbsp;at\u0026nbsp;first diagnosis.\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;R-square\u0026nbsp;was\u0026nbsp;13.2%,\u0026nbsp;and\u0026nbsp;the\u0026nbsp;F-statistic\u0026nbsp;was\u0026nbsp;significant at \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001. All the\u0026nbsp;coefficients\u0026nbsp;are statistically significant at \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01.\u003c/p\u003e\n\u003cp\u003eThis means that we can reject the null hypothesis that there is no association between the number of years of hypertension management and management outcome,\u0026nbsp;specifically, the current systolic\u0026nbsp;level.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRegression model 2\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eY = 0.204X\u003csub\u003e1\u003c/sub\u003e + 0.421X\u003csub\u003e2\u003c/sub\u003e + 45.066\u003c/p\u003e\n\u003cp\u003ewhere\u0026nbsp;Y = current diastolic\u0026nbsp;BP, X\u003csub\u003e1\u003c/sub\u003e = number of years of management,\u0026nbsp;and\u0026nbsp;X\u003csub\u003e2\u0026nbsp;\u003c/sub\u003e= diastolic BP\u0026nbsp;at\u0026nbsp;first diagnosis.\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;R-square\u0026nbsp;was\u0026nbsp;29.2%,\u0026nbsp;and\u0026nbsp;the\u0026nbsp;F-statistic\u0026nbsp;was\u0026nbsp;significant at \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01.\u0026nbsp;However, the coefficient of the number\u0026nbsp;of years of hypertension management was not statistically significant.\u003c/p\u003e\n\u003cp\u003eThis means that diastolic BP may not be strongly\u0026nbsp;affected\u0026nbsp;by the number of years of management.\u003c/p\u003e\n\u003cp\u003e3.3 \u003cstrong\u003ePositive management outcomes (reduced current systolic and diastolic) with conventional drug therapy for hypertension\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA paired sample t test was performed to evaluate the impact of pharmacological management on the BP readings. The results showed a significant reduction in the systolic BP of the patients before (M = 157.01 ± 28.159)\u0026nbsp;compared\u0026nbsp;to after (M =138.07 ± 19.591), t (372) = 12.959, \u003cem\u003ep\u003c/em\u003e \u0026lt;0.001\u0026nbsp;(two-tailed). The mean decrease in systolic BP was 18.979, Std. Error\u0026nbsp;was\u0026nbsp;1.465,\u0026nbsp;with a 95% confidence interval ranging\u0026nbsp;from\u0026nbsp;16.099-21.858. The eta-squared\u0026nbsp;value of\u0026nbsp;0.311 indicated a medium effect size. (Table 2)\u003c/p\u003e\n\u003cp\u003eSimilarly, the results showed a significant reduction in the diastolic BP of the patients before (M = 91.85 ± 15.934)\u0026nbsp;compared\u0026nbsp;to after (M =85.19 ± 12.955), t (372) = 9.062, \u003cem\u003ep\u003c/em\u003e \u0026lt;0.001\u0026nbsp;(two-tailed). The mean decrease in diastolic BP was 6.66, Std. Error\u0026nbsp;was\u0026nbsp;0.735,\u0026nbsp;with a 95% confidence interval ranging\u0026nbsp;from\u0026nbsp;5.215-8.105. The eta-squared\u0026nbsp;value of\u0026nbsp;0.181 indicated a small effect size. (Table 2)\u003c/p\u003e\n\u003cp\u003eIt can also be inferred from the data analysis that conventional drug therapy yields a positive outcome. Additionally, there were few records (2 out of 373, 0.54%) of\u0026nbsp;cardiovascular\u0026nbsp;accidents (CVA), strokes (none reported) or hypertensive\u0026nbsp;crises\u0026nbsp;(none reported).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between the BP\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eat\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;the first diagnosis and the current BP\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere\u0026nbsp;was\u0026nbsp;a positive correlation between the\u0026nbsp;systolic level at\u0026nbsp;first diagnosis and the current\u0026nbsp;level, as did\u0026nbsp;the diastolic\u0026nbsp;level\u0026nbsp;(Figure 1 \u0026amp; Table 3). This\u0026nbsp;result was\u0026nbsp;significant at\u003cem\u003e\u0026nbsp;p\u003c/em\u003e \u0026lt; 0.001. (Table 4). This means that patients who had higher systolic or diastolic BP readings\u0026nbsp;at\u0026nbsp;first diagnosis\u0026nbsp;had greater\u0026nbsp;current systolic or diastolic BP readings\u0026nbsp;than did\u0026nbsp;those who had lower values.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisparities between\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ehypertension\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;characteristics and management\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eoutcomes according to\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;patient\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;sex\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndependent\u0026nbsp;sample t\u0026nbsp;tests were\u0026nbsp;performed to compare hypertension characteristics between males and females. There were significant differences (t (371) = 3.37, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01) in the systolic\u0026nbsp;blood pressure at\u0026nbsp;first diagnosis,\u0026nbsp;with\u0026nbsp;the\u0026nbsp;mean BP for\u0026nbsp;males\u0026nbsp;(M = 165 ± 33.2) being\u0026nbsp;greater\u0026nbsp;than that for\u0026nbsp;females\u0026nbsp;(M = 154.09 ± 25.5). The magnitude of the differences in means (mean difference\u0026nbsp;= 10.91 ± 3.2, 95% CI: 4.54 to 17.27) was significant. However, there\u0026nbsp;were\u0026nbsp;no statistically significant differences between males and females