Prevalence and Factors Associated With Good Blood Pressure Control Among Hypertensive Patients in a Malaysian Primary Health Clinic

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Even a slight reduction in BP may significantly improve cardiovascular outcomes. Several factors have been associated with good BP control. We aimed to determine the prevalence of good BP control among hypertensive patients and its associated factors in a Malaysian primary health clinic. Method: A cross-sectional study was conducted among Malaysian adults aged 18 years and above with underlying hypertension who attended a public healthcare clinic located in a suburban area of Melaka, Malaysia, from December 2024 to February 2025. Participants were selected via systematic random sampling. Data were collected through self-administered questionnaires, medical records, and blood pressure levels, including both clinical blood pressure measurements and documented home blood pressure monitoring. BP control was categorized based on patients' co-morbidities as recommended by the Malaysian Clinical Practice Guideline. A multiple logistic regression was conducted to determine the factors associated with good blood pressure control. Results: A total of 460 hypertensive patients were included in this study, with a response rate of 96.8%. Only 41.5% of the participants (n=191) had good BP control. The median age was 64 (IQR:17) and the majority were female (57.4%, n=264). The significant factors associated with good blood pressure control among the study population were increasing age (aOR=1.038, 95% CI [1.018,1.057], p<0.001), females gender (aOR=2.103, 95% CI [1.395,3.171], p<0.001), participants who took one and two anti-hypertensive (aOR=1.922, 95% CI [1.146,3.226],p=0.013) and (aOR=2.822, 95% CI [1.632,4.881], p<0.001) respectively, participants without diabetes (aOR=1.685, 95% CI [1.109,2.560], p=0.015), and participant who had documented Home BP Monitoring (HBPM) (aOR=4.650, 95% CI [2.397,9.022], p<0.001). Conclusions: The findings suggest that the prevalence of good blood pressure control, 41.5% is still low among the study population. Factors associated with good Blood pressure control include increasing age, female gender, patients on fewer than three antihypertensive medications, hypertensive patients without diabetes mellitus, and those who have documented home blood pressure monitoring, even after controlling for confounders. hypertension blood pressure control anti-hypertensive home blood pressure monitoring medication adherence predictors BACKGROUND Hypertension is one of the leading risk factors for cardiovascular disease and premature death worldwide [ 1 , 2 ]. The relationship between blood pressure (BP) and the risk of cardiovascular events is continuous, consistent, and independent of other risk factors; the higher the BP, the greater the chance of myocardial infarction, heart failure, stroke, and kidney disease [ 3 ]. Globally, the prevalence of hypertension is increasing due to population ageing and greater exposure to lifestyle risk factors such as unhealthy diets and physical inactivity [ 4 ]. In Malaysia, the prevalence of hypertension among adults aged 18 years and above is 29.2%, with one in three adults affected [ 5 ]. However, only 17.3% are aware that they have the disease, and more than half of these individuals are under Ministry of Health health clinic follow-up [ 5 ]. According to the Malaysian Management of Hypertension Clinical Practice Guideline (CPG) 2018, good BP control is defined as BP < 140/90 mmHg for all patients < 80 years old, < 150/90 mmHg for patients aged 80 and above, < 140/80 mmHg for patients with diabetes, and < 130/80 mmHg for patients with ischemic heart disease, cerebrovascular disease, or renal impairment [ 3 ]. Despite various measures to improve BP control, only 48% of Malaysians with hypertension achieve target BP levels [ 5 ]. Controlling BP remains challenging due to multiple contributing factors. Local studies have shown that medication adherence [ 6 ], the number of antihypertensives [ 7 ], and comorbid diabetes mellitus [6.7] are associated with BP control. However, limited published data have examined the effect of home blood pressure monitoring (HBPM) on BP control in Malaysian primary care. Although HBPM is recommended in Malaysian guidelines, its use in the general population is low; the most recent National Health and Morbidity Survey (NHMS) 2023 reported that only 44.3% of hypertensive patients had a HBPM device at home [ 5 ]. Furthermore, a regional survey across Asia found that while 95.9% of physicians recommended HBPM, only 33.5% believed patients recognised or understood its importance [ 8 ], indicating a persistent knowledge and practice gap. Understanding the factors associated with good BP control, particularly HBPM is essential for reducing hypertension-related morbidity and mortality in Malaysia. By identifying these factors, this study can contribute valuable insights into the barriers that hinder optimal hypertension management. The findings can help in designing targeted public health interventions, guiding policymakers and health administrators in prioritizing resource allocation, and strengthening primary care strategies, such as integrating HBPM and structured adherence support into routine hypertension management. In addition, the results may provide evidence to support policies to subsidise home BP devices, enhance patient education on self-monitoring, and improve counselling protocols within non-communicable disease care models. Currently, there is limited local data on the influence of HBPM on BP control. This study aims to address this gap by determining the prevalence and factors associated with good BP control among hypertensive patients attending Klinik Kesihatan Seri Tanjung, Melaka, Malaysia. METHODS This cross-sectional study was conducted from December 2024 to February 2025 to evaluate the prevalence and factors associated with good BP control among hypertensive patients in primary care. Ethical approval was obtained from the Medical Review and Ethics Committee (MREC), Ministry of Health Malaysia (NMRR ID: 2400402-OMQ [IIR], approved 24 May 2024). The University Putra Malaysia Ethical Committee (JKEUPM) was informed, and written permission to conduct the study at Klinik Kesihatan Seri Tanjung was granted by the Director of Jabatan Kesihatan Negeri Melaka (JKNM) on 5 December 2024. The ethics approval letter and the permission document have been provided as Supplementary Files S1 and S2, respectively. A systematic random sampling method was used to recruit the participants. During the data collection period, the first patient was randomly selected from the name list. The patient was screened for the inclusion and exclusion criteria and invited to participate in this study. Subsequently, every third patient of the day was screened for the inclusion and exclusion criteria and invited to join until the target number of respondents was achieved. Participants completed a self-administered, structured questionnaire in Malay or English. The questionnaire consisted of four sections: (1) sociodemographic characteristics, (2) clinical characteristics, (3) Malaysia Medication Adherence Assessment Tool (MyMAAT), and (4) HBPM practice. Clinical measurements (weight, height, waist circumference, BP) were taken by trained healthcare personnel following Malaysian CPG 2018 protocols [ 3 ]. BP was measured twice, 5 minutes apart, and averaged; for HBPM readings, ≤ 135/85 mmHg was considered controlled. No therapeutic intervention was applied. Setting and Sample The study was conducted at Klinik Kesihatan Seri Tanjung, a type 3 government health clinic in Tanjung Kling, Melaka, Malaysia, serving approximately 35,169 residents and recording 300–350 daily patient attendances. Eligible participants were Malaysian adults aged ≥ 18 years, diagnosed with hypertension, and on antihypertensive treatment for ≥ 6 months. Exclusion criteria included pregnancy, severe cognitive impairment, or acute illness at the time of recruitment. Written informed consent was obtained from all participants prior to data collection. A copy of the informed consent form is provided as Supplementary File S3. The sample size was calculated using a formula to estimate a proportion (one group) for categorical data. The prevalence of blood pressure controlled based on the National Health Morbidity Survey (NHMS) 2019 was