The magnitude of blood pressure control and associated factors among hypertensive patients at selected health center, A.A, Ethiopia.

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Ermiyas Kuma, Abenet Tafesse, Yared Zenebe, Seblewonel Asmare, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6517572/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Hypertension is a major risk factor for stroke, contributing to high mortality and morbidity, particularly in low-income countries like Ethiopia. Studies indicate a rising incidence of stroke in developing nations, with intracerebral hemorrhage disproportionately affecting low-income populations. Assessing blood pressure control, and associated factors is essential for identifying key contributors to the increasing stroke burden and guiding targeted interventions. While most existing data come from hospital-based studies, this research focuses on primary healthcare facilities, where a significant proportion of hypertensive patients receive follow-up care. Future studies can explore additional contributing factors to the growing burden of stroke in developing countries. Methods A cross-sectional study was conducted using multi-stage sampling at selected health centers from October to December 2024. Data were collected via structured questionnaires and analyzed using SPSS version 25. A multiple logistic regression model was employed to determine factors associated with BP control. Results Of 348 patients, only 27.3% achieved the target Blood pressure of 139/89 mmHg), indicating poor control. Factors significantly associated with BP control included adherence levels, frequency of BP monitoring, appointment frequency, education, income, and age. Lifestyle modifications such as exercise and dietary habits showed concerning trends but were not significant predictors in the regression model. A significant proportion of the patients are on monotherapy. Conclusion Poor blood pressure control underscores the urgent need for targeted interventions to reduce the burden of stroke and other hypertension-related complications in Ethiopia. Key strategies include enhancing patient education, improving access to healthcare, strengthening healthcare systems through regular follow-up appointments, and promoting home blood pressure monitoring. Additionally, promoting healthy lifestyle choices, addressing financial barriers, and optimizing treatment regimens to prevent therapeutic inertia are essential to improving hypertension management. These efforts can help mitigate the burden of stroke and other cardiovascular diseases. Further research, including longitudinal and qualitative studies, is recommended to explore underlying barriers, identify effective intervention strategies, and investigate other contributing factors beyond hypertension-related issues. Hypertension blood pressure control Ethiopia primary healthcare Figures Figure 1 1. Introduction Hypertension affects over one billion people worldwide and is a leading cause of cardiovascular disease, stroke, and chronic kidney disease. In Ethiopia, hypertension prevalence is estimated at 16%, yet control rates are suboptimal, especially in primary healthcare settings.¹ ² ³ An overview of 14 hypertension treatment trials concluded that a long-term (mean five years) 5 to 6 mmHg decrease in the usual diastolic blood pressure was associated with a 35 to 40 percent reduction in stroke.⁴ While the incidence of stroke is decreasing in high-income countries, including the United States ⁵ ⁶, the incidence is increasing in low-income countries. ⁷ In one study done in Ethiopia, the pooled burden of hemorrhagic and ischemic stroke was 46.42% and 51.40%, respectively. ⁸ Similar studies show the same result, suggesting a relatively high burden of ICH compared to the West. In the United States, ICH accounts for ~ 10% of all strokes, and ~ 35–45% of patients die within the first month. ² ⁹ Globally, it accounts for 9–27%. ¹⁰ The clinical impact of ICH appears disproportionately high among lower-resource populations both in the United States and internationally. ⁹ Various factors can explain the significant disparity in stroke burden between developing and developed countries. These factors include challenges in managing hypertension (HTN). Other contributing factors are issues with DM management, increased life expectancy, and advancements in diagnostic imaging, among others. This study aims to evaluate issues related to hypertension management, such as the degree of blood pressure control as well as associated factors, as potential reasons for the significant difference in stroke burden between developing and developed countries - This is a primary stroke prevention study. 2. Methodology A cross-sectional study was done involving a total of 10 health centers across six sub-cities, including three health centers from Nifas Silk Lafto, three from Kality, and one each from Arada, Yeka, Bole, and Lideta from April 2024 - December 2024 GC. The sample size was 422 (adjusted for 10% non-response). The final sample included 348 participants. Ethical clearance to conduct the study was obtained before the beginning of data collection from the Research and Publication Committee (RPC) of the Department of Neurology, TASH. Informed written consent was obtained from all patients. Then face-to-face interview with a pretested structured questionnaire was conducted to collect socio-demographic factors, Blood pressure control, and the associated factors. In addition to collecting data directly from the patients, data was also gathered from their charts. Data was collected by trained data collectors under the supervision of the investigator and was collected by trained general practitioners, nurses, and health officers who agreed to collect data from 35 patients each. Data collectors had one-day training on how to extract the required information from patients' and patients’ charts and complete the Google form questionnaire. The time in target range (TTR) was used from multiple records over the past several months( 3–6 months) to determine where the patient's blood pressure lies in the given categories. ¹¹ A pilot study was done to evaluate feasibility, duration, and cost and improve upon the study design. Adult patients with hypertension who are on antihypertensive medication and under follow-up care at selected health centers in Addis Ababa were sampled using a multi-stage sampling method. Patients with confirmed secondary Hypertension were excluded from the study. Operational Definitions Good BP control: < 130/80 or < 140/80 depending on patient characteristics.² ¹² Recent clinical trials also show benefits toward more intensive BP control: SPRINT, ACCORED, SPS-3, ESPRIT, and BPROAD. ¹¹ ¹³-¹⁶ Data Processing and Analysis The data was entered into and analyzed using SPSS version 25. Data cleaning was conducted exclusively by the Investigator. A descriptive summary of the data was presented in Tables and Figures. Frequency distributions were used to organize the data and present the responses obtained. Multiple logistic regression was used to identify variables that are associated with BP control, and drug adherence. Adjusted odds ratios with a 95% confidence interval were used to determine the strength of association between dependent and independent variables. Variables having P-value < 0.05 will be considered as significant. 3. Result 3.1 Socio-demographic characteristics A total of 348 patients were included in the study. Females account for the majority of the patients (60.5%). The majority of participants (54.9%) were in the 46–65-year age group. The 18–45 years age group is the smallest, accounting for only 14.9% of the sample. The largest group is elementary education, making up 35.3% of the total. A significant portion of the population is uneducated (22.7%). 