Hypertension and quality of life among Afghan type-2 diabetic patients: A cross-sectional study

Hypertension and quality of life among Afghan type-2 diabetic patients: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Hypertension and quality of life among Afghan type-2 diabetic patients: A cross-sectional study Mohammad Naser Naseri, Bilal Ahmad Rahimi, Nosaibah Razaqi, Mehrab Neyazi, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7433783/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The main objectives of this study were to study the prevalence and associated factors of hypertension and quality of life among DM outpatients in the Herat province of Afghanistan. Methods: In this cross-sectional study, a total of 351 diabetic hospitalized patients were studied between January–June 2024. Health-related quality of life among diabetic patients was assessed using the World Health Organization Quality of Life (WHOQOL-BREF-26) questionnaire. Data were analyzed by using descriptive statistics, Chi-square tests, and multiple regression analysis. A two-tailed p-value below 0.05 was considered statistically significant. Results: The majority of patients were aged ³50 years (59.3%), females (61.5%), illiterate (64.7%), and having low income (74.9%). Among these patients, 63.0% were overweight/obese and 51.0% experienced a significant negative event in the past month. The prevalence of hypertension among DM patients was 62.4%. Statistically significant factors associations with hypertension among DM patients were having >5 children, having low economic status, being overweight/obese, and experiencing a negative event in the past month. Regarding the quality of life domains, 80.3%, 59.8%, 27.4%, and 53.8% of the study participants demonstrated low quality of life in the physical, psychological, social, and environmental domains, respectively. Conclusion: The high prevalence of hypertension and poor quality of life among diabetic patients in Herat highlight the urgent need for integrated management strategies that address both blood pressure control and psychosocial well-being. Strengthening hospital-based screening, improving access to antihypertensive treatment, and implementing targeted interventions to improve quality of life could reduce the burden of diabetes-related complications in this population. Hypertension Diabetes Mellitus Type 2 Outpatients Quality of Life Afghanistan Cross-Sectional Studies Figures Figure 1 Introduction Diabetes mellitus (DM) is a chronic metabolic disease. Globally, the prevalence of DM has increased from 200 million people in 1990 to 830 million in 2022, the majority living in low- and middle-income countries. In 2021, more than two million people globally died due to DM (World Health Organization, 2024 ). Hypertension is a condition in which the blood pressure (BP) of a person is abnormally high, i.e., systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg (Chobanian et al., 2003 )(Haile et al., 2023 ). Globally, approximately 1.28 billion adults aged 30–79 years are suffering from hypertension, with two-thirds of these patients living in low- and middle-income countries. Nearly half (46%) of the adults with hypertension are unaware that they have hypertension (World Health Organization, 2023 ). Several studies from countries with healthcare systems and sociodemographic profiles comparable to Afghanistan report high burden of hypertension among people with type-2 diabetes and substantial impairments in health-related quality of life (HRQoL). Studies in Iran have documented important gaps in diabetes self-management and suboptimal control of cardiovascular risk factors among disadvantaged populations, including slum dwellers, which contributes to elevated risk of hypertension and poor HRQoL (Ghammari et al., 2024 ) (Ghammari et al., 2023 ). Hypertension among DM patients is a global public health challenge and one of the main modifiable risk factors for other cardiovascular diseases and death (Lopez-Jaramillo et al., 2014 ). The prevalence of hypertension among type 2 DM patients is 32% to 82%, i.e., higher than that of age- and sex-matched patients without DM (Baskar et al., 2006 ). Meanwhile, compared to other cardiovascular disorders, hypertension is the most common comorbidity among DM patients (Kahya Eren et al., 2014 ). In general, the quality of life (QoL) decreases in DM patients regardless of gender (Jorgetto et al., 2018). Patients with