used, with a desired precision of 0.05 and a standard error of 1.96 [ 9 ]. The total sample is 475 after considering a 20% drop-out and missing data. The sample size calculation is as below: Table 1 The prevalence of blood pressure control in Malaysia Author Finding National Health and Morbidity Survey 2019 45% patient with Hypertension have their blood pressure Controlled [ 9 ] Formula: With, n = Total sample P = estimated prevalence of blood pressure controlled based on National health and morbidity survey 2019 d = desired precision Z (1−α/2) = Standard error associated with confidence interval Therefore, if Z (1−α/2) = 1.96, P = 0.45, d = 0.05 Calculated sample = 380 Considering the drop-out rate of 20%, therefore, n = 380/0.8 = 475. The minimum sample size calculated is 475. (The drop-out rate includes non-respondents and incomplete assessments). A final sample size of 475 was chosen in view of it being the largest sample and achievable in the study period. The largest sample size was selected because it can enhance the precision of estimates, reduce the margin of error, and improve the generalizability of the findings to the target population [ 10 ]. Hence, a total of 475 patients with hypertension who fulfilled the inclusion and exclusion criteria were approached to participate in this study.15 declined to participated. This resulted in a response rate of 96.8%. As a result, the final sample size for analysis was 460 respondents. Assessment of factors associated with good blood pressure control The intervention involved administering a structured, self-administered questionnaire, available in Malay and English, consisting of four sections, followed by standardised clinical measurements. The questionnaire used in this study is provided as Supplementary File S4. Section 1: Sociodemographic characteristics – Seven items on age, gender, ethnicity, marital status, education level, working status, and household monthly income. Section 2: Clinical characteristics – Six items covering duration of hypertension, number of antihypertensives, co-morbidities, smoking status, and alcohol use. Data were verified against participants’ latest medical records. Section 3: Malaysian Medication Adherence Assessment Tool (MyMAAT) – A validated 12-item tool (Cronbach’s alpha = 0.910; test-retest Spearman’s rho = 0.96, p = 0.001) used in Malaysian healthcare to identify medication non-adherence. Each item was scored from 1 (strongly agree) to 5 (strongly disagree), with total scores ranging from 12 to 60. Scores ≥ 54 indicated good adherence; scores < 54 indicated poor adherence. Section 4: HBPM practice – One self-reported yes/no item on performing HBPM, verified against medical records to confirm documentation and control status. Clinical measurement Clinical measurements (weight, height, waist circumference, and average blood pressure) were performed by trained healthcare personnel on the same visit day before questionnaire completion. Weight (kg) was measured using a calibrated weighing scale; height (cm) and waist circumference (cm) were measured using a measuring tape positioned midway between the lowest rib margin and iliac crest. BP measurements were taken upon patient arrival at the vital sign counter. BP was measured with a calibrated electronic BP device using an appropriately sized cuff, following standard pre-measurement protocols (no smoking, eating, caffeine, or exercise within 30 minutes; 1-minute rest; supported back and arm; legs uncrossed). BP was measured in both arms, with the higher reading taken as the first measurement. A second measurement was performed 5 minutes later on the same arm, and the two readings were averaged for the final BP value. The average duration for completing the questionnaire and clinical measurements was approximately 10 minutes. Medical record review Medical records were reviewed for information on patients' co-morbidities, anti-hypertensive medication, and documented home blood pressure monitoring. Outcome Measures The primary outcome of this study was BP control, categorised as good or poor . By utilizing the average reading from 5 mins apart as their BP value, a good BP control was defined according to the Malaysian CPG 2018, as outlined in the introduction [ 3 ]. Secondary outcomes included the influence of socio-demographic profile, clinical characteristics, medication adherence (assessed using the validated MyMAAT questionnaire), and the HBPM practice on the primary outcome. Statistical analysis Data were analysed using IBM SPSS Statistics version 29 (IBM Corp., Armonk, NY, USA). Independent variables, including socio-demographic characteristics, clinical characteristics, medication adherence, and HBPM use, were summarised descriptively. Categorical variables were presented as frequency (n) and percentage (%), while continuous variables were expressed as mean ± standard deviation (SD) for normally distributed data or median and interquartile range (IQR) for non-normally distributed data. The dependent variable, BP control, was categorised as “good” or “poor” based on the study’s operational definition. Associations between BP control and independent variables were first examined using simple logistic regression for univariate analysis. Variables with p < 0.05 in the univariate analysis were included in the multiple logistic regression (MLR) model to identify factors independently associated with good BP control. Multicollinearity was assessed using tolerance values ( 10 indicating concern). Final MLR results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Model fit was assessed using the Hosmer–Lemeshow goodness-of-fit test, where p > 0.05 indicated adequate model calibration. A p-value < 0.05 was considered statistically significant for all analyses. RESULTS Table 1 presents the socio-demographic profile and clinical characteristics of the respondents. A total of 460 hypertensive patients were included, with a median age of 64 years (IQR 17). The majority were female and of Malay ethnicity. Most were married, had secondary or primary education, and were not working, with a median household monthly income of RM1500 (IQR 1500). The median duration of hypertension was 9 years (IQR 9). Over one-third were prescribed two antihypertensive medications, and almost all had at least one comorbidity, most commonly dyslipidaemia and diabetes mellitus. The majority were non-smokers and did not consume alcohol. The median BMI was 28 kg/m² (IQR 7.6) and median waist circumference was 98 cm (IQR 16), with nearly 90% having increased waist circumference. Table 2 summarizes medication adherence, HBPM practice, and blood pressure control among the respondents. The median MyMAAT score was 57 (IQR 5), with 78.5% of participants classified as adherent and 21.5% as non-adherent. Only 30.0% reported practicing HBPM, of which 12.0% had verifiable documentation. Overall, 41.5% of patients achieved controlled blood pressure, while 58.5% had uncontrolled blood pressure. Table 3 shows the univariate logistic regression analysis of factors associated with blood pressure control. Significant associations were observed for age (p=0.004), female gender (p<0.001), working status (p=0.016), use of two antihypertensives (p=0.002), presence of diabetes mellitus (p=0.002), and non-smoking status (p=0.009). Table 4 shows the simple logistic regression analysis of medication adherence and blood pressure control. Among adherent participants, 41.8% achieved BP control compared with 40.4% of non-adherent participants. Adherence was not significantly associated with BP control (OR 1.061; 95% CI 0.674–1.688; p=0.799), and the total MyMAAT score as a continuous measure was also not significant (OR 1.025; 95% CI 0.983–1.068; p=0.244). Despite 78.5% reporting good adherence, only 41.8% achieved BP control, suggesting that adherence alone may be insufficient and that other factors, including comorbidities and treatment complexity, may play a role. Table 5 shows the simple logistic regression analysis of HBPM practice and blood pressure control. Participants who self-reported HBPM had higher rates of BP control (50.7%) compared with those who did not practice HBPM (37.6%). Documented HBPM was strongly associated with BP control, with 67.3% achieving control and a significant odds ratio of 3.415 (95% CI 1.861–6.264; p<0.001). Table 6 presents the multiple logistic regression analysis of predictors of blood pressure control. Multicollinearity