48% of the population has low income (< 5000 birr). (Baseline demographic characteristics are depicted in Table 1 below.) Table 1 Socio-demographic characteristics among patients with HTN on follow-up at the selected health center, A.A, Ethiopia October to December 2024 GC N Marginal Percentage Age 18–45 year 52 15.4% 46–65 year 186 55.0% > 65 year 100 29.6% Sex Male Female 134 204 39.5% 60.5% Marital status Married 214 63.3% Unmarried 23 6.8% Widowed 74 21.9% Divorced 27 8.0% Income 10,000 birr 35 10.4% I Don't Know 59 17.5% Education Elementary 119 35.2% High school 66 19.5% College/University 75 22.2% Uneducated 78 23.1% Valid 338 100.0% Missing 10 Total 348 3.2 Magnitude of blood pressure control and associated factors Approximately 35.1% (CI (0.301,0.401)) of the individuals fall into the blood pressure category of 130/80–139/89. Around 35.9% (CI (0.309,0.409)) of the individuals have high blood pressure, which indicates poor BP control (> 139/89). About 27.3% (CI (0.226,0.320)) of the individuals have blood pressure within the target range of less than 130/80 mmHg. A significant portion of the population (71%) has blood pressure at or above 130/80 mmHg. Only about 27.3% of the individuals have blood pressure within the desired range. (Fig. 1 .) Key findings from multiple logistic regression analysis are depicted in Tables 2 and 3 . Table 2 Parameter Estimates of the magnitude of blood pressure control and associated factors among patients with HTN at the selected health center, A.A, Ethiopia, October to December 2024 GC. BP controlª P value AOR 95% CI Education: elementary 0.42 2.62 1.037 6.61 Frequency of BP measurement: monthly 0.007 0.227 0.077 0.671 Appointment: every 1 months < 0.001 5.277 2.087 13.361 Smoking: yes 0.02 0.104 0.015 0.701 ª Blood Pressure (BP) Category: 130/80–139/89 in reference to BP < 130/90 Age, marital status, income, and other lifestyle factors (e.g., exercise, fruit consumption, salt intake) did not show significant associations with having a BP between 130/80 and 139/89. Table 3 Parameter Estimates of the magnitude of blood pressure control and associated factors among patients with HTN at the selected health center, A.A, Ethiopia, October to December 2024 GC. BP controlª P value AOR 95% CI Appointment: every 1 month < 0.001 4.921 1.976 12.258 Income: 139/89 in reference to BP 139/89. Although no association was found in this study, 40.6% of the population does not exercise, 26.8% exercise only 1–2 times/week for 30 minutes, while only 10.0% meet recommended levels (5 times a week, 30 min per session), and 40.3% have low fruit consumption. 25.5% consume salt more than recommended. The most common comorbidity identified was diabetes mellitus (27%), followed by dyslipidemia (16%). Stroke and cardiac disease each accounted for 3%. The majority of patients (55%) did not have any comorbidities. Hydrochlorothiazide was the most commonly used medication (37%), followed by enalapril (34%) and amlodipine (33%). Monotherapy was being used in 45% of the patients. 4. Discussion This study aimed to assess the magnitude of blood pressure (BP) control, antihypertensive drug adherence, and associated factors among patients with HTN at a selected health center in A.A., Ethiopia. The findings reveal critical insights into BP control, adherence levels, and the factors influencing them, which are essential for designing targeted interventions to improve hypertension management, potentially decreasing the burden of stroke as well as other cardiovascular diseases in developing countries like Ethiopia. Below is a detailed discussion of the results, their implications, and their alignment with existing literature. This study provides critical insights into the magnitude of blood pressure (BP) control and the factors associated with different BP categories. The findings reveal that a significant portion of the population has suboptimal BP control, with only 27.3% (CI: 22.6–32.0%) of individuals achieving the target BP of 139/89 mmHg), indicating poor BP control. These results underscore the urgent need for targeted interventions to improve BP control and reduce the burden of hypertension-related complications including stroke. All studies reviewed in the literature were conducted at the hospital level, whereas our study, conducted in local health centers, found BP control to be at the lower end of the spectrum when using a target of < 130/80 mmHg, with control rates ranging from 30–68% in previous studies ¹⁷-²¹. Similar findings have been reported in other African countries such as Nigeria and Cameroon ²²-²⁴. In contrast, a study conducted in the USA demonstrated a significantly higher BP control rate of 72%. ²⁵ The recent studies and guidelines ² ¹¹‒¹⁶ recommend for lower BP target and our study highlights the challenges in managing hypertension effectively and suggests that current interventions may be insufficient. Contrary to another study ²⁶, individuals with monthly appointments were more likely to have BP in the range of 130/80–139/89 compared to those with BP < 130/80 mmHg (AOR = 5.277, p < 0.001). This counterintuitive finding may indicate that individuals with higher BP are more likely to seek regular care, or that current care is insufficient to achieve optimal BP control. In this study, there are many other factors identified which are not mentioned in the literature reviews. Individuals with elementary education were more likely to have BP in the range of 130/80–139/89 compared to those with BP < 130/80 mmHg (AOR = 2.618, p = 0.042). This suggests that lower education levels may be associated with poorer BP control, possibly due to limited health literacy or access to resources. Individuals who measured their BP monthly were less likely to have BP in the range of 130/80–139/89 compared to those with BP < 130/80 mmHg (AOR = 0.227, p = 0.007). This highlights the importance of regular BP monitoring in maintaining control. Another unexpected result is smokers were less likely to have 130/80–139/89 compared to those with BP < 130/80 mmHg (AOR = 0.104, p = 0.020). This unexpected result may reflect a combination of survivor bias, confounding factors, small sample size, and potential data quality issues. It is unlikely that smoking itself has a protective effect on blood pressure, given the well-established risks associated with smoking. The analysis also identified factors associated with BP > 139/89 compared to individuals with BP 139/89) compared to those with BP 139/89), emphasizing the importance of medication adherence in achieving BP control. The appointment frequency showed a similar result to the above, but the subsequent variable was not found to be associated with BP control in our literature review. Younger individuals (18–45 years) were less likely to have high BP compared to those with BP < 130/80 mmHg (AOR = 0.159, p = 0.004). This aligns with the natural progression of hypertension, which is more common in older adults. Individuals with the lowest income (< 1000 birr) were less likely to have high BP compared to those with BP < 130/80 mmHg (AOR = 0.130, p = 0.003). This may reflect underdiagnosis or lack of healthcare access among low-income groups, and another possibility could be dietary factors. Marital status, education, frequency of healthcare visits, fruit consumption, exercise, salt intake, alcohol consumption, and smoking did not show significant associations with having BP > 139/89. This contrasts with some studies that have identified some of these factors as predictors of good BP control, like sex, exercise, dietary modification, and high salt intake. The lack of significance in this study may reflect the unique characteristics of the study population or the influence of other unmeasured variables. Although lifestyle factors such as exercise, fruit consumption, and salt intake did not show significant associations with BP categories in the regression analysis, the descriptive data reveal concerning patterns. Only 10.0% of the population meets the recommended exercise levels (5 times/week, 30 minutes per session), while 40.6% do not exercise at all. This lack of physical activity is a significant risk factor for hypertension and stroke. 40.3% of the population has low fruit consumption, which may contribute to poor dietary habits and increased BP. 25.5% of the population consumes more salt than recommended, which is a well-established risk factor for hypertension. These findings highlight the need for lifestyle interventions to address these modifiable risk factors, even though they were not significant predictors in the regression model. Finally, a significant proportion of patients (45%) are on monotherapy despite the guideline recommendation of dual therapy for most patients ⁶ and the high prevalence of therapeutic inertia. ²⁷ Randomized controlled trials have demonstrated that treatment with 1 antihypertensive medication is effective for reaching the blood pressure goal in only ≈ 30% of participants and that the majority of participants achieved the goal with 2 or 3 medications. Therefore, ≥ 2 antihypertensive medications are recommended for primary stroke prevention in most patients who require pharmacological treatment of hypertension. ²⁸ 5. Conclusion The findings of this study suggest that poor blood pressure control may be a major contributor to the increasing burden of stroke, particularly hemorrhagic stroke, in developing countries compared to Western nations. The study also highlights key factors that require targeted interventions to improve health outcomes. Although regression analysis did not reveal significant associations between lifestyle factors—such as exercise, fruit consumption, and salt intake—and blood pressure categories, concerning trends observed in the descriptive data indicate a need for intervention in these areas. Notably, 45% of patients were found to be on monotherapy, pointing to opportunities for optimizing treatment regimens and addressing therapeutic inertia. This study also provides insights from a previously unexplored healthcare facility, aiming to identify areas where interventions could reduce the burden of stroke. 