complications of DM suffer from different types of lifestyle problems. Finally, it affects the renal system by causing nephropathy, loss of vision, cardiac disorders, erectile dysfunction, and peripheral neuropathies which negatively affect the QoL (Prajapati et al., 2017 ). Although there are few published articles from Afghanistan on hypertension (Saeed, 2017a )(Rahimi, Hemat, et al., 2020 ) and DM (Saeed, 2017b )(Rahimi, Mako, et al., 2020 ) separately, to our knowledge, only two researches have been published where hypertension is studied among DM patients, i.e., one is from Kabul (the capital city of Afghanistan) (Naseri et al., 2022 ) and the other from Southern Afghanistan (Kandahar and Lashkar Gah cities) (Stanikzai et al., 2025 ). Understanding the prevalence and determinants of hypertension and quality of life among outpatients with diabetes is essential for developing effective outpatient management programs and reducing long-term complications. However, there is no published study from the entire Western Afghanistan. Also, no published study from the entire Afghanistan has studied hypertension and quality of life among diabetic outpatients. Therefore, the main objectives of this study were to study the prevalence and associated factors of hypertension and quality of life among diabetic outpatients in the Herat province of Afghanistan. Materials and Methods Study Design, Participants, and Procedure A cross-sectional study was conducted between January 1 and June 30, 2024, in Herat province, Afghanistan. The study population comprised adult patients with a confirmed diagnosis of type-2 diabetes mellitus who were visited hospitals during the study period. A convenience cluster sampling approach was used, where clusters were defined as hospitals. Three major public hospitals in Herat province were purposefully selected because they provide the majority of diabetes-related outpatient care in the region. Within these hospitals, all eligible diabetic outpatients present during the data collection shifts were invited to participate, ensuring consecutive recruitment to minimize selection bias. Eligibility criteria included: (1) confirmed diagnosis of type-2 diabetes mellitus (verified via medical records), (2) hospitalization within the selected hospitals, and (3) provision of written informed consent. Patients who were critically ill, pregnant, or unable to communicate were excluded. Of the 400 eligible patients approached, 351 consented and completed the questionnaire, yielding a response rate of 87.8%. Data collection was conducted through structured, interviewer-administered questionnaires, and trained data collectors followed standardized procedures to ensure reliability and completeness. Measures The study questionnaire comprised three sections: sociodemographic information, blood pressure measurement, and quality of life assessment. Sociodemographic data included information on age group, gender, marital status, residency, total number of children, education level, economic status, and body mass index (BMI) category. Participants were also asked about the occurrence of any adverse event in the past month, defined as any incident that had a negative impact on their mental well-being (e.g., family conflict, financial crisis, loss of a loved one). Responses were recorded as “yes” or “no.” Health-related quality of life among diabetic patients was assessed using the World Health Organization Quality of Life (WHOQOL-BREF-26) questionnaire. This validated instrument evaluates four key domains of quality of life: physical health, psychological well-being, social relationships, and environmental factors. Each item is rated on a 5-point Likert scale, with higher scores indicating better quality of life. The total scores for each domain were categorized into low, moderate, and high quality of life based on standard WHOQOL-BREF guidelines. The internal consistency of the instrument, as reflected by Cronbach’s alpha, was 0.86 in the present study. Blood pressure measurements were obtained twice for each participant using a calibrated sphygmomanometer in the standard sitting position after at least 5 minutes of rest. The first measurement was taken before the interview and the second measurement after the interview, and the mean of these two readings was used as the final blood pressure value. Participants were classified as hypertensive if they had a systolic blood pressure of ≥ 140 mmHg, a diastolic