for\u0026nbsp;either the\u0026nbsp;current systolic BP\u0026nbsp;or\u0026nbsp;both the diastolic\u0026nbsp;BP\u0026nbsp;at\u0026nbsp;first diagnosis and\u0026nbsp;the\u0026nbsp;current diastolic\u0026nbsp;BP. This\u0026nbsp;finding\u0026nbsp;implies that although there was a greater percentage of females with hypertension in this\u0026nbsp;dataset, males had a relatively\u0026nbsp;higher systolic BP at\u0026nbsp;first diagnosis than females\u0026nbsp;did. (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommon first\u003c/strong\u003e\u003cstrong\u003e-line\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;therapy drugs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNifedipine and\u0026nbsp;amlodipine are the most common calcium\u0026nbsp;channel blocker drugs (CCBs) used for initial management. (Figure 2). Angiotensin II receptor blockers (ARBs) also\u0026nbsp;seem\u0026nbsp;to be prescribed more than\u0026nbsp;angiotensin\u0026nbsp;converting enzyme inhibitors (ACEIs).\u0026nbsp;The term “polypharmacy”,\u0026nbsp;which connotes the pattern of multiple\u0026nbsp;prescriptions\u0026nbsp;for hypertension management, did\u0026nbsp;not\u0026nbsp;seem\u0026nbsp;to be evident,\u0026nbsp;as the mean number of drugs per patient was\u0026nbsp;1.49 ± 0.031. (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalent\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ecomorbidities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eType 2\u0026nbsp;diabetes\u0026nbsp;mellitus was the most prevalent\u0026nbsp;comorbidity and was\u0026nbsp;reported by many the respondents. (Figure 3). Notable comorbidities reported by patients were arthritis;\u0026nbsp;peripheral neuropathy;\u0026nbsp;and musculoskeletal conditions such as myalgia, lumbago, spondylosis, musculoskeletal pains,\u0026nbsp;and\u0026nbsp;mastalgia, among\u0026nbsp;others. The group called “Others”\u0026nbsp;included individuals with\u0026nbsp;erectile dysfunction, chronic kidney disease, cellulitis,\u0026nbsp;and\u0026nbsp;cardiovascular accidents, among\u0026nbsp;others.\u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eHypertension has been reported in other studies to be prevalent among people aged\u0026nbsp;65years\u0026nbsp;and above [18];\u0026nbsp;in this study, the mean age (approx.\u0026nbsp;63years) of hypertensive patients was\u0026nbsp;similar. The high incidence of\u0026nbsp;hypertension\u0026nbsp;in females\u0026nbsp;in this study may be due to weight gain associated with pregnancy [19] and contraceptive use [20]. Weight gain has been linked to an increased chance of developing preeclampsia, a condition characterized by elevated blood pressure [19]. Some of these conditions can\u0026nbsp;persist\u0026nbsp;after childbirth [21].\u0026nbsp;Additionally,\u0026nbsp;female sex is\u0026nbsp;more strongly correlated with early-onset hypertension and hypertension in general with sex-specific genetic risk factors than\u0026nbsp;male sex is\u0026nbsp;according to a study\u0026nbsp;performed\u0026nbsp;in the Finnish population [22].\u003c/p\u003e\n\u003cp\u003eThe regression model generated postulates a negative albeit possible association between the number of years of hypertension management and the systolic BP reading,\u0026nbsp;which is acceptable. Generally,\u0026nbsp;a\u0026nbsp;positive management outcome,\u0026nbsp;which is evidenced by a decrease in BP from the baseline of diagnosis,\u0026nbsp;is expected after years of management, provided there is adherence to therapy and other modifications [23]. Patients who accept pharmacological\u0026nbsp;treatment\u0026nbsp;usually\u0026nbsp;achieve\u0026nbsp;positive outcomes\u0026nbsp;within\u0026nbsp;some years [24,25,26]. This\u0026nbsp;was\u0026nbsp;further confirmed in\u0026nbsp;the present\u0026nbsp;study,\u0026nbsp;as\u0026nbsp;reductions\u0026nbsp;in both systolic and diastolic BP were\u0026nbsp;observed. Notably, two classes of antihypertensives are used for management [18]. Both\u0026nbsp;calcium channel blockers\u0026nbsp;(CCBs) and\u0026nbsp;angiotensin receptor blockers\u0026nbsp;(ARBs) are predominant [12,18]. The combination of CCBs and ARBs is cost-saving [11].\u0026nbsp;Additionally, single-pill, fixed-dose combination treatment\u0026nbsp;improved\u0026nbsp;adherence and\u0026nbsp;prevented\u0026nbsp;or\u0026nbsp;reduced\u0026nbsp;the occurrence of resistant hypertension [27].\u0026nbsp;According to one study,\u0026nbsp;CCBs are superior for\u0026nbsp;the\u0026nbsp;prevention of stroke [2]. This could be an informative factor\u0026nbsp;for\u0026nbsp;its preferred use. Ashdad reported that prescribing patterns may not\u0026nbsp;occur\u0026nbsp;according to guidelines in\u0026nbsp;low- and\u0026nbsp;middle-income countries\u0026nbsp;(LMICs) [12],\u0026nbsp;and this could be true,\u0026nbsp;as a few discrepancies were observed in the dataset;\u0026nbsp;however,\u0026nbsp;because\u0026nbsp;the average number of antihypertensive drugs per patient was approximately two (2), it can be said that prescribing patterns are good to some extent.\u003c/p\u003e\n\u003cp\u003eIn this study, males\u0026nbsp;were observed to have a\u0026nbsp;greater\u0026nbsp;systolic BP than females because\u0026nbsp;males are more likely\u0026nbsp;to defer hospital attendance and\u0026nbsp;therapy. Some studies report that women have better reporting patterns of health conditions than\u0026nbsp;men\u0026nbsp;[28,29,30]. In view of this, the delay in seeking medical care could be the contributing factor to higher systolic BP readings\u0026nbsp;at\u0026nbsp;first diagnosis.