was assessed and found to be negligible, with the highest VIF of 1.541 and all tolerance values above 0.1. The final model showed good fit (Omnibus test p<0.001; Hosmer–Lemeshow p=0.720) with an overall classification accuracy of 66.5%. Older age (AOR 1.038; 95% CI 1.018–1.057; p<0.001) and female gender (AOR 2.103; 95% CI 1.395–3.171; p<0.001) were significantly associated with better BP control. Participants on one (AOR 1.922; 95% CI 1.146–3.226; p=0.013) or two medications (AOR 2.822; 95% CI 1.632–4.881; p<0.001) had higher odds of control compared to those on three or more drugs. Absence of diabetes mellitus was associated with improved control (AOR 1.685; 95% CI 1.109–2.560; p=0.015). Documented HBPM practice was a strong predictor, with more than fourfold increased odds of BP control (AOR 4.650; 95% CI 2.397–9.022; p<0.001). Working and smoking status were not significant after adjustment. DISCUSSION This study evaluated BP control and its associated factors among hypertensive patients in a primary care setting. The overall BP control rate was 41.5%, which is consistent with findings from other local and regional studies that reported control rates ranging between 33% and 48% [ 11 , 12 , 13 ]. Despite high levels of treatment and follow-up, more than half of the participants remained uncontrolled, reflecting the persistent challenge of achieving optimal BP management in routine practice. Socio-demographic and clinical characteristics were important determinants of BP control. Older age was positively associated with good BP control, a finding that has been reported in previous studies [ 12 , 14 , 15 ]. This may be due to greater health awareness, more frequent healthcare visits, or better treatment compliance among older individuals. Female patients were also significantly more likely to achieve BP control compared with males, consistent with other studies showing that women generally demonstrate better health-seeking behaviours and treatment adherence [ 12 , 14 , 15 ]. Medication use was another strong predictor. Patients prescribed one and two antihypertensive agents were more likely to achieve control compared to those on three or more medications, suggesting that individuals requiring multiple therapies may represent a more resistant hypertensive group [ 11 , 16 ]. The presence of diabetes mellitus was associated with poorer BP control, in line with existing evidence that comorbid diabetes complicates hypertension management and increases treatment burden [ 14 , 17 , 18 ]. Medication adherence, assessed using the validated MyMAAT tool, was generally high, with 78.5% of participants classified as adherent. However, adherence was not significantly associated with BP control, which contrasts with findings from other studies [ 19 , 20 , 21 ]. The lack of association in this study may reflect the high baseline adherence rate, potential overreporting due to self-assessment, or the influence of other factors such as comorbidities and treatment complexity. This highlights that adherence alone, while necessary, may not be sufficient to achieve optimal BP outcomes. HBPM practice showed a stronger association with BP control. Although only 30.0% of participants reported HBPM, and just 12.0% had verifiable documentation, those with documented HBPM were more than four times as likely to achieve BP control. This finding is consistent with international evidence supporting HBPM as an effective self-management tool that promotes treatment compliance and facilitates physician decision-making [ 8 , 22 , 23 ]. The lack of significance for self-reported but undocumented HBPM suggests that objective documentation may reflect a more structured and consistent practice, reinforcing its clinical value. Although working status, smoking and BMI showed associations in the univariate analysis, they were not significant after adjustment of confounders, consistent with previous local studies (6,7). The lack of association with adherence, despite its established role in BP control [ 24 , 25 ], may reflect the high prevalence of reported adherence in this sample and possible overestimation due to self-report bias [ 26 ]. Overall, the predictors identified in this study - older age, female gender, fewer antihypertensive agents, absence of diabetes, and documented HBPM are consistent with established literature while also highlighting specific gaps in local practice. Importantly, the strong effect of documented HBPM underscores the potential of structured home monitoring programs to improve BP control in Malaysian primary care settings. These findings highlight the importance of integrating structured HBPM programs, simplifying treatment regimens where feasible, and targeted interventional program for specific groups such as men and patients with diabetes to tackle BP control issues among population. Future research should explore longitudinal and interventional approaches to confirm causality and evaluate strategies to enhance BP control. Taken together, the results reinforce the need for comprehensive, patient-centred hypertension management in primary care settings. STRENGTH AND LIMITATIONS This study was conducted in a primary health clinic setting, reflecting real-world clinical practice and patients’ behaviour. The findings can be generalised to similar public healthcare settings in Malaysia. The socio-demographic profile of respondents closely mimics Malaysian hypertensive population patterns, particularly in age, gender, income, and comorbidities, increasing the relevance and applicability of findings. The Malaysian Medication Adherence Assessment Tool (MyMAAT) used is a validated tool developed locally in 2020 [ 19 ], culturally and contextually appropriate, enhancing accuracy and reliability. BP control was defined from the average of two measurements 5 minutes apart, with documented HBPM reviewed for those with uncontrolled clinic BP—an approach rarely used. Self-reported and documented HBPM were analysed separately to give greater insight into self-care behaviour. Multiple logistic regression was applied to adjust for confounding variables, improving credibility [ 27 ]. However, the cross-sectional design limits causal inference [ 28 ], and BP control was assessed at a single point in time, preventing evaluation of long-term trends. Some data (MyMAAT, self-reported HBPM) relied on self-report, introducing recall and social desirability bias. Non-pharmacological factors such as salt intake, physical activity, stress, and sleep were not included, potentially leaving residual confounding. The sample overrepresented Malay respondents (90.9%), limiting generalisability to other ethnic groups, and data were collected from a single clinic, which may not reflect the diversity of healthcare settings in Malaysia. CONCLUSIONS This study found that the prevalence of good BP control was 41.7%, which remains suboptimal, indicating a gap in achieving therapeutic targets. Significant predictors of good BP control included increasing age, female gender, simpler antihypertensive regimens, absence of diabetes mellitus, and documented HBPM. These findings highlight the need for targeted interventions, particularly for male patients, those with multiple medications, and patients with diabetes. HBPM should be promoted among all hypertensive patients through the use of validated devices, proper training on accurate measurement, and emphasis on documentation. Where feasible, antihypertensive regimens should be simplified to improve adherence. Primary care should focus on personalised management plans, especially for patients with multiple comorbidities. At the policy level, government support or subsidies for home BP monitors, coupled with public education campaigns, may enhance self-monitoring and awareness. Future research should explore factors such as stress, health literacy, and motivation, and conduct multicentre longitudinal studies to improve generalisability and assess causal relationships with BP control. Abbreviations AOR Adjusted Odds Ratio CI Confidence Interval HBPM Home Blood Pressure Monitoring NHMS National Health Morbidity Survey MREC Medical Review And Ethics Committee CPG Clinical Practice Guide BP Blood Pressure JKEUPM University Putra Malaysia Ethical Committee JKNM Jabatan Kesihatan Negeri Melaka MYMAAT Malaysia Medication Adherence Assessment Tool MMAS-8 Morisky Medication Adherence In Malaysian Hypertensive Patients HBTS-M Hill-Bone Compliance