blood pressure of ≥ 90 mmHg, or both. All participants were not on antihypertensive treatment, and none had pharmacologically controlled blood pressure during the study period. Statistical Analysis Data were entered into Microsoft Excel 2016 and analyzed using IBM SPSS version 26.0 for Windows. Descriptive statistics (mean, standard deviation, frequency, and percentage) were used to summarize participant characteristics. Associations between categorical variables (e.g., hypertension status and sociodemographic factors) were assessed using Pearson’s Chi-square test. To identify independent predictors of hypertension, a multiple logistic regression model was constructed. Variables with a p-value < 0.05 in bivariate analysis and clinically important factors (age, sex, BMI, income status) were included in the initial model. Backward stepwise selection was applied to derive the final model, and adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported. A p-value < 0.05 was considered statistically significant. All participants were interviewed in person, and questionnaires were completed in full. There were no missing data for any of the study variables. Results A total of 351 diabetic patients participated in the study, with the majority aged 50–95 years (59.3%) and females (61.5%). Most were married (83.5%) and resided in urban areas (62.1%). Nearly half had more than five children (49.6%), and a significant proportion were illiterate (64.7%), with only 6.0% having attained university education. Economic status was predominantly low, with 74.9% classified as low-income. In terms of BMI, 43.9% were overweight, 19.1% were obese, 33.6% had normal weight, and 3.4% were underweight. Additionally, 51.0% of participants reported experiencing a significant negative event in the past month. [ Table 1 ] Table 1 Characteristics distribution of the study participants (n = 351). Characteristic Categories Frequency (n) Percentage (%) Age group 18–49 years 50–95 years 143 208 40.7 59.3 Gender Male Female 135 216 38.5 61.5 Marital status Single Married Widow/divorced 3 293 55 0.9 83.5 15.7 Residency Urban Rural 218 133 62.1 37.9 Total number of children None 1–5 > 5 11 166 174 3.1 47.3 49.6 Education Illiterate Primary school Secondary school High school University 227 63 18 22 21 64.7 17.9 5.1 6.3 6.0 Economic status High-income Middle-income Low-income 11 77 263 3.2 21.9 74.9 BMI Underweight Normal weight Overweight Obesity 12 118 154 67 3.4 33.6 43.9 19.1 Bad event occurring in the past month Yes No 179 172 51.0 49.0 Regarding the quality of life domains, the physical domain showed the highest proportion of participants in the low category (80.3%), with only 14.0% and 5.7% in the moderate and high categories, respectively. In the psychological domain, 59.8% of participants reported a low quality of life, while 29.6% and 10.5% had moderate and high scores, respectively. The social domain demonstrates a more even distribution, with 27.4% in the low category, 31.6% in the moderate, and 41.0% in the high category. The environment domain follows a similar pattern, with 53.8% of participants reporting a low quality of life, 41.3% moderate, and only 4.8% high. [ Figure 1 ] Hypertension was prevalent in 62.4% of participants, with no significant association observed with age ( p -value = 0.618), gender ( p -value = 0.236), marital status ( p -value = 0.520), residency ( p -value = 0.254), or education level ( p -value = 0.548). However, significant associations were found between hypertension and the number of children ( p -value = 0.031), economic status ( p -value = 0.029), BMI ( p -value = 0.018), and experiencing a negative event in the past month ( p -value = 0.013). Participants with more than five children (66.1%) and those from low-income backgrounds (65.0%) had a higher prevalence of hypertension. Additionally, overweight (66.9%) and obese (71.6%) individuals exhibited higher hypertension rates compared to those with normal weight (53.4%) or underweight (41.7%). Furthermore, those who experienced a significant negative event in the past month had a higher prevalence of hypertension (68.7%) compared to those who did not (55.8%). [ Table 2 ] Table 2 Association of hypertension with sociodemographic characteristics of the study participation (n = 351). Characteristic Categories Blood Pressure p -value Normotensive Hypertensive N (%) N (%) Age group 18–49-years 50–95-years 56 (39.2) 76 (36.5) 87 (60.8) 132 (63.5) 0. 