\u003c/p\u003e\n\u003cp\u003eAmong the 1000\u0026nbsp;patients with hypertensive crisis,\u0026nbsp;63 (6.3%)\u0026nbsp;were included\u0026nbsp;in one African study,\u0026nbsp;and\u0026nbsp;these patients\u0026nbsp;were predominantly female [31]; however,\u0026nbsp;in our study,\u0026nbsp;none\u0026nbsp;were\u0026nbsp;reported.\u0026nbsp;This is likely\u0026nbsp;due to the\u0026nbsp;small\u0026nbsp;sample size.\u003c/p\u003e\n\u003cp\u003eDiabetes is undoubtedly a well-known comorbidity of hypertension,\u0026nbsp;so\u0026nbsp;proper control of one of these conditions is believed to\u0026nbsp;lead to improvement in the other. It is not surprising that\u0026nbsp;this was\u0026nbsp;the highest reported comorbidity in this study. One other\u0026nbsp;comorbid condition\u0026nbsp;is arthritis [16].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLimitations and Challenges\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThere was difficulty in controlling for confounding variables and external factors influencing treatment outcomes, one of which was the lack of knowledge on the concomitant use of herbal medicines\u0026nbsp;and\u0026nbsp;conventional\u0026nbsp;antihypertensive agents.\u003c/p\u003e\n\u003cp\u003eAdditionally, there\u0026nbsp;are\u0026nbsp;generalizability limitations due to variations in healthcare systems, patient populations, and treatment practices across different settings.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRecommendations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCollaboration with healthcare stakeholders and policy makers to encourage prescribers to continue to desist from polypharmacy, as this collaboration will improve concordance between health practitioners and patients.\u003c/p\u003e"},{"header":"5. CONCLUSIONS","content":"\u003cp\u003eIt was concluded that the number of years of hypertension management is associated with the outcome of hypertension management, as is the number of blood pressure readings at first diagnosis. Appropriate treatment combinations involving two classes of antihypertensive drugs may encourage patient adherence and yield positive outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eACEIs –\u0026nbsp;angiotensin-converting enzyme inhibitors\u003c/p\u003e\n\u003cp\u003eARBs – Angiotensin\u0026nbsp;receptor blockers\u003c/p\u003e\n\u003cp\u003eBP – Blood\u0026nbsp;pressure\u003c/p\u003e\n\u003cp\u003eCCBs – Calcium channel blockers\u003c/p\u003e\n\u003cp\u003eRTI – Respiratory tract infections\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics Approval and Consent to participate - Ethics\u0026nbsp;approval\u0026nbsp;was obtained from the Institute of Research, Innovation and Development (IRID) at Kumasi Technical University. Reference number: IRID/EC2024/HS0003\u003c/p\u003e\n\u003cp\u003eConsent for publication – Not applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials – Data\u0026nbsp;are\u0026nbsp;available from the author upon request.\u003c/p\u003e\n\u003cp\u003eCompeting interests –\u0026nbsp;None declared.\u003c/p\u003e\n\u003cp\u003eFunding -\u0026nbsp;No external funding\u003c/p\u003e\n\u003cp\u003eAuthor\u0026nbsp;contributions – SAA was responsible for the research idea\u0026nbsp;and\u0026nbsp;supervision of\u0026nbsp;the\u0026nbsp;data collection and was a major contributor\u0026nbsp;to the\u0026nbsp;writing\u0026nbsp;of\u0026nbsp;the manuscript. JAA was responsible for shaping the research idea, formulating\u0026nbsp;the\u0026nbsp;research questions, and writing the manuscript. CKB was responsible for the analysis of the data. All\u0026nbsp;the\u0026nbsp;authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgments – We would like to thank all the data collectors, namely, Theophilus Hodalor, Evans Akonnor, Samuel Opoku, Abigail Torsah, Nana Kwame Owusu-Ansah and Anita Opoku, for their hard work. Additionally, the Dean of Health Sciences, Prof. Samuel Osei-Djarbeng and Prof. Emmanuel Omari-Siaw (Head of Department, Pharmaceutical Sciences) deserve special mention for their support and experienced contributions during manuscript preparation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCarey RM, Wright Jr JT, Taler SJ, Whelton PK. Guideline-driven management of hypertension: an evidence-based update. Circulation research. 2021 Apr 2;128(7):827-46.\u003c/li\u003e\n \u003cli\u003eEttehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, Chalmers J, Rodgers A, Rahimi K. 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Clinical Hypertension. 2023 Oct 1;29(1):27.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable\u0026nbsp;1\u0026nbsp;Descriptive statistics of\u0026nbsp;the scale variables\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"578\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cem\u003eDescriptive Statistics\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.34948096885813%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.764705882352942%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.494809688581315%\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.013840830449826%\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.377162629757784%\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.34948096885813%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.764705882352942%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.494809688581315%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.013840830449826%\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.377162629757784%\"\u003e\n \u003cp\u003e62.57 \u0026plusmn; 0.635\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.34948096885813%\"\u003e\n \u003cp\u003eNumber of years of High BP Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.764705882352942%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.494809688581315%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.013840830449826%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.377162629757784%\"\u003e\n \u003cp\u003e7.23 \u0026plusmn; 0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.34948096885813%\"\u003e\n \u003cp\u003eSystolic BP on First Diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.764705882352942%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.494809688581315%\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.013840830449826%\"\u003e\n \u003cp\u003e322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.377162629757784%\"\u003e\n \u003cp\u003e157.05 \u0026plusmn; 1.458\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.34948096885813%\"\u003e\n \u003cp\u003eCurrent systolic BP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.764705882352942%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.494809688581315%\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.013840830449826%\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.377162629757784%\"\u003e\n \u003cp\u003e138.07 \u0026plusmn; 1.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.34948096885813%\"\u003e\n \u003cp\u003eDifference in Systolics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.764705882352942%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.494809688581315%\"\u003e\n \u003cp\u003e-51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.013840830449826%\"\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.377162629757784%\"\u003e\n \u003cp\u003e18.98 \u0026plusmn; 1.465\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.34948096885813%\"\u003e\n \u003cp\u003eDiastolic BP on First Diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.764705882352942%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.494809688581315%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.013840830449826%\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.377162629757784%\"\u003e\n \u003cp\u003e91.85 \u0026plusmn; 0.825\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.34948096885813%\"\u003e\n \u003cp\u003eCurrent diastolic BP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.764705882352942%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.494809688581315%\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.013840830449826%\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.377162629757784%\"\u003e\n \u003cp\u003e85.19 \u0026plusmn; 0.671\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.34948096885813%\"\u003e\n \u003cp\u003eDifference in Diastolics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.764705882352942%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.494809688581315%\"\u003e\n \u003cp\u003e-76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.013840830449826%\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.377162629757784%\"\u003e\n \u003cp\u003e6.66 \u0026plusmn; 0.735\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.34948096885813%\"\u003e\n \u003cp\u003eNumber of BP drugs per patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.764705882352942%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.494809688581315%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.013840830449826%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.377162629757784%\"\u003e\n \u003cp\u003e1.49 \u0026plusmn; 0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.34948096885813%\" valign=\"bottom\"\u003e\n \u003cp\u003eTotal Number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.764705882352942%\" valign=\"bottom\"\u003e\n \u003cp\u003e373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.494809688581315%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.013840830449826%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.377162629757784%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 Differences in the mean BP readings at first diagnosis and at the time of diagnosis.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"696\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.107604017216644%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ePaired Sample T test\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.890961262553802%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.477761836441895%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.621233859397417%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.164992826398852%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaired Samples Statistics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.107604017216644%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.890961262553802%\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.477761836441895%\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003eStd. Error Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.621233859397417%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.164992826398852%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.317073170731708%\" rowspan=\"2\"\u003e\n \u003cp\u003ePair 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.790530846484934%\"\u003e\n \u003cp\u003eSystolic BP on first diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003e157.