6. Recommendations Based on these findings, several recommendations are proposed to enhance blood pressure control. Improving access to healthcare is crucial, particularly by addressing financial barriers through subsidized medications and free healthcare services, and expanding community-based programs to underserved populations. Enhancing patient education is also vital, with the development of tailored materials to improve health literacy, especially for individuals with lower education levels. Strengthening healthcare systems by encouraging more frequent follow-up visits can support continuous education and monitoring, while promoting the use of home blood pressure monitoring devices may empower patients and improve adherence. Additionally, promoting healthy lifestyle choices, such as increased fruit consumption, reduced salt intake, and regular physical activity, can support cardiovascular health. Addressing medication adherence and optimizing treatment regimens are essential, particularly considering the high proportion of patients on a single medication. Ensuring patients follow prescribed treatments and receive appropriate therapeutic combinations may lead to better outcomes. Lastly, further research is recommended, including longitudinal studies to establish causal relationships, qualitative research to understand barriers faced by low-income groups, and intervention studies to evaluate the impact of financial support, education, and lifestyle programs on blood pressure control. 7. Strengths and limitations of the study 7.1 Strength This is the first study conducted at lower-level health facilities in Ethiopia, addressing a notable knowledge gap as most previous studies were hospital-based. It revealed unique factors not identified in earlier literature, offering valuable insights for targeted recommendations. The study also provided important numerical data, highlighting significant gaps in blood pressure control and medication adherence compared to Western countries. Multinomial logistic regression enabled a deeper understanding of the factors influencing varying levels of BP control and adherence. 7.2 Limitation The study faced limitations including financial constraints affecting data quality control and BP measurement, and sampling bias due to underrepresentation of some sub-cities from the multi-stage sampling. Its cross-sectional design restricts causal inference, while reliance on self-reported data may introduce reporting bias. Small sample sizes in certain subgroups, like smokers and low-income individuals, may affect result reliability. Additionally, the lack of detailed clinical data—such as medication type, comorbidities, side effects, or ASCVD risk—limits a deeper analysis of factors influencing BP control and adherence. Abbreviations AAU Addis Abeba University ACC/American College of Cardiology and the American Heart Association ACEI Angiotensin-converting enzyme inhibitors ADCQ Antidepressant Compliance Questionnaire ARBs Angiotensin receptor blockers AOR Adjusted odd ratio ASCVD Atherosclerosis cardiovascular disease BP Blood pressure CHD Cardiovascular heart disease CHS College of health science DM Diabetes Mellitus EDHS Ethiopian Demographic and Health Survey FDA Food and Drug Administration ICH Intracranial hemorrhage HTN Hypertension MMAS 8-Morisky Medication Adherence Scale-8 RPC Research and Publication Committee TASH Tikur Anbessa specialized hospital UOG University of Gonder USA United state of America WHO World health organization. Declarations Authors’ contributions: E.R. was involved in the conception and design of the study, developed the data collection tools, supervised the data collection, analyzed the data, and wrote the manuscript. A.T., Y.Z., and S.A. participated in the study design, oversaw the development of the study instruments, and reviewed the data analysis. All authors read and approved the final manuscript. Acknowledgment: I would like to express my sincere gratitude to my advisors for their guidance and support throughout the manuscript process. I am thankful to Addis Ababa University College of Health Sciences and the School of Medicine, Department of Neurology, for this opportunity and their administrative assistance. Additionally, I appreciate everyone who contributed to the development of this thesis and the participants of the study. Competing interests: The authors declare that they have no competing interests. Data and Materials Availability: Datasets supporting this study's conclusions are included in the article. Additional data is available upon request, along with the MMAS-8 questions and coding. Consent to publish: Not applicable. Ethics approval and consent to participate: Ethical clearance to conduct the study was obtained before the beginning of data collection from the Research and Publication Committee (RPC) of the Department of Neurology, TASH. The participant’s rights were protected by explaining the purpose and significance of the study. Funding: The study was partly funded by the Office of the Vice President for Research and Technology Transfer at Addis Ababa University, which had no role in the study's design, data handling, or manuscript writing. Clinical trial number: not applicable. References PAHO. World Hypertension Day 2020 [Internet]. PAHO; 2020 [cited 2023 Dec 24]. Available from: https://www.paho.org/en/campaigns/world-hypertension-day-2020 Loscalzo J, Kasper DL, Longo DL, Fauci AS, Hauser SL, Jameson JL. Harrison’s Principles of Internal Medicine. 21st ed. New York: McGraw Hill; 2021. Yadeta D, Mekonen D, Mintesnot H, Begna D. National Noncommunicable Diseases Management Protocols. 1st ed. Addis Ababa: Ministry of Health; 2021. Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, et al. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: an overview of randomized drug trials in their epidemiological context. Lancet. 1990;335(8693):827–38. Koton S, Schneider AL, Rosamond WD, Shahar E, Sang Y, Gottesman RF, et al. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA. 2014;312(3):259–68. Vangen-Lønne AM, Wilsgaard T, Johnsen SH, Løchen ML, Njølstad I, Mathiesen EB. Declining incidence of ischemic stroke: What is the impact of changing risk factors? The Tromsø Study 1995 to 2012. Stroke. 2017;48(3):544–50. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014;383(9913):245–54. Abate TW, Zeleke B, Genanew A, Abate BW. The burden of stroke and modifiable risk factors in Ethiopia: A systematic review and meta-analysis. PLoS ONE. 2021;16(11):e0259244. Steven MG, Wendy CZ, Charlotte C, Dar D, Brandon F, Joshua NG, et al. 2022 Guideline for the Management of Patients with Spontaneous Intracerebral Hemorrhage: A Guideline from the American Heart Association/American Stroke Association. America: AHA/ASA; 2022. Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, et al. Heart Disease and Stroke Statistics-2022 Update: A Report from the American Heart Association. Circulation. 2022;145(8):e153–639. The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. *N Engl J Med*. 2015;373(22):2103–16. 10.1056/NEJMoa1511939 . Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A et al. 2023 ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension. Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874–2071. doi: 10.1097/HJH.0000000000003480. Epub 2023 Sep 26. Erratum in: J Hypertens. 2024;42(1):194. 10.1097/HJH.0000000000003621 . PMID: 37345492. The ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. *N Engl J Med*. 2010;362(17):1575–85. 10.1056/NEJMoa1001286 . Benavente OR, Coffey CS, Conwit R, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomized trial. *Lancet*. 2013;382(9891):507–15. 10.1016/S0140-6736(13)60852-1 . Liu A, et al. Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk: the ESPRIT TRIAL. *The Lancet*. 2024;404(1048):248–55. B1Y, et al. Intensive blood-pressure control in patients with type 2 diabetes: the BPROAD Trial. *N Engl J Med*. 