618 Gender Male Female 56 (41.5) 76 (35.2) 79 (58.5) 140 (64.8) 0.236 Marital status Single Married Widow/divorced 2 (66.7) 111 (37.9) 19 (34.5) 1 (33.3) 182 (62.1) 36 (65.5) 0.520 Residency Urban Rural 87 (39.9) 45 (33.8) 131 (60.1) 88 (66.2) 0.254 Total number of children None 1–5 > 5 8 (82.7) 65 (39.2) 59 (33.9) 3 (27.3) 101 (60.8) 115 (66.1) 0.031 Education Illiterate Primary school Secondary school High school University 90 (39.6) 22 (34.9) 6 (33.3) 5 (22.7) 9 (42.9) 137 (60.4) 41 (65.1) 12 (66.7) 17 (77.3) 12 (57.1) 0.548 Economic status High-income Middle-income Low-income 8 (72.7) 32 (41.6) 92 (35.0) 3 (27.3) 45 (58.4) 171 (65.0) 0.029 BMI Underweight Normal weight Overweight Obesity 7 (58.3) 55 (46.6) 51 (33.1) 19 (28.4) 5 (41.7) 63 (53.4) 103 (66.9) 48 (71.6) 0.018 Bad event occurring in the past month Yes No 56 (31.3) 76 (44.2) 123 (68.7) 96 (55.8) 0.013 Total 132 (37.6) 219 (62.4) No significant associations were observed between hypertension and overall self-rated quality of life ( p -value = 0.430), health satisfaction ( p -value = 0.654), or physical ( p -value = 0.068), psychological ( p -value = 0.710), and environmental ( p -value = 0.630) quality of life domains. However, a significant association was found in the social relationship domain ( p -value = 0.040), where individuals with low social relationship scores had a lower prevalence of hypertension (52.1%) compared to those with moderate (64.0%) and high (68.1%) scores. [ Table 3 ] Table 3 Association of quality of life with the presence of hypertension in the study participants (n = 351). Quality of life Categories Blood Pressure p -value Normotensive Hypertensive N (%) N (%) How would you rate your quality of life? Very poor Poor Neither poor nor good Good Very good 14 (35.0) 35 (33.7) 44 (36.4) 38 (46.3) 1 (25.0) 26 (65.0) 69 (66.3) 77 (63.6) 44 (53.7) 3 (75.0) 0.430 How satisfied are you with your health? Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied 9 (26.5) 49 (38.6) 48 (38.4) 25 (41.0) 1 (25.0) 25 (73.5) 78 (61.4) 77 (61.6) 36 (59.0) 3 (75.0) 0.654 Physical domain Low Moderate High 98 (34.8) 23 (46.9) 11 (55.0) 184 (65.2) 26 (53.1) 9 (45.0) 0.068 Psychological domain Low Moderate High 79 (37.6) 37 (35.6) 16 (43.2) 131 (62.4) 67 (64.4) 21 (56.8) 0.710 Social relationship domain Low Moderate High 46 (47.9) 40 (36.0) 46 (31.9) 50 (52.1) 71 (64.0) 98 (68.1) 0.040 Environment domain Low Moderate High 68 (36.0) 56 (38.6) 8 (47.1) 121 (64.0) 89 (61.4) 9 (52.9) 0.630 Total 132 (37.6) 219 (62.4) Discussion In this study, 80.3%, 59.8%, 27.4%, and 53.8% of the patients demonstrated low quality of life in the physical, psychological, social, and environmental domains, respectively. Increased chances of hypertension were present in DM patients with moderate and high social relationship scores. In a study conducted among 609 DM patients in Kandahar and Lashkar Gah cities of Southern Afghanistan, the prevalence of hypertension among DM patients was 55.3%. The main factors associated with hypertension among DM patients were female gender (adjusted odds ratio [AOR] 1.73, 95% CI 1.09–2.74), aged ≥ 50 years (AOR 4.35, 95%CI 2.78–2.6.81), having diabetes for ³5 years (AOR 2.13, 95%CI 1.37–3.31), poor glycemic control (AOR 1.80, 95%CI 1.18–2.75), and presence of depressive symptoms (AOR 3.25, 95%CI 2.59–4.80) (Stanikzai et al., 2025). In a cross-sectional study conducted among 321 DM patients in Kabul city of Afghanistan, the prevalence of hypertension among DM patients was 70.5%. hypertension was more prevalent in women (76.8%), with mean systolic and diastolic blood pressures of 146.9 mmHg and 89.6 mmHg, respectively. Moreover, the mean duration of DM, HbA1c values, and body mass index (BMI) of the study participants were 7.1 years, 9.3%, and 28.8, respectively (Naseri et al., 2022). A hospital-based cross-sectional study conducted in Al-Kharj, Saudi Arabia, among 1178 diabetic patients revealed that the prevalence of uncontrolled hypertension among DM patients was 71.8%. The main factors associated with uncontrolled hypertension were age >65 years (OR 2.0, 95%CI 1.1–3.8), male gender (OR 1.5, 95%CI 1.0–2.2), and obesity (OR 2.4, 95%CI 1.6–3.5) (Almalki et al., 2020). In Southwest Ethiopia, a hospital-based cross-sectional study was conducted among 366 DM patients. The prevalence of hypertension among DM patients was 37.4%. The main factors associated with hypertension among DM patients were age ≥50 years (AOR 