To High Blood Pressure Therapy Scale IQR Interquartile Range MLR Multiple Logistic Regresssion VIF Variance Inflation Factor OR Odds Ratio Declarations ACKNOWLEDGEMENT This study was supported by a research grant funded by Servier (Malaysia) Sdn. Bhd., in collaboration with Universiti Putra Malaysia. The sponsor had no role in the study design, data collection, analysis, interpretation of data, or in the writing of the manuscript. The authors would like to thank all participants for their willingness to be involved in this study. Ethics approval and consent to participate This study was approved by Medical Review and Ethics Committee (MREC), Ministry of Health Malaysia. The MREC approval was given on 24 May 2024 with NMRR ID: 24-00402-OMQ (IIR). The University Putra Malaysia Ethical Committee (JKEUPM) was also informed regarding this study and conducted in accordance with the Declaration of Helsinki. Written informed consent to participate was obtained from all participants. Consent for publication Not applicable. Availability of data and materials The datasets supporting the conclusions of this article are included within the article and its supplementary files. However, data containing potentially identifiable participant information (such as age, gender, race, education level, income, employment status, and clinical characteristics) are not publicly available. To protect participants’ privacy, access to these data is restricted in accordance with the requirements of the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia, and the Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia (JKEUPM). Requests for data access may be directed to the Medical Research and Ethics Committee, National Institutes of Health, Ministry of Health Malaysia, Block A, Level 2, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia (Telephone: +603-3362 8398; Email: [email protected] ). Competing interests The authors declare that they have no competing interests. Funding This study was supported by a research grant funded by Servier (Malaysia) Sdn. Bhd., in collaboration with Universiti Putra Malaysia. The sponsor had no role in the design of the study, data collection, analysis, interpretation, or in writing the manuscript. Authors’ Contributions Conceptualization: AB, AAR Methodology: AB, AAR, FB Data collection: AB Formal analysis: AB, AAR, FB Writing – original draft: AB Writing – review & editing: AB, AAR, FB Supervision: AAR Funding acquisition: AAR References Fuchs FD, Whelton PK. High blood pressure and cardiovascular disease. Hypertension. 2020;75(2):285–92. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223–37. Ak P. Clinical practice guidelines management of hypertension. 5th ed. 2018. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet. 2017;389(10064):37–55. Institute for Public Health. NHMS 2023 [Internet]. 2023 [cited 2025 May 25]. Available from: https://iku.gov.my/nhms-2023 Ghazali R, Lukman KA, Naing DKS, Kadir F, Jeffree MS, Robinson F, et al. 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Available from: https://books.google.com/books?hl=en&lr=&id=bRoxQBIZRd4C&oi=fnd&pg=PR13 Read E. What is a cross-sectional study? Advantages, disadvantages, and examples [Internet]. Enago Read. 2020 [cited 2025 May 27]. Available from: https://www.read.enago.com/blog/what-is-a-cross-sectional-study-advantages-disadvantages-and-examples/ Tables Tables 1 to 6 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table16.docx S2.pdf File S2: Formal permission to conduct the study at study location S3.pdf File S3: Written Informed Consent (English) S4.pdf File S4: Questionnaire (English) Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 12 Feb, 2026 Reviews received at journal 12 Feb, 2026 Reviews received at journal 12 Feb, 2026 Reviews received at journal 08 Feb, 2026 Reviewers agreed at journal 04 Feb, 2026 Reviewers agreed at journal 01 Feb, 2026 Reviewers agreed at journal 30 Jan, 2026 Reviewers agreed at journal 19 Nov, 2025 Reviewers agreed at journal 08 Nov, 2025 Reviewers invited by journal 10 Sep, 2025 Editor invited by journal 09 Sep, 2025 Editor assigned by journal 04 Sep, 2025 Submission checks completed at journal 04 Sep, 2025 First submitted to journal 31 Aug, 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. 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The relationship between blood pressure (BP) and the risk of cardiovascular events is continuous, consistent, and independent of other risk factors; the higher the BP, the greater the chance of myocardial infarction, heart failure, stroke, and kidney disease [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Globally, the prevalence of hypertension is increasing due to population ageing and greater exposure to lifestyle risk factors such as unhealthy diets and physical inactivity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In Malaysia, the prevalence of hypertension among adults aged 18 years and above is 29.2%, with one in three adults affected [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, only 17.3% are aware that they have the disease, and more than half of these individuals are under Ministry of Health health clinic follow-up [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. According to the Malaysian Management of Hypertension Clinical Practice Guideline (CPG) 2018, good BP control is defined as BP\u0026thinsp;\u0026lt;\u0026thinsp;140/90 mmHg for all patients\u0026thinsp;\u0026lt;\u0026thinsp;80 years old, \u0026lt;\u0026thinsp;150/90 mmHg for patients aged 80 and above, \u0026lt;\u0026thinsp;140/80 mmHg for patients with diabetes, and \u0026lt;\u0026thinsp;130/80 mmHg for patients with ischemic heart disease, cerebrovascular disease, or renal impairment [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite various measures to improve BP control, only 48% of Malaysians with hypertension achieve target BP levels [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eControlling BP remains challenging due to multiple contributing factors. Local studies have shown that medication adherence [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], the number of antihypertensives [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and comorbid diabetes mellitus [6.7] are associated with BP control. However, limited published data have examined the effect of home blood pressure monitoring (HBPM) on BP control in Malaysian primary care. Although HBPM is recommended in Malaysian guidelines, its use in the general population is low; the most recent National Health and Morbidity Survey (NHMS) 2023 reported that only 44.3% of hypertensive patients had a HBPM device at home [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Furthermore, a regional survey across Asia found that while 95.9% of physicians recommended HBPM, only 33.5% believed patients recognised or understood its importance [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], indicating a persistent knowledge and practice gap.\u003c/p\u003e\u003cp\u003eUnderstanding the factors associated with good BP control, particularly HBPM is essential for reducing hypertension-related morbidity and mortality in Malaysia. By identifying these factors, this study can contribute valuable insights into the barriers that hinder optimal hypertension management. The findings can help in designing targeted public health interventions, guiding policymakers and health administrators in prioritizing resource allocation, and strengthening primary care strategies, such as integrating HBPM and structured adherence support into routine hypertension management. In addition, the results may provide evidence to support policies to subsidise home BP devices, enhance patient education on self-monitoring, and improve counselling protocols within non-communicable disease care models. Currently, there is limited local data on the influence of HBPM on BP control. This study aims to address this gap by determining the prevalence and factors associated with good BP control among hypertensive patients attending Klinik Kesihatan Seri Tanjung, Melaka, Malaysia.