2024;391(20): Nov 16. Kebede B, Chelkeba L, Dessie B. Rate of blood pressure control and its determinants among adult hypertensive patients at Jimma University Medical Center, Ethiopia: Prospective cohort study. SAGE Open Med. 2021;9:20503121211012206. Gebremichael GB, Berhe KK, Zemichael TM. Uncontrolled hypertension and associated factors among adult hypertensive patients in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia, 2018. BMC Cardiovasc Disord. 2019;19(1):121. Tesfaye A, Kumela K, Wolde M. Blood pressure control associates and antihypertensive pharmacotherapy patterns in Tikur Anbessa General Specialized Hospital Chronic Care Department, Addis Ababa, Ethiopia. Am J Biol Life Sci. 2015;3(3):41–8. Yazie D, Shibeshi W, Alebachew M, Berha A. Assessment of blood pressure control among hypertensive patients in Zewditu Memorial Hospital, Addis Ababa, Ethiopia: A cross-sectional study. J Bioanal Biomed. 2018;10:80–7. Teshome DF, Demssie AF, Zeleke BM. Determinants of blood pressure control amongst hypertensive patients in Northwest Ethiopia. PLoS ONE. 2018;13(5):e0196535. Menanga A, Edie S, Nkoke C, Boombhi J, Musa AJ, Mfeukeu LK, et al. Factors associated with blood pressure control amongst adults with hypertension in Yaounde, Cameroon: a cross-sectional study. Cardiovasc Diagn Ther. 2016;6(5):439–45. Chimezie GO, Nnamdi EO, Enajite IO, Fatai MA. Patient-related barriers to hypertension control in a Nigerian population. Int J Gen Med. 2014;7:345–53. Iloh GU, Amadi AN. Treatment satisfaction, medication adherence, and blood pressure control among adult Nigerians with essential hypertension. Int J Health Allied Sci. 2017;6(2):75–81. Muntner P, Hardy ST, Fine LJ, Jaeger BC, Wozniak G, Levitan EB, et al. Trends in blood pressure control among US adults with hypertension, 1999–2000 to 2017–2018. JAMA. 2020;324(12):1190–200. Abegaz TM, Tefera YG, Abebe TB. Antihypertensive drug prescription patterns and their impact on outcome of blood pressure in Ethiopia: a hospital-based cross-sectional study. Integr Pharm Res Pract. 2017;6:29–35. MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, et al. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990;335(8692):765–74. Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gąsecki D, Gornik HL et al. 2024 Guideline for the primary prevention of stroke: A guideline from the American Heart Association/American Stroke Association. Stroke. 2024;55(3). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 05 Jun, 2025 Reviewers invited by journal 28 May, 2025 Editor invited by journal 07 May, 2025 Editor assigned by journal 07 May, 2025 Submission checks completed at journal 07 May, 2025 First submitted to journal 24 Apr, 2025 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. 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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-6517572","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":462938953,"identity":"57945d77-a03d-415d-a3af-7794e2f80248","order_by":0,"name":"Ermiyas Kuma","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYJCCA0BsAMSMDz9UAClm5gaitTAbS5wBUYyEtTBAtbBJ8LaB2AS08EufTjzMU1NnbHDt8GMDyXm10fztQC0/Krbh1CLZl7vhMM+xw2YGt9MMHxRuO5474zBjA2PPmdu4HXSGF6iF7YCNwe0EYwPJbcdyG4BamBnbcGuxB2v5VwfUkv5NgnfOsdz5hLQY8AC18LYxAx2WYybB21ADdCcBLRJAWw7O7TtsLHk7p9hY4tiB3I1ALQfx+YW/h3fzhzff6gz7bqdvfPihpi533vnDBx/8qMCtBQSYeBDsw2DyAF71QMD4A8GuI6R4FIyCUTAKRiAAAM53YLLwnBwJAAAAAElFTkSuQmCC","orcid":"","institution":"Addis Ababa University","correspondingAuthor":true,"prefix":"","firstName":"Ermiyas","middleName":"","lastName":"Kuma","suffix":""},{"id":462938955,"identity":"aad6ac9d-25ed-4aaf-914b-969604d0a92d","order_by":1,"name":"Abenet Tafesse","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Abenet","middleName":"","lastName":"Tafesse","suffix":""},{"id":462938959,"identity":"a52eed7e-e2aa-4da4-a9d8-ae7079774464","order_by":2,"name":"Yared Zenebe","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Yared","middleName":"","lastName":"Zenebe","suffix":""},{"id":462938960,"identity":"9491d87c-6531-47ff-b022-5fdbd42fdb0d","order_by":3,"name":"Seblewonel Asmare","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Seblewonel","middleName":"","lastName":"Asmare","suffix":""},{"id":462938961,"identity":"72723905-1d4f-4207-ab47-4989b4358891","order_by":4,"name":"Bersabeh Yilma","email":"","orcid":"","institution":"St. Paul's Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Bersabeh","middleName":"","lastName":"Yilma","suffix":""}],"badges":[],"createdAt":"2025-04-24 06:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6517572/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6517572/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83648945,"identity":"2ec51c46-86e9-4fc5-bdd8-6f5ba8f403e3","added_by":"auto","created_at":"2025-05-30 06:24:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":59366,"visible":true,"origin":"","legend":"\u003cp\u003eThe magnitude of blood pressure control among patients with hypertension at the selected health center, A.A, Ethiopia October to December 2024 GC\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6517572/v1/d77219122cbfd5b5a9c78546.png"},{"id":83648970,"identity":"f49218f9-7b6f-4620-891e-be2ba5cbbe96","added_by":"auto","created_at":"2025-05-30 06:24:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":609777,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6517572/v1/5d60b40c-29a5-4405-b26f-93f7c9306acb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The magnitude of blood pressure control and associated factors among hypertensive patients at selected health center, A.A, Ethiopia.","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eHypertension affects over one billion people worldwide and is a leading cause of cardiovascular disease, stroke, and chronic kidney disease. In Ethiopia, hypertension prevalence is estimated at 16%, yet control rates are suboptimal, especially in primary healthcare settings.\u0026sup1; \u0026sup2; \u0026sup3;\u003c/p\u003e \u003cp\u003eAn overview of 14 hypertension treatment trials concluded that a long-term (mean five years) 5 to 6 mmHg decrease in the usual diastolic blood pressure was associated with a 35 to 40 percent reduction in stroke.⁴ While the incidence of stroke is decreasing in high-income countries, including the United States ⁵ ⁶, the incidence is increasing in low-income countries. ⁷\u003c/p\u003e \u003cp\u003eIn one study done in Ethiopia, the pooled burden of hemorrhagic and ischemic stroke was 46.42% and 51.40%, respectively. ⁸ Similar studies show the same result, suggesting a relatively high burden of ICH compared to the West. In the United States, ICH accounts for ~\u0026thinsp;10% of all strokes, and ~\u0026thinsp;35\u0026ndash;45% of patients die within the first month. \u0026sup2; ⁹ Globally, it accounts for 9\u0026ndash;27%. \u0026sup1;⁰ The clinical impact of ICH appears disproportionately high among lower-resource populations both in the United States and internationally. ⁹\u003c/p\u003e \u003cp\u003eVarious factors can explain the significant disparity in stroke burden between developing and developed countries. These factors include challenges in managing hypertension (HTN). Other contributing factors are issues with DM management, increased life expectancy, and advancements in diagnostic imaging, among others.\u003c/p\u003e \u003cp\u003eThis study aims to evaluate issues related to hypertension management, such as the degree of blood pressure control as well as associated factors, as potential reasons for the significant difference in stroke burden between developing and developed countries - This is a primary stroke prevention study.\u003c/p\u003e"},{"header":"2. Methodology","content":"\u003cp\u003eA cross-sectional study was done involving a total of 10 health centers across six sub-cities, including three health centers from Nifas Silk Lafto, three from Kality, and one each from Arada, Yeka, Bole, and Lideta from April 2024 - December 2024 GC. The sample size was 422 (adjusted for 10% non-response). The final sample included 348 participants. Ethical clearance to conduct the study was obtained before the beginning of data collection from the Research and Publication Committee (RPC) of the Department of Neurology, TASH. Informed written consent was obtained from all patients. Then face-to-face interview with a pretested structured questionnaire was conducted to collect socio-demographic factors, Blood pressure control, and the associated factors. In addition to collecting data directly from the patients, data was also gathered from their charts.