4.8, 95% CI 1.4–16.4], overweight/obese (AOR 3.1, 95% CI 1.6–6.1), and khat chewing (AOR 19.3, 95% CI 10.3–36.4) (Abdissa et al, 2020). In the current study, overweight/obesity was a statistically significant risk factor for hypertension among DM patients. This finding is in agreement with the existing literature showing the higher probability of hypertension among obese adults (Dua et al., 2014)(Drøyvold et al., 2005)(Chorin et al., 2015)(Abebe et al., 2015). In the literature, the association between obesity and hypertension is poorly understood, i.e., mechanisms through which obesity directly causes hypertension and increases disease progression are complex and have still been intensively studied (Hall et al., 2000)(Haynes et al., 1997)(Kotsis et al., 2010). However, fortunately, obesity among adult DM patients can be controlled by designing an effective prevention plan, such as increasing public health awareness and encouraging DM patients to bring lifestyle changes, including specific diet and exercise recommendations, which could help in decreasing weight and raise their levels of blood pressure control. In Bantul, Indonesia, a cross-sectional study was conducted to evaluate the level of adherence and quality of life of 143 DM patients with hypertension. For measuring the level of treatment adherence, the Modified Morisky Medication Adherence Scale was used, while the SF36 questionnaire was used to measure the quality of life. The majority (76.3%) of respondents had moderate (39.2%) and low (37.1%) levels of adherence. The mean score of quality of life was 61.96±12.48. Relatively low medication adherence and quality of life were observed among DM patients with hypertension. DM patients who were male and college-educated had higher medication adherence (OR >1, p -value <0.05) (Akrom & Anggitasari, 2019). This study had a few limitations. First, data for this study was collected from Herat province only, one of the 34 provinces of Afghanistan. So, we cannot generalize our results to the diabetic patients of the entire Afghanistan. Second, we collected data through face-to-face interviews. Therefore, there are more chances of recall bias. Third, we did not include many important associated factors, such as the presence of comorbidities of diabetes mellitus, duration of the T2DM, complications of T2DM, and HbA1c levels of the study participants. Fourth, it was a cross-sectional study. So, the nature of the data did not allow for causal inferences regarding associated factors that might affect the prevalence of hypertension among DM patients. Fifth, due to very limited funding for this study, we could not assess dyslipidemia, a potential risk factor for hypertension among DM patients, in our study participants. Conclusion and recommendation The results of this study are important and give useful information in order to guide policymakers for policies and interventions on hypertension among patients with diabetes who have been lacking adequate care. There is a high prevalence of hypertension and low quality of life among DM patients in Herat province of Afghanistan. Factors associated with depression were being female, having low economic status, and having had a bad event in the past month. The main factors associated with hypertension among DM patients were having >5 children, having low economic status, being overweight/obese, and experiencing a negative event in the past month. Meanwhile, increased chances of hypertension were present in DM patients with moderate and high social relationship scores. The findings of this study suggest that while most quality-of-life aspects were not significantly associated with hypertension, social relationships may play a role in its prevalence among diabetic patients. It is highly recommended that all diabetic patients who seek medical contact should be screened for hypertension and its complications as well as quality of life. Afghanistan Ministry of Public Health, as well as international donor agencies such as WHO and UNICEF, should work in collaboration to design appropriate preventive strategies targeting the modifiable risk factors associated with hypertension. There is an intense need for more studies, especially prospective cohort studies with larger sample sizes, to be conducted in all 34 provinces of Afghanistan (both rural and urban areas) to find out the real burden and risk factors of hypertension among DM patients in the Afghan population. Future