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis cross-sectional study was conducted from December 2024 to February 2025 to evaluate the prevalence and factors associated with good BP control among hypertensive patients in primary care. Ethical approval was obtained from the Medical Review and Ethics Committee (MREC), Ministry of Health Malaysia (NMRR ID: 2400402-OMQ [IIR], approved 24 May 2024). The University Putra Malaysia Ethical Committee (JKEUPM) was informed, and written permission to conduct the study at Klinik Kesihatan Seri Tanjung was granted by the Director of Jabatan Kesihatan Negeri Melaka (JKNM) on 5 December 2024. The ethics approval letter and the permission document have been provided as Supplementary Files S1 and S2, respectively. A systematic random sampling method was used to recruit the participants. During the data collection period, the first patient was randomly selected from the name list. The patient was screened for the inclusion and exclusion criteria and invited to participate in this study. Subsequently, every third patient of the day was screened for the inclusion and exclusion criteria and invited to join until the target number of respondents was achieved. Participants completed a self-administered, structured questionnaire in Malay or English. The questionnaire consisted of four sections: (1) sociodemographic characteristics, (2) clinical characteristics, (3) Malaysia Medication Adherence Assessment Tool (MyMAAT), and (4) HBPM practice. Clinical measurements (weight, height, waist circumference, BP) were taken by trained healthcare personnel following Malaysian CPG 2018 protocols [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. BP was measured twice, 5 minutes apart, and averaged; for HBPM readings, \u0026le;\u0026thinsp;135/85 mmHg was considered controlled. No therapeutic intervention was applied.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eSetting and Sample\u003c/h2\u003e\n \u003cp\u003eThe study was conducted at Klinik Kesihatan Seri Tanjung, a type 3 government health clinic in Tanjung Kling, Melaka, Malaysia, serving approximately 35,169 residents and recording 300\u0026ndash;350 daily patient attendances. Eligible participants were Malaysian adults aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years, diagnosed with hypertension, and on antihypertensive treatment for \u0026ge;\u0026thinsp;6 months. Exclusion criteria included pregnancy, severe cognitive impairment, or acute illness at the time of recruitment. Written informed consent was obtained from all participants prior to data collection. A copy of the informed consent form is provided as Supplementary File S3. The sample size was calculated using a formula to estimate a proportion (one group) for categorical data. The prevalence of blood pressure controlled based on the National Health Morbidity Survey (NHMS) 2019 was used, with a desired precision of 0.05 and a standard error of 1.96 [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]. The total sample is 475 after considering a 20% drop-out and missing data. The sample size calculation is as below:\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe prevalence of blood pressure control in Malaysia\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAuthor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFinding\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNational Health and Morbidity Survey 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45% patient with Hypertension have their blood pressure\u003c/p\u003e\n \u003cp\u003eControlled [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\u003cbr\u003e\n \u003cp\u003eFormula:\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003e\u003cimg 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class=\"BlockQuote\"\u003e\n \u003cp\u003eWith,\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;Total sample\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eP\u0026thinsp;=\u0026thinsp;estimated prevalence of blood pressure controlled based on National health and morbidity survey 2019\u003c/p\u003e\n\u003cp\u003ed\u0026thinsp;=\u0026thinsp;desired precision\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eZ\u003csub\u003e(1\u0026minus;\u0026alpha;/2)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;Standard error associated with confidence interval\u003c/p\u003e\n \u003cp\u003eTherefore, if Z\u003csub\u003e(1\u0026minus;\u0026alpha;/2)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;1.96, P\u0026thinsp;=\u0026thinsp;0.45, d\u0026thinsp;=\u0026thinsp;0.05\u003c/p\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eCalculated sample\u0026thinsp;=\u0026thinsp;380\u003c/p\u003e\n\u003cp\u003eConsidering the drop-out rate of 20%, therefore, n\u0026thinsp;=\u0026thinsp;380/0.8\u0026thinsp;=\u0026thinsp;475. The minimum sample size calculated is 475. \u003cem\u003e(The drop-out rate includes non-respondents and incomplete assessments).\u003c/em\u003e A final sample size of 475 was chosen in view of it being the largest sample and achievable in the study period. The largest sample size was selected because it can enhance the precision of estimates, reduce the margin of error, and improve the generalizability of the findings to the target population [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. Hence, a total of 475 patients with hypertension who fulfilled the inclusion and exclusion criteria were approached to participate in this study.15 declined to participated. This resulted in a response rate of 96.8%. As a result, the final sample size for analysis was 460 respondents.\u003c/p\u003e\n\u003ch3\u003eAssessment of factors associated with good blood pressure control\u003c/h3\u003e\n\u003cp\u003eThe intervention involved administering a structured, self-administered questionnaire, available in Malay and English, consisting of four sections, followed by standardised clinical measurements. The questionnaire used in this study is provided as Supplementary File S4.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eSection 1: Sociodemographic characteristics \u0026ndash; Seven items on age, gender, ethnicity, marital status, education level, working status, and household monthly income.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eSection 2: Clinical characteristics \u0026ndash; Six items covering duration of hypertension, number of antihypertensives, co-morbidities, smoking status, and alcohol use. Data were verified against participants\u0026rsquo; latest medical records.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eSection 3: Malaysian Medication Adherence Assessment Tool (MyMAAT) \u003cstrong\u003e\u0026ndash;\u003c/strong\u003e A validated 12-item tool (Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.910; test-retest Spearman\u0026rsquo;s rho\u0026thinsp;=\u0026thinsp;0.96, p\u0026thinsp;=\u0026thinsp;0.001) used in Malaysian healthcare to identify medication non-adherence. Each item was scored from 1 (strongly agree) to 5 (strongly disagree), with total scores ranging from 12 to 60. Scores\u0026thinsp;\u0026ge;\u0026thinsp;54 indicated good adherence; scores\u0026thinsp;\u0026lt;\u0026thinsp;54 indicated poor adherence.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eSection 4: HBPM practice \u0026ndash; One self-reported yes/no item on performing HBPM, verified against medical records to confirm documentation and control status.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eClinical measurement\u003c/h3\u003e\n\u003cp\u003eClinical measurements (weight, height, waist circumference, and average blood pressure) were performed by trained healthcare personnel on the same visit day before questionnaire completion. Weight (kg) was measured using a calibrated weighing scale; height (cm) and waist circumference (cm) were measured using a measuring tape positioned midway between the lowest rib margin and iliac crest. BP measurements were taken upon patient arrival at the vital sign counter. BP was measured with a calibrated electronic BP device using an appropriately sized cuff, following standard pre-measurement protocols (no smoking, eating, caffeine, or exercise within 30 minutes; 1-minute rest; supported back and arm; legs uncrossed). BP was measured in both arms, with the higher reading taken as the first measurement. A second measurement was performed 5 minutes later on the same arm, and the two readings were averaged for the final BP value. The average duration for completing the questionnaire and clinical measurements was approximately 10 minutes.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eMedical record review\u003c/h2\u003e\n \u003cp\u003eMedical records were reviewed for information on patients\u0026apos; co-morbidities, anti-hypertensive medication, and documented home blood pressure monitoring.