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.890961262553802%\"\u003e\n \u003cp\u003e373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.477761836441895%\"\u003e\n \u003cp\u003e28.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003e1.458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.621233859397417%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.164992826398852%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.195046439628484%\"\u003e\n \u003cp\u003eCurrent systolic BP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.371517027863778%\"\u003e\n \u003cp\u003e138.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.513931888544892%\"\u003e\n \u003cp\u003e373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.38390092879257%\"\u003e\n \u003cp\u003e19.591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.371517027863778%\"\u003e\n \u003cp\u003e1.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.538699690402476%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.572755417956657%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.317073170731708%\" rowspan=\"2\"\u003e\n \u003cp\u003ePair 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.790530846484934%\"\u003e\n \u003cp\u003eDiastolic BP on first diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003e91.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.890961262553802%\"\u003e\n \u003cp\u003e373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.477761836441895%\"\u003e\n \u003cp\u003e15.934\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003e0.825\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.621233859397417%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.164992826398852%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.195046439628484%\"\u003e\n \u003cp\u003eCurrent diastolic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.371517027863778%\"\u003e\n \u003cp\u003e85.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.513931888544892%\"\u003e\n \u003cp\u003e373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.38390092879257%\"\u003e\n \u003cp\u003e12.955\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.371517027863778%\"\u003e\n \u003cp\u003e0.671\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.538699690402476%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.572755417956657%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.317073170731708%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.790530846484934%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.890961262553802%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.477761836441895%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.621233859397417%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.164992826398852%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaired Differences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.317073170731708%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.790530846484934%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.890961262553802%\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.477761836441895%\"\u003e\n \u003cp\u003eStd. Error Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.233859397417504%\" colspan=\"2\"\u003e\n \u003cp\u003e95% Confidence Interval of the Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.164992826398852%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.317073170731708%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.790530846484934%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.890961262553802%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.477761836441895%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.621233859397417%\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.164992826398852%\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.317073170731708%\"\u003e\n \u003cp\u003ePair 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.790530846484934%\"\u003e\n \u003cp\u003eSystolic BP on first diagnosis - Current systolic BP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003e18.979\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.890961262553802%\"\u003e\n \u003cp\u003e28.285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.477761836441895%\"\u003e\n \u003cp\u003e1.465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003e16.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.621233859397417%\"\u003e\n \u003cp\u003e21.858\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\"\u003e\n \u003cp\u003e12.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.164992826398852%\"\u003e\n \u003cp\u003e372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.317073170731708%\"\u003e\n \u003cp\u003ePair 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.790530846484934%\"\u003e\n \u003cp\u003eDiastolic BP on first diagnosis - Current diastolic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003e6.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.890961262553802%\"\u003e\n \u003cp\u003e14.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.477761836441895%\"\u003e\n \u003cp\u003e0.735\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\"\u003e\n \u003cp\u003e5.215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.621233859397417%\"\u003e\n \u003cp\u003e8.