\u003c/p\u003e \u003cp\u003eData was collected by trained data collectors under the supervision of the investigator and was collected by trained general practitioners, nurses, and health officers who agreed to collect data from 35 patients each. Data collectors had one-day training on how to extract the required information from patients' and patients\u0026rsquo; charts and complete the Google form questionnaire. The time in target range (TTR) was used from multiple records over the past several months( 3\u0026ndash;6 months) to determine where the patient's blood pressure lies in the given categories. \u0026sup1;\u0026sup1; A pilot study was done to evaluate feasibility, duration, and cost and improve upon the study design.\u003c/p\u003e \u003cp\u003eAdult patients with hypertension who are on antihypertensive medication and under follow-up care at selected health centers in Addis Ababa were sampled using a multi-stage sampling method. Patients with confirmed secondary Hypertension were excluded from the study.\u003c/p\u003e \u003cp\u003eOperational Definitions\u003c/p\u003e \u003cp\u003eGood BP control: \u0026lt; 130/80 or \u0026lt;\u0026thinsp;140/80 depending on patient characteristics.\u0026sup2; \u0026sup1;\u0026sup2; Recent clinical trials also show benefits toward more intensive BP control: SPRINT, ACCORED, SPS-3, ESPRIT, and BPROAD. \u0026sup1;\u0026sup1; \u0026sup1;\u0026sup3;-\u0026sup1;⁶\u003c/p\u003e \u003cp\u003eData Processing and Analysis\u003c/p\u003e \u003cp\u003eThe data was entered into and analyzed using SPSS version 25. Data cleaning was conducted exclusively by the Investigator. A descriptive summary of the data was presented in Tables and Figures. Frequency distributions were used to organize the data and present the responses obtained. Multiple logistic regression was used to identify variables that are associated with BP control, and drug adherence. Adjusted odds ratios with a 95% confidence interval were used to determine the strength of association between dependent and independent variables. Variables having P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 will be considered as significant.\u003c/p\u003e"},{"header":"3. Result","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Socio-demographic characteristics\u003c/h2\u003e \u003cp\u003eA total of 348 patients were included in the study. Females account for the majority of the patients (60.5%). The majority of participants (54.9%) were in the 46\u0026ndash;65-year age group. The 18\u0026ndash;45 years age group is the smallest, accounting for only 14.9% of the sample. The largest group is elementary education, making up 35.3% of the total. A significant portion of the population is uneducated (22.7%). 48% of the population has low income (\u0026lt;\u0026thinsp;5000 birr). (Baseline demographic characteristics are depicted in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below.)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics among patients with HTN on follow-up at the selected health center, A.A, Ethiopia October to December 2024 GC\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarginal Percentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;45 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u0026ndash;65 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;65 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134\u003c/p\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.5%\u003c/p\u003e \u003cp\u003e60.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eIncome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000 birr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1000\u0026ndash;5000 birr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5000 birr\u0026minus;10,000 birr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10,000 birr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI Don't Know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElementary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege/University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUneducated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Magnitude of blood pressure control and associated factors\u003c/h2\u003e \u003cp\u003eApproximately 35.1% (CI (0.301,0.401)) of the individuals fall into the blood pressure category of 130/80\u0026ndash;139/89. Around 35.9% (CI (0.309,0.409)) of the individuals have high blood pressure, which indicates poor BP control (\u0026gt;\u0026thinsp;139/89). About 27.3% (CI (0.226,0.320)) of the individuals have blood pressure within the target range of less than 130/80 mmHg. A significant portion of the population (71%) has blood pressure at or above 130/80 mmHg. Only about 27.3% of the individuals have blood pressure within the desired range. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.)\u003c/p\u003e \u003cp\u003eKey findings from multiple logistic regression analysis are depicted in Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParameter Estimates of the magnitude of blood pressure control and associated factors among patients with HTN at the selected health center, A.A, Ethiopia, October to December 2024 GC.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBP control\u0026ordf;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation: elementary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of BP measurement: monthly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.671\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppointment: every 1 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.361\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking: yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026ordf; Blood Pressure (BP) Category: 130/80\u0026ndash;139/89 in reference to BP\u0026thinsp;\u0026lt;\u0026thinsp;130/90\u003c/p\u003e \u003cp\u003eAge, marital status, income, and other lifestyle factors (e.g., exercise, fruit consumption, salt intake) did not show significant associations with having a BP between 130/80 and 139/89.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParameter Estimates of the magnitude of blood pressure control and associated factors among patients with HTN at the selected health center, A.A, Ethiopia, October to December 2024 GC.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBP control\u0026ordf;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppointment: every 1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.921\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.258\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncome: \u0026lt;1000 birr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge: 18\u0026ndash;45 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.558\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdherence: high adherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026ordf; Blood Pressure (BP) Category: BP\u0026thinsp;\u0026gt;\u0026thinsp;139/89 in reference to BP\u0026thinsp;\u0026lt;\u0026thinsp;130/90\u003c/p\u003e \u003cp\u003eMarital status, education, frequency of healthcare visits, fruit consumption, exercise, salt intake, alcohol consumption, and smoking did not show significant associations with having BP\u0026thinsp;\u0026gt;\u0026thinsp;139/89.\u003c/p\u003e \u003cp\u003eAlthough no association was found in this study, 40.6% of the population does not exercise, 26.8% exercise only 1\u0026ndash;2 times/week for 30 minutes, while only 10.0% meet recommended levels (5 times a week, 30 min per session), and 40.3% have low fruit consumption. 25.5% consume salt more than recommended.\u003c/p\u003e \u003cp\u003eThe most common comorbidity identified was diabetes mellitus (27%), followed by dyslipidemia (16%). Stroke and cardiac disease each accounted for 3%. The majority of patients (55%) did not have any comorbidities. Hydrochlorothiazide was the most commonly used medication (37%), followed by enalapril (34%) and amlodipine (33%). Monotherapy was being used in 45% of the patients.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study aimed to assess the magnitude of blood pressure (BP) control, antihypertensive drug adherence, and associated factors among patients with HTN at a selected health center in A.A., Ethiopia. The findings reveal critical insights into BP control, adherence levels, and the factors influencing them, which are essential for designing targeted interventions to improve hypertension management, potentially decreasing the burden of stroke as well as other cardiovascular diseases in developing countries like Ethiopia. Below is a detailed discussion of the results, their implications, and their alignment with existing literature.