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eOutcome Measures\u003c/h3\u003e\n\u003cp\u003eThe primary outcome of this study was BP control, categorised as \u003cem\u003egood\u003c/em\u003e or \u003cem\u003epoor\u003c/em\u003e. By utilizing the average reading from 5 mins apart as their BP value, a good BP control was defined according to the Malaysian CPG 2018, as outlined in the introduction [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. Secondary outcomes included the influence of socio-demographic profile, clinical characteristics, medication adherence (assessed using the validated MyMAAT questionnaire), and the HBPM practice on the primary outcome.\u003c/p\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eData were analysed using IBM SPSS Statistics version 29 (IBM Corp., Armonk, NY, USA). Independent variables, including socio-demographic characteristics, clinical characteristics, medication adherence, and HBPM use, were summarised descriptively. Categorical variables were presented as frequency (n) and percentage (%), while continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) for normally distributed data or median and interquartile range (IQR) for non-normally distributed data. The dependent variable, BP control, was categorised as \u0026ldquo;good\u0026rdquo; or \u0026ldquo;poor\u0026rdquo; based on the study\u0026rsquo;s operational definition. Associations between BP control and independent variables were first examined using simple logistic regression for univariate analysis. Variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in the univariate analysis were included in the multiple logistic regression (MLR) model to identify factors independently associated with good BP control. Multicollinearity was assessed using tolerance values (\u0026lt;\u0026thinsp;0.1 indicating concern) and variance inflation factor (VIF) values (\u0026gt;\u0026thinsp;10 indicating concern). Final MLR results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Model fit was assessed using the Hosmer\u0026ndash;Lemeshow goodness-of-fit test, where p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 indicated adequate model calibration. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant for all analyses.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTable 1 presents the socio-demographic profile and clinical characteristics of the respondents. A total of 460 hypertensive patients were included, with a median age of 64 years (IQR 17). The majority were female and of Malay ethnicity. Most were married, had secondary or primary education, and were not working, with a median household monthly income of RM1500 (IQR 1500). The median duration of hypertension was 9 years (IQR 9). Over one-third were prescribed two antihypertensive medications, and almost all had at least one comorbidity, most commonly dyslipidaemia and diabetes mellitus. The majority were non-smokers and did not consume alcohol. The median BMI was 28 kg/m² (IQR 7.6) and median waist circumference was 98 cm (IQR 16), with nearly 90% having increased waist circumference.\u003c/p\u003e\n\u003cp\u003eTable 2 summarizes medication adherence, HBPM practice, and blood pressure control among the respondents. The median MyMAAT score was 57 (IQR 5), with 78.5% of participants classified as adherent and 21.5% as non-adherent. Only 30.0% reported practicing HBPM, of which 12.0% had verifiable documentation. Overall, 41.5% of patients achieved controlled blood pressure, while 58.5% had uncontrolled blood pressure.\u003c/p\u003e\n\u003cp\u003eTable 3 shows the univariate logistic regression analysis of factors associated with blood pressure control. Significant associations were observed for age (p=0.004), female gender (p\u0026lt;0.001), working status (p=0.016), use of two antihypertensives (p=0.002), presence of diabetes mellitus (p=0.002), and non-smoking status (p=0.009).\u003c/p\u003e\n\u003cp\u003eTable 4 shows the simple logistic regression analysis of medication adherence and blood pressure control. Among adherent participants, 41.8% achieved BP control compared with 40.4% of non-adherent participants. Adherence was not significantly associated with BP control (OR 1.061; 95% CI 0.674–1.688; p=0.799), and the total MyMAAT score as a continuous measure was also not significant (OR 1.025; 95% CI 0.983–1.068; p=0.244). Despite 78.5% reporting good adherence, only 41.8% achieved BP control, suggesting that adherence alone may be insufficient and that other factors, including comorbidities and treatment complexity, may play a role.\u003c/p\u003e\n\u003cp\u003eTable 5 shows the simple logistic regression analysis of HBPM practice and blood pressure control. Participants who self-reported HBPM had higher rates of BP control (50.7%) compared with those who did not practice HBPM (37.6%). Documented HBPM was strongly associated with BP control, with 67.3% achieving control and a significant odds ratio of 3.415 (95% CI 1.861–6.264; p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eTable 6 presents the multiple logistic regression analysis of predictors of blood pressure control. Multicollinearity was assessed and found to be negligible, with the highest VIF of 1.541 and all tolerance values above 0.1. The final model showed good fit (Omnibus test p\u0026lt;0.001; Hosmer–Lemeshow p=0.720) with an overall classification accuracy of 66.5%. Older age (AOR 1.038; 95% CI 1.018–1.057; p\u0026lt;0.001) and female gender (AOR 2.103; 95% CI 1.395–3.171; p\u0026lt;0.001) were significantly associated with better BP control. Participants on one (AOR 1.922; 95% CI 1.146–3.226; p=0.013) or two medications (AOR 2.822; 95% CI 1.632–4.881; p\u0026lt;0.001) had higher odds of control compared to those on three or more drugs. Absence of diabetes mellitus was associated with improved control (AOR 1.685; 95% CI 1.109–2.560; p=0.015). Documented HBPM practice was a strong predictor, with more than fourfold increased odds of BP control (AOR 4.650; 95% CI 2.397–9.022; p\u0026lt;0.001). Working and smoking status were not significant after adjustment.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study evaluated BP control and its associated factors among hypertensive patients in a primary care setting. The overall BP control rate was 41.5%, which is consistent with findings from other local and regional studies that reported control rates ranging between 33% and 48% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Despite high levels of treatment and follow-up, more than half of the participants remained uncontrolled, reflecting the persistent challenge of achieving optimal BP management in routine practice.\u003c/p\u003e\u003cp\u003eSocio-demographic and clinical characteristics were important determinants of BP control. Older age was positively associated with good BP control, a finding that has been reported in previous studies [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This may be due to greater health awareness, more frequent healthcare visits, or better treatment compliance among older individuals. Female patients were also significantly more likely to achieve BP control compared with males, consistent with other studies showing that women generally demonstrate better health-seeking behaviours and treatment adherence [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMedication use was another strong predictor. Patients prescribed one and two antihypertensive agents were more likely to achieve control compared to those on three or more medications, suggesting that individuals requiring multiple therapies may represent a more resistant hypertensive group [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The presence of diabetes mellitus was associated with poorer BP control, in line with existing evidence that comorbid diabetes complicates hypertension management and increases treatment burden [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMedication adherence, assessed using the validated MyMAAT tool, was generally high, with 78.5% of participants classified as adherent. However, adherence was not significantly associated with BP control, which contrasts with findings from other studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The lack of association in this study may reflect the high baseline adherence rate, potential overreporting due to self-assessment, or the influence of other factors such as comorbidities and treatment complexity. This highlights that adherence alone, while necessary, may not be sufficient to achieve optimal BP outcomes.