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\"\u003e\n \u003cp\u003e9.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.164992826398852%\"\u003e\n \u003cp\u003e372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Table 3 Correlations among different variables in the dataset.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"666\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.423423423423422%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCorrelations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.216216216216218%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.45945945945946%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.765765765765765%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.00900900900901%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.423423423423422%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.216216216216218%\" valign=\"bottom\"\u003e\n \u003cp\u003eNumber of years of Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"bottom\"\u003e\n \u003cp\u003eSystolic on first diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.45945945945946%\" valign=\"bottom\"\u003e\n \u003cp\u003eCurrent systolic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.765765765765765%\" valign=\"bottom\"\u003e\n \u003cp\u003eDiastolic on first diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"bottom\"\u003e\n \u003cp\u003eCurrent diastolic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.00900900900901%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.423423423423422%\" valign=\"bottom\"\u003e\n \u003cp\u003eNumber of years of Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.216216216216218%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.45945945945946%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.765765765765765%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.00900900900901%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.423423423423422%\" valign=\"bottom\"\u003e\n \u003cp\u003eSystolic on first diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.216216216216218%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.45945945945946%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.765765765765765%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.00900900900901%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.423423423423422%\" valign=\"bottom\"\u003e\n \u003cp\u003eCurrent systolic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.216216216216218%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.45945945945946%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.765765765765765%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.00900900900901%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.423423423423422%\" valign=\"bottom\"\u003e\n \u003cp\u003eDiastolic on first diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.216216216216218%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.45945945945946%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.765765765765765%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.00900900900901%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.423423423423422%\" valign=\"bottom\"\u003e\n \u003cp\u003eCurrent diastolic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.216216216216218%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.45945945945946%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.765765765765765%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.00900900900901%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Table 4 Differences in the mean systolic BP at first diagnosis according to sex.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"501\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.52694610778443%\"\u003e\n \u003cp\u003e\u003cem\u003eIndependent Sample T test\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.353293413173652%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.774451097804391%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.345309381237524%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.52694610778443%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.353293413173652%\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.774451097804391%\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.345309381237524%\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.52694610778443%\"\u003e\n \u003cp\u003eSystolic on first diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.353293413173652%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.774451097804391%\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.345309381237524%\"\u003e\n \u003cp\u003e165 \u0026plusmn; 33.201\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.52694610778443%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.353293413173652%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.774451097804391%\"\u003e\n \u003cp\u003e272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.345309381237524%\"\u003e\n \u003cp\u003e154.09 \u0026plusmn; 25.483\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.52694610778443%\"\u003e\n \u003cp\u003eF (equal variances assumed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.353293413173652%\"\u003e\n \u003cp\u003e4.