\u003c/p\u003e \u003cp\u003eThis study provides critical insights into the magnitude of blood pressure (BP) control and the factors associated with different BP categories. The findings reveal that a significant portion of the population has suboptimal BP control, with only 27.3% (CI: 22.6\u0026ndash;32.0%) of individuals achieving the target BP of \u0026lt;\u0026thinsp;130/80 mmHg. Meanwhile, 35.1% (CI: 30.1\u0026ndash;40.1%) fall into the 130/80\u0026ndash;139/89 mmHg category, and 35.9% (CI: 30.9\u0026ndash;40.9%) have high BP (\u0026gt;\u0026thinsp;139/89 mmHg), indicating poor BP control. These results underscore the urgent need for targeted interventions to improve BP control and reduce the burden of hypertension-related complications including stroke. All studies reviewed in the literature were conducted at the hospital level, whereas our study, conducted in local health centers, found BP control to be at the lower end of the spectrum when using a target of \u0026lt;\u0026thinsp;130/80 mmHg, with control rates ranging from 30\u0026ndash;68% in previous studies \u0026sup1;⁷-\u0026sup2;\u0026sup1;. Similar findings have been reported in other African countries such as Nigeria and Cameroon \u0026sup2;\u0026sup2;-\u0026sup2;⁴. In contrast, a study conducted in the USA demonstrated a significantly higher BP control rate of 72%. \u0026sup2;⁵\u003c/p\u003e \u003cp\u003e The recent studies and guidelines \u0026sup2; \u0026sup1;\u0026sup1;‒\u0026sup1;⁶ recommend for lower BP target and our study highlights the challenges in managing hypertension effectively and suggests that current interventions may be insufficient.\u003c/p\u003e \u003cp\u003eContrary to another study \u0026sup2;⁶, individuals with monthly appointments were more likely to have BP in the range of 130/80\u0026ndash;139/89 compared to those with BP\u0026thinsp;\u0026lt;\u0026thinsp;130/80 mmHg (AOR\u0026thinsp;=\u0026thinsp;5.277, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This counterintuitive finding may indicate that individuals with higher BP are more likely to seek regular care, or that current care is insufficient to achieve optimal BP control.\u003c/p\u003e \u003cp\u003eIn this study, there are many other factors identified which are not mentioned in the literature reviews. Individuals with elementary education were more likely to have BP in the range of 130/80\u0026ndash;139/89 compared to those with BP\u0026thinsp;\u0026lt;\u0026thinsp;130/80 mmHg (AOR\u0026thinsp;=\u0026thinsp;2.618, p\u0026thinsp;=\u0026thinsp;0.042). This suggests that lower education levels may be associated with poorer BP control, possibly due to limited health literacy or access to resources.\u003c/p\u003e \u003cp\u003eIndividuals who measured their BP monthly were less likely to have BP in the range of 130/80\u0026ndash;139/89 compared to those with BP\u0026thinsp;\u0026lt;\u0026thinsp;130/80 mmHg (AOR\u0026thinsp;=\u0026thinsp;0.227, p\u0026thinsp;=\u0026thinsp;0.007). This highlights the importance of regular BP monitoring in maintaining control. Another unexpected result is smokers were less likely to have 130/80\u0026ndash;139/89 compared to those with BP\u0026thinsp;\u0026lt;\u0026thinsp;130/80 mmHg (AOR\u0026thinsp;=\u0026thinsp;0.104, p\u0026thinsp;=\u0026thinsp;0.020). This unexpected result may reflect a combination of survivor bias, confounding factors, small sample size, and potential data quality issues. It is unlikely that smoking itself has a protective effect on blood pressure, given the well-established risks associated with smoking.\u003c/p\u003e \u003cp\u003eThe analysis also identified factors associated with BP\u0026thinsp;\u0026gt;\u0026thinsp;139/89 compared to individuals with BP\u0026thinsp;\u0026lt;\u0026thinsp;130/80. In agreement with other study \u0026sup1;⁷, our study found that Individuals with high adherence are less likely to have high BP (\u0026gt;\u0026thinsp;139/89) compared to those with BP\u0026thinsp;\u0026lt;\u0026thinsp;130/80 (AOR\u0026thinsp;=\u0026thinsp;0.256, p\u0026thinsp;=\u0026thinsp;0.001) suggesting high adherence is associated with a lower likelihood of high BP (\u0026gt;\u0026thinsp;139/89), emphasizing the importance of medication adherence in achieving BP control.\u003c/p\u003e \u003cp\u003eThe appointment frequency showed a similar result to the above, but the subsequent variable was not found to be associated with BP control in our literature review. Younger individuals (18\u0026ndash;45 years) were less likely to have high BP compared to those with BP\u0026thinsp;\u0026lt;\u0026thinsp;130/80 mmHg (AOR\u0026thinsp;=\u0026thinsp;0.159, p\u0026thinsp;=\u0026thinsp;0.004). This aligns with the natural progression of hypertension, which is more common in older adults. Individuals with the lowest income (\u0026lt;\u0026thinsp;1000 birr) were less likely to have high BP compared to those with BP\u0026thinsp;\u0026lt;\u0026thinsp;130/80 mmHg (AOR\u0026thinsp;=\u0026thinsp;0.130, p\u0026thinsp;=\u0026thinsp;0.003). This may reflect underdiagnosis or lack of healthcare access among low-income groups, and another possibility could be dietary factors. Marital status, education, frequency of healthcare visits, fruit consumption, exercise, salt intake, alcohol consumption, and smoking did not show significant associations with having BP\u0026thinsp;\u0026gt;\u0026thinsp;139/89. This contrasts with some studies that have identified some of these factors as predictors of good BP control, like sex, exercise, dietary modification, and high salt intake. The lack of significance in this study may reflect the unique characteristics of the study population or the influence of other unmeasured variables.\u003c/p\u003e \u003cp\u003eAlthough lifestyle factors such as exercise, fruit consumption, and salt intake did not show significant associations with BP categories in the regression analysis, the descriptive data reveal concerning patterns. Only 10.0% of the population meets the recommended exercise levels (5 times/week, 30 minutes per session), while 40.6% do not exercise at all. This lack of physical activity is a significant risk factor for hypertension and stroke. 40.3% of the population has low fruit consumption, which may contribute to poor dietary habits and increased BP. 25.5% of the population consumes more salt than recommended, which is a well-established risk factor for hypertension. These findings highlight the need for lifestyle interventions to address these modifiable risk factors, even though they were not significant predictors in the regression model. Finally, a significant proportion of patients (45%) are on monotherapy despite the guideline recommendation of dual therapy for most patients ⁶ and the high prevalence of therapeutic inertia. \u0026sup2;⁷ Randomized controlled trials have demonstrated that treatment with 1 antihypertensive medication is effective for reaching the blood pressure goal in only\u0026thinsp;\u0026asymp;\u0026thinsp;30% of participants and that the majority of participants achieved the goal with 2 or 3 medications. Therefore, \u0026ge;\u0026thinsp;2 antihypertensive medications are recommended for primary stroke prevention in most patients who require pharmacological treatment of hypertension. \u0026sup2;⁸\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe findings of this study suggest that poor blood pressure control may be a major contributor to the increasing burden of stroke, particularly hemorrhagic stroke, in developing countries compared to Western nations. The study also highlights key factors that require targeted interventions to improve health outcomes. Although regression analysis did not reveal significant associations between lifestyle factors\u0026mdash;such as exercise, fruit consumption, and salt intake\u0026mdash;and blood pressure categories, concerning trends observed in the descriptive data indicate a need for intervention in these areas. Notably, 45% of patients were found to be on monotherapy, pointing to opportunities for optimizing treatment regimens and addressing therapeutic inertia. This study also provides insights from a previously unexplored healthcare facility, aiming to identify areas where interventions could reduce the burden of stroke.\u003c/p\u003e"},{"header":"6. Recommendations","content":"\u003cp\u003eBased on these findings, several recommendations are proposed to enhance blood pressure control. Improving access to healthcare is crucial, particularly by addressing financial barriers through subsidized medications and free healthcare services, and expanding community-based programs to underserved populations. Enhancing patient education is also vital, with the development of tailored materials to improve health literacy, especially for individuals with lower education levels. Strengthening healthcare systems by encouraging more frequent follow-up visits can support continuous education and monitoring, while promoting the use of home blood pressure monitoring devices may empower patients and improve adherence. Additionally, promoting healthy lifestyle choices, such as increased fruit consumption, reduced salt intake, and regular physical activity, can support cardiovascular health. Addressing medication adherence and optimizing treatment regimens are essential, particularly considering the high proportion of patients on a single medication. Ensuring patients follow prescribed treatments and receive appropriate therapeutic combinations may lead to better outcomes. Lastly, further research is recommended, including longitudinal studies to establish causal relationships, qualitative research to understand barriers faced by low-income groups, and intervention studies to evaluate the impact of financial support, education, and lifestyle programs on blood pressure control.