\u003c/p\u003e\u003cp\u003eHBPM practice showed a stronger association with BP control. Although only 30.0% of participants reported HBPM, and just 12.0% had verifiable documentation, those with documented HBPM were more than four times as likely to achieve BP control. This finding is consistent with international evidence supporting HBPM as an effective self-management tool that promotes treatment compliance and facilitates physician decision-making [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The lack of significance for self-reported but undocumented HBPM suggests that objective documentation may reflect a more structured and consistent practice, reinforcing its clinical value.\u003c/p\u003e\u003cp\u003eAlthough working status, smoking and BMI showed associations in the univariate analysis, they were not significant after adjustment of confounders, consistent with previous local studies (6,7). The lack of association with adherence, despite its established role in BP control [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], may reflect the high prevalence of reported adherence in this sample and possible overestimation due to self-report bias [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Overall, the predictors identified in this study - older age, female gender, fewer antihypertensive agents, absence of diabetes, and documented HBPM are consistent with established literature while also highlighting specific gaps in local practice. Importantly, the strong effect of documented HBPM underscores the potential of structured home monitoring programs to improve BP control in Malaysian primary care settings.\u003c/p\u003e\u003cp\u003eThese findings highlight the importance of integrating structured HBPM programs, simplifying treatment regimens where feasible, and targeted interventional program for specific groups such as men and patients with diabetes to tackle BP control issues among population. Future research should explore longitudinal and interventional approaches to confirm causality and evaluate strategies to enhance BP control. Taken together, the results reinforce the need for comprehensive, patient-centred hypertension management in primary care settings.\u003c/p\u003e"},{"header":"STRENGTH AND LIMITATIONS","content":"\u003cp\u003eThis study was conducted in a primary health clinic setting, reflecting real-world clinical practice and patients’ behaviour. The findings can be generalised to similar public healthcare settings in Malaysia. The socio-demographic profile of respondents closely mimics Malaysian hypertensive population patterns, particularly in age, gender, income, and comorbidities, increasing the relevance and applicability of findings. The Malaysian Medication Adherence Assessment Tool (MyMAAT) used is a validated tool developed locally in 2020 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], culturally and contextually appropriate, enhancing accuracy and reliability. BP control was defined from the average of two measurements 5 minutes apart, with documented HBPM reviewed for those with uncontrolled clinic BP—an approach rarely used. Self-reported and documented HBPM were analysed separately to give greater insight into self-care behaviour. Multiple logistic regression was applied to adjust for confounding variables, improving credibility [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, the cross-sectional design limits causal inference [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], and BP control was assessed at a single point in time, preventing evaluation of long-term trends. Some data (MyMAAT, self-reported HBPM) relied on self-report, introducing recall and social desirability bias. Non-pharmacological factors such as salt intake, physical activity, stress, and sleep were not included, potentially leaving residual confounding. The sample overrepresented Malay respondents (90.9%), limiting generalisability to other ethnic groups, and data were collected from a single clinic, which may not reflect the diversity of healthcare settings in Malaysia.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis study found that the prevalence of good BP control was 41.7%, which remains suboptimal, indicating a gap in achieving therapeutic targets. Significant predictors of good BP control included increasing age, female gender, simpler antihypertensive regimens, absence of diabetes mellitus, and documented HBPM. These findings highlight the need for targeted interventions, particularly for male patients, those with multiple medications, and patients with diabetes. HBPM should be promoted among all hypertensive patients through the use of validated devices, proper training on accurate measurement, and emphasis on documentation. Where feasible, antihypertensive regimens should be simplified to improve adherence. Primary care should focus on personalised management plans, especially for patients with multiple comorbidities. At the policy level, government support or subsidies for home BP monitors, coupled with public education campaigns, may enhance self-monitoring and awareness. Future research should explore factors such as stress, health literacy, and motivation, and conduct multicentre longitudinal studies to improve generalisability and assess causal relationships with BP control.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence Interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHBPM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHome Blood Pressure Monitoring\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNHMS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNational Health Morbidity Survey\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMREC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMedical Review And Ethics Committee\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCPG\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eClinical Practice Guide\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\"\u003eJKEUPM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUniversity Putra Malaysia Ethical Committee\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eJKNM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eJabatan Kesihatan Negeri Melaka\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMYMAAT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMalaysia Medication Adherence Assessment Tool\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMMAS-8\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMorisky Medication Adherence In Malaysian Hypertensive Patients\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHBTS-M\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHill-Bone Compliance To High Blood Pressure Therapy Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInterquartile Range\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMLR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMultiple Logistic Regresssion\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eVIF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVariance Inflation Factor\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOdds Ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by a research grant funded by Servier (Malaysia) Sdn. Bhd., in collaboration with Universiti Putra Malaysia. The sponsor had no role in the study design, data collection, analysis, interpretation of data, or in the writing of the manuscript. The authors would like to thank all participants for their willingness to be involved in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by Medical Review and Ethics Committee (MREC), Ministry of Health Malaysia. The MREC approval was given on 24 May 2024 with NMRR ID: 24-00402-OMQ (IIR). The\u0026nbsp;University Putra Malaysia Ethical Committee (JKEUPM) was also informed regarding this study\u0026nbsp;and conducted in accordance with the Declaration of Helsinki. Written informed consent to participate was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets supporting the conclusions of this article are included within the article and its supplementary files. However, data containing potentially identifiable participant information (such as age, gender, race, education level, income, employment status, and clinical characteristics) are not publicly available. To protect participants\u0026rsquo; privacy, access to these data is restricted in accordance with the requirements of the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia, and the Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia (JKEUPM). Requests for data access may be directed to the Medical Research and Ethics Committee, National Institutes of Health, Ministry of Health Malaysia, Block A, Level 2, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia (Telephone: +603-3362 8398; Email: [email protected]).