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.774451097804391%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.345309381237524%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.52694610778443%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.353293413173652%\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.774451097804391%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.345309381237524%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.52694610778443%\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.353293413173652%\"\u003e\n \u003cp\u003e3.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.774451097804391%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.345309381237524%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.52694610778443%\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.353293413173652%\"\u003e\n \u003cp\u003e371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.774451097804391%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.345309381237524%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.52694610778443%\"\u003e\n \u003cp\u003esig.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.353293413173652%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.774451097804391%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.345309381237524%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.52694610778443%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.353293413173652%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.774451097804391%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.345309381237524%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.52694610778443%\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.353293413173652%\" valign=\"bottom\"\u003e\n \u003cp\u003e10.908 \u0026plusmn; 3.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.774451097804391%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"27.345309381237524%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.52694610778443%\"\u003e\n \u003cp\u003e95% Confidence interval of difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.353293413173652%\" valign=\"bottom\"\u003e\n \u003cp\u003e4.544-17.272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.774451097804391%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.345309381237524%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Kumasi Technical University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hypertension, calcium-channel blockers, comorbidities, diabetes mellitus, arthritis, adherence, polypharmacy.","lastPublishedDoi":"10.21203/rs.3.rs-4471168/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4471168/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eBackground\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHypertension remains a significant global health concern due to its high incidence and association with cardiovascular diseases, stroke, and other complications. This research aimed to determine the dynamics of blood pressure control over the course of disease management, focusing on the systolic and diastolic readings at baseline and at the time of the study and on the number of years of patient management and sex.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMethods\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective study with a multicenter approach was used. The information of a total of 373 patients was collected and analyzed using Python and SPSS.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResults\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOverall, 72.9% of the patients were female, and 27.1% were male. The mean age was 62.57 ± 0.635 years. A regression model was used to evaluate the associations between the number of years of hypertension management, systolic anddiastolic BP at first diagnosis and current systolic and diastolic BP at R-square, (13.2% and 29.2%, respectively; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01). There was a significant reduction in the systolic BP before (M = 157.01 ± 28.159) compared to after (M =138.07 ± 19.591), t (372) = 12.959, \u003cem\u003ep\u003c/em\u003e \u0026lt;0.001. Similarly, the results showed a significant reduction in the diastolic BP of the patients before (M = 91.85 ± 15.934) compared to after (M =85.19 ± 12.955), t (372) = 9.062, \u003cem\u003ep\u003c/em\u003e \u0026lt;0.001. There was a greater systolic BP at first diagnosis in males than in females.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConclusions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe number of years of hypertension management and BP at first diagnosis may be associated with the outcome of management. Appropriate treatment combinations involving two classes of antihypertensive drugs may encourage patient adherence and yield positive outcomes.\u003c/p\u003e","manuscriptTitle":"Effective Management of Hypertension: A Cross-Sectional Study of Five Health Facilities","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-30 01:16:42","doi":"10.21203/rs.3.rs-4471168/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cc9c7691-fd9e-46c4-9341-f057c0383695","owner":[],"postedDate":"May 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":32355268,"name":"Clinical Pharmacology"}],"tags":[],"updatedAt":"2024-05-30T01:16:42+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-30 01:16:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4471168","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4471168","identity":"rs-4471168","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}