\u003c/p\u003e"},{"header":"7. Strengths and limitations of the study","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e7.1 Strength\u003c/h2\u003e \u003cp\u003eThis is the first study conducted at lower-level health facilities in Ethiopia, addressing a notable knowledge gap as most previous studies were hospital-based. It revealed unique factors not identified in earlier literature, offering valuable insights for targeted recommendations. The study also provided important numerical data, highlighting significant gaps in blood pressure control and medication adherence compared to Western countries. Multinomial logistic regression enabled a deeper understanding of the factors influencing varying levels of BP control and adherence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e7.2 Limitation\u003c/h2\u003e \u003cp\u003eThe study faced limitations including financial constraints affecting data quality control and BP measurement, and sampling bias due to underrepresentation of some sub-cities from the multi-stage sampling. Its cross-sectional design restricts causal inference, while reliance on self-reported data may introduce reporting bias. Small sample sizes in certain subgroups, like smokers and low-income individuals, may affect result reliability. Additionally, the lack of detailed clinical data\u0026mdash;such as medication type, comorbidities, side effects, or ASCVD risk\u0026mdash;limits a deeper analysis of factors influencing BP control and adherence.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAAU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAddis Abeba University\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACC/American College of Cardiology and the American Heart Association\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACEI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAngiotensin-converting enzyme inhibitors\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eADCQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAntidepressant Compliance Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eARBs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAngiotensin receptor blockers\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted odd ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASCVD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAtherosclerosis cardiovascular disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBlood pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCHD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCardiovascular heart disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCollege of health science\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEDHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEthiopian Demographic and Health Survey\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFDA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFood and Drug Administration\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntracranial hemorrhage\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHTN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMMAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e8-Morisky Medication Adherence Scale-8\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRPC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eResearch and Publication Committee\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTASH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTikur Anbessa specialized hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUOG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUniversity of Gonder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited state of America\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld health organization.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthors\u0026rsquo; contributions: E.R. was involved in the conception and design of the study, developed the data collection tools, supervised the data collection, analyzed the data, and wrote the manuscript. A.T., Y.Z., and S.A. participated in the study design, oversaw the development of the study instruments, and reviewed the data analysis. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgment: I would like to express my sincere gratitude to my advisors for their guidance and support throughout the manuscript process. I am thankful to Addis Ababa University College of Health Sciences and the School of Medicine, Department of Neurology, for this opportunity and their administrative assistance. Additionally, I appreciate everyone who contributed to the development of this thesis and the participants of the study.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eData and Materials Availability: Datasets supporting this study\u0026apos;s conclusions are included in the article. Additional data is available upon request, along with the MMAS-8 questions and coding.\u003c/p\u003e\n\u003cp\u003eConsent to publish: Not applicable.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate: Ethical clearance to conduct the study was obtained before the beginning of data collection from the Research and Publication Committee (RPC) of the Department of Neurology, TASH. The participant\u0026rsquo;s rights were protected by explaining the purpose and significance of the study.\u003c/p\u003e\n\u003cp\u003eFunding: The study was partly funded by the Office of the Vice President for Research and Technology Transfer at Addis Ababa University, which had no role in the study\u0026apos;s design, data handling, or manuscript writing.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePAHO. World Hypertension Day 2020 [Internet]. PAHO; 2020 [cited 2023 Dec 24]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.paho.org/en/campaigns/world-hypertension-day-2020\u003c/span\u003e\u003cspan address=\"https://www.paho.org/en/campaigns/world-hypertension-day-2020\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoscalzo J, Kasper DL, Longo DL, Fauci AS, Hauser SL, Jameson JL. Harrison\u0026rsquo;s Principles of Internal Medicine. 21st ed. New York: McGraw Hill; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYadeta D, Mekonen D, Mintesnot H, Begna D. National Noncommunicable Diseases Management Protocols. 1st ed. Addis Ababa: Ministry of Health; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCollins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, et al. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: an overview of randomized drug trials in their epidemiological context. Lancet. 1990;335(8693):827\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoton S, Schneider AL, Rosamond WD, Shahar E, Sang Y, Gottesman RF, et al. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA. 2014;312(3):259\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVangen-L\u0026oslash;nne AM, Wilsgaard T, Johnsen SH, L\u0026oslash;chen ML, Nj\u0026oslash;lstad I, Mathiesen EB. Declining incidence of ischemic stroke: What is the impact of changing risk factors? The Troms\u0026oslash; Study 1995 to 2012. Stroke. 2017;48(3):544\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990\u0026ndash;2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014;383(9913):245\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbate TW, Zeleke B, Genanew A, Abate BW. The burden of stroke and modifiable risk factors in Ethiopia: A systematic review and meta-analysis. PLoS ONE. 2021;16(11):e0259244.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteven MG, Wendy CZ, Charlotte C, Dar D, Brandon F, Joshua NG, et al. 2022 Guideline for the Management of Patients with Spontaneous Intracerebral Hemorrhage: A Guideline from the American Heart Association/American Stroke Association. America: AHA/ASA; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, et al. Heart Disease and Stroke Statistics-2022 Update: A Report from the American Heart Association. Circulation. 2022;145(8):e153\u0026ndash;639.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. *N Engl J Med*. 