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by a research grant funded by Servier (Malaysia) Sdn. Bhd., in collaboration with Universiti Putra Malaysia. The sponsor had no role in the design of the study, data collection, analysis, interpretation, or in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eConceptualization:\u003c/strong\u003e AB, AAR\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e AB, AAR, FB\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eData collection:\u003c/strong\u003e AB\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFormal analysis:\u003c/strong\u003e AB, AAR, FB\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eWriting \u0026ndash; original draft:\u003c/strong\u003e AB\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eWriting \u0026ndash; review \u0026amp; editing:\u003c/strong\u003e AB, AAR, FB\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSupervision:\u003c/strong\u003e AAR\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFunding acquisition:\u003c/strong\u003e AAR\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFuchs FD, Whelton PK. 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Oxid Med Cell Longev. 2021;2021:5523516.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs: a systematic review and meta-analysis. Med (Baltim). 2017;96(4):e5641.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChia YC, Devaraj NK, Ching SM, Ooi PB, Chew MT, Chew BN, et al. Relationship of an adherence score with blood pressure control status among patients with hypertension and their determinants: findings from a nationwide blood pressure screening program. J Clin Hypertens. 2021;23(3):638\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSuleiman SZ, Htay MNN, Soe HHK, Low LYC, Alias SH, Yussof S, et al. Association between medication adherence and blood pressure control and factors associated with antihypertensive medication adherence in the Melaka Tengah District: a cross-sectional survey. Malays Fam Physician. 2024;19:56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHosmer DW Jr, Lemeshow S, Sturdivant RX. Applied logistic regression [Internet]. 3rd ed. Hoboken: John Wiley \u0026amp; Sons; 2013 [cited 2025 May 27]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://books.google.com/books?hl=en\u0026amp;lr=\u0026amp;id=bRoxQBIZRd4C\u0026amp;oi=fnd\u0026amp;pg=PR13\u003c/span\u003e\u003cspan address=\"https://books.google.com/books?hl=en\u0026amp;lr=\u0026amp;id=bRoxQBIZRd4C\u0026amp;oi=fnd\u0026amp;pg=PR13\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRead E. What is a cross-sectional study? Advantages, disadvantages, and examples [Internet]. Enago Read. 2020 [cited 2025 May 27]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.read.enago.com/blog/what-is-a-cross-sectional-study-advantages-disadvantages-and-examples/\u003c/span\u003e\u003cspan address=\"https://www.read.enago.com/blog/what-is-a-cross-sectional-study-advantages-disadvantages-and-examples/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\n\u003cp\u003eTables 1 to 6 are available in the Supplementary Files section.\u003c/p\u003e\n"}],"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-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"hypertension, blood pressure control, anti-hypertensive, home blood pressure monitoring, medication adherence, predictors","lastPublishedDoi":"10.21203/rs.3.rs-7499416/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7499416/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eGood blood pressure (BP) control in hypertensive patients is essential in reducing the risk of cardiovascular diseases. Even a slight reduction in BP may significantly improve cardiovascular outcomes. Several factors have been associated with good BP control. We aimed to determine the prevalence of good BP control among hypertensive patients and its associated factors in a Malaysian primary health clinic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e A cross-sectional study was conducted among Malaysian adults aged 18 years and above with underlying hypertension who attended a public healthcare clinic located in a suburban area of Melaka, Malaysia, from December 2024 to February 2025. Participants were selected via systematic random sampling. Data were collected through self-administered questionnaires, medical records, and blood pressure levels, including both clinical blood pressure measurements and documented home blood pressure monitoring. BP control was categorized based on patients' co-morbidities as recommended by the Malaysian Clinical Practice Guideline. A multiple logistic regression was conducted to determine the factors associated with good blood pressure control.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 460 hypertensive patients were included in this study, with a response rate of 96.8%.\u003cstrong\u003e \u003c/strong\u003eOnly 41.5% of the participants (n=191) had good BP control. The median age was 64 (IQR:17) and the majority were female (57.4%, n=264). The significant factors associated with good blood pressure control among the study population were increasing age (aOR=1.038, 95% CI [1.018,1.057], p\u0026lt;0.001), females gender (aOR=2.103, 95% CI [1.395,3.171], p\u0026lt;0.001), participants who took one and two anti-hypertensive (aOR=1.922, 95% CI [1.146,3.226],p=0.013) and (aOR=2.822, 95% CI [1.632,4.881], p\u0026lt;0.001) respectively, participants without diabetes (aOR=1.685, 95% CI [1.109,2.560], p=0.015), and participant who had documented Home BP Monitoring (HBPM) (aOR=4.650, 95% CI [2.397,9.022], p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe findings suggest that the prevalence of good blood pressure control, 41.5% is still low among the study population. Factors associated with good Blood pressure control include increasing age, female gender, patients on fewer than three antihypertensive medications, hypertensive patients without diabetes mellitus, and those who have documented home blood pressure monitoring, even after controlling for confounders.\u003c/p\u003e","manuscriptTitle":"Prevalence and Factors Associated With Good Blood Pressure Control Among Hypertensive Patients in a Malaysian Primary Health Clinic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 19:08:07","doi":"10.21203/rs.3.rs-7499416/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-13T03:37:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T13:28:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T11:39:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-08T09:02:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93066278522780347029608051617519972625","date":"2026-02-04T14:44:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"275803163243869355898170910763846482363","date":"2026-02-01T11:01:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"114517302170227719878595569281143271609","date":"2026-01-30T13:09:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"323482068229612787060123489652588853253","date":"2025-11-20T01:36:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227787532900282544039523336432461396476","date":"2025-11-09T04:48:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-10T06:59:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-09T04:33:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-04T08:24:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-04T08:22:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2025-08-31T08:40:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d225208-21cd-4c3a-9a68-aa283d67df19","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-16T06:10:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 19:08:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7499416","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7499416","identity":"rs-7499416","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}