2015;373(22):2103\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJMoa1511939\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa1511939\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMancia G, Kreutz R, Brunstr\u0026ouml;m M, Burnier M, Grassi G, Januszewicz A et al. 2023 ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension. Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874\u0026ndash;2071. doi: 10.1097/HJH.0000000000003480. Epub 2023 Sep 26. Erratum in: J Hypertens. 2024;42(1):194. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/HJH.0000000000003621\u003c/span\u003e\u003cspan address=\"10.1097/HJH.0000000000003621\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 37345492.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. *N Engl J Med*. 2010;362(17):1575\u0026ndash;85. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJMoa1001286\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa1001286\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenavente OR, Coffey CS, Conwit R, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomized trial. *Lancet*. 2013;382(9891):507\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(13)60852-1\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(13)60852-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu A, et al. Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk: the ESPRIT TRIAL. *The Lancet*. 2024;404(1048):248\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eB1Y, et al. Intensive blood-pressure control in patients with type 2 diabetes: the BPROAD Trial. *N Engl J Med*. 2024;391(20): Nov 16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKebede B, Chelkeba L, Dessie B. Rate of blood pressure control and its determinants among adult hypertensive patients at Jimma University Medical Center, Ethiopia: Prospective cohort study. SAGE Open Med. 2021;9:20503121211012206.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGebremichael GB, Berhe KK, Zemichael TM. Uncontrolled hypertension and associated factors among adult hypertensive patients in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia, 2018. BMC Cardiovasc Disord. 2019;19(1):121.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTesfaye A, Kumela K, Wolde M. Blood pressure control associates and antihypertensive pharmacotherapy patterns in Tikur Anbessa General Specialized Hospital Chronic Care Department, Addis Ababa, Ethiopia. Am J Biol Life Sci. 2015;3(3):41\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYazie D, Shibeshi W, Alebachew M, Berha A. Assessment of blood pressure control among hypertensive patients in Zewditu Memorial Hospital, Addis Ababa, Ethiopia: A cross-sectional study. J Bioanal Biomed. 2018;10:80\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeshome DF, Demssie AF, Zeleke BM. Determinants of blood pressure control amongst hypertensive patients in Northwest Ethiopia. PLoS ONE. 2018;13(5):e0196535.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMenanga A, Edie S, Nkoke C, Boombhi J, Musa AJ, Mfeukeu LK, et al. Factors associated with blood pressure control amongst adults with hypertension in Yaounde, Cameroon: a cross-sectional study. Cardiovasc Diagn Ther. 2016;6(5):439\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChimezie GO, Nnamdi EO, Enajite IO, Fatai MA. Patient-related barriers to hypertension control in a Nigerian population. Int J Gen Med. 2014;7:345\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIloh GU, Amadi AN. Treatment satisfaction, medication adherence, and blood pressure control among adult Nigerians with essential hypertension. Int J Health Allied Sci. 2017;6(2):75\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuntner P, Hardy ST, Fine LJ, Jaeger BC, Wozniak G, Levitan EB, et al. Trends in blood pressure control among US adults with hypertension, 1999\u0026ndash;2000 to 2017\u0026ndash;2018. JAMA. 2020;324(12):1190\u0026ndash;200.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbegaz TM, Tefera YG, Abebe TB. Antihypertensive drug prescription patterns and their impact on outcome of blood pressure in Ethiopia: a hospital-based cross-sectional study. Integr Pharm Res Pract. 2017;6:29\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, et al. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990;335(8692):765\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gąsecki D, Gornik HL et al. 2024 Guideline for the primary prevention of stroke: A guideline from the American Heart Association/American Stroke Association. Stroke. 2024;55(3).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hypertension, blood pressure control, Ethiopia, primary healthcare","lastPublishedDoi":"10.21203/rs.3.rs-6517572/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6517572/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHypertension is a major risk factor for stroke, contributing to high mortality and morbidity, particularly in low-income countries like Ethiopia. Studies indicate a rising incidence of stroke in developing nations, with intracerebral hemorrhage disproportionately affecting low-income populations. Assessing blood pressure control, and associated factors is essential for identifying key contributors to the increasing stroke burden and guiding targeted interventions. While most existing data come from hospital-based studies, this research focuses on primary healthcare facilities, where a significant proportion of hypertensive patients receive follow-up care. Future studies can explore additional contributing factors to the growing burden of stroke in developing countries.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted using multi-stage sampling at selected health centers from October to December 2024. Data were collected via structured questionnaires and analyzed using SPSS version 25. A multiple logistic regression model was employed to determine factors associated with BP control.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf 348 patients, only 27.3% achieved the target Blood pressure of \u0026lt;\u0026thinsp;130/80 mmHg, while 35.1% fell into the category of 130/80\u0026ndash;139/89 mmHg, and 35.9% had high BP (\u0026gt;\u0026thinsp;139/89 mmHg), indicating poor control. Factors significantly associated with BP control included adherence levels, frequency of BP monitoring, appointment frequency, education, income, and age. Lifestyle modifications such as exercise and dietary habits showed concerning trends but were not significant predictors in the regression model. A significant proportion of the patients are on monotherapy.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePoor blood pressure control underscores the urgent need for targeted interventions to reduce the burden of stroke and other hypertension-related complications in Ethiopia. Key strategies include enhancing patient education, improving access to healthcare, strengthening healthcare systems through regular follow-up appointments, and promoting home blood pressure monitoring. Additionally, promoting healthy lifestyle choices, addressing financial barriers, and optimizing treatment regimens to prevent therapeutic inertia are essential to improving hypertension management. These efforts can help mitigate the burden of stroke and other cardiovascular diseases. Further research, including longitudinal and qualitative studies, is recommended to explore underlying barriers, identify effective intervention strategies, and investigate other contributing factors beyond hypertension-related issues.\u003c/p\u003e","manuscriptTitle":"The magnitude of blood pressure control and associated factors among hypertensive patients at selected health center, A.A, Ethiopia.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-30 06:23:28","doi":"10.21203/rs.3.rs-6517572/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"82921600184389270358321223188417945353","date":"2025-06-05T06:52:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-28T08:00:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-07T11:18:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-07T06:48:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-07T06:44:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-04-24T06:12:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"41ae4818-7a25-4a42-81f4-f695b0374ac0","owner":[],"postedDate":"May 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-30T06:23:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-30 06:23:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6517572","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6517572","identity":"rs-6517572","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}