studies should also investigate other factors that predispose DM patients to hypertension, such as dyslipidemia, medication adherence, dietary patterns, concomitant medical conditions, and corticosteroid use. Declarations Acknowledgment We are cordially thankful to the officials and personnel of all the hospitals of Herat Province who helped us in this research. We are also grateful to all the study participants for their cooperation and participation in our study. Ethical approval and consent to participate The current research received ethical approval from the Ethical Committee of the Afghanistan Center for Epidemiological Studies, with the assigned reference number #23.1.017. Before engaging participants, the study's aims and procedures were thoroughly elucidated. Written informed consent was secured from all participants prior to their inclusion, and they were explicitly informed of their right to withdraw from the study at any point without consequence. All methodologies and processes were conducted in strict compliance with applicable ethical principles and regulatory frameworks. Conflict of interest The authors assert that there are no conflicts of interest to disclose. Author contributions MNN designed the study. MNN contributed to the data collection of this study. AN analyzed the data. BAR, NR, MN, NAK, PA, KI and AN prepared the draft of the manuscript. AN critically reviewed, rewrote, edited, and finalized the manuscript. All authors reviewed the manuscript. Funding This research received no external funding. Consent for publication Not applicable. Clinical trial number Not applicable. Data availability The datasets utilized and/or analyzed in the course of the present study are accessible from the corresponding author upon reasonable inquiry. References Abdissa, D., & Kene, K. (2020). Prevalence and Determinants of Hypertension Among Diabetic Patients in Jimma University Medical Center, Southwest Ethiopia, 2019. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy , 13 , 2317–2325. https://doi.org/10.2147/DMSO.S255695 Abebe, S. M., Berhane, Y., Worku, A., & Getachew, A. (2015). Prevalence and associated factors of hypertension: A crossectional community based study in northwest ethiopia. 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Prevalence of hypertension in Type-2 diabetes mellitus. Annals of Medicine and Surgery , 78 , 103758. https://doi.org/10.1016/j.amsu.2022.103758 Prajapati, V., Blake, R., Acharya, L., & Seshadri, S. (2017). Assessment of quality of life in type II diabetic patients using the modified diabetes quality of life (MDQOL)-17 questionnaire. Brazilian Journal of Pharmaceutical Sciences , 53 (4), e17144. https://doi.org/10.1590/s2175-97902017000417144 Rahimi, B., Hemat, M., Rahimy, N., Rafiqi, N., & Kakar, M. (2020). Determinants of Uncontrolled Hypertension Among Hypertensive Patients in Kandahar, Afghanistan. Online J Health Allied Scs , 19 (2), 7. Rahimi, B., Mako, M., Rahimy, N., & Wasiq, A. (2020). Uncontrolled type 2 diabetes mellitus in Kandahar, Afghanistan: A cross-sectional analytical study. Clinical Diabetology , 9 (6), 416–425. https://doi.org/10.5603/DK.2020.0053 Saeed, K. M. I. (2017a). Burden of Hypertension in the Capital of Afghanistan: A Cross-Sectional Study in Kabul City, 2015. International Journal of Hypertension , 2017 (1), 3483872. https://doi.org/10.1155/2017/3483872 Saeed, K. M. I. (2017b). Diabetes Mellitus Among Adults in Herat, Afghanistan: A Cross-Sectional Study. Central Asian Journal of Global Health , 6 (1), 271. https://doi.org/10.5195/cajgh.2017.271 Stanikzai, M. H., Amirzada, M. E., Ishaq, N., Kamil, K. A., Anwary, Z., Farzad, A., Baray, A. H., & Sayam, H. (2025). Prevalence of Hypertension and Its Associated Factors Among Patients with Type 2 Diabetes in Southern Afghanistan: A Multi-Center Cross-Sectional Study. Diabetes, Metabolic Syndrome and Obesity , 18 , 715–725. https://doi.org/10.2147/DMSO.S503725 World Health Organization. (2023). Hypertension . World Health Organization. https://www.who.int/news-room/fact-sheets/detail/hypertension World Health Organization. (2024). Diabetes . World Health Organization. https://www.who.int/news-room/fact-sheets/detail/diabetes Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7433783","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":523722616,"identity":"8e9fb61d-06d0-4e4b-8eae-1fa2e03b5c38","order_by":0,"name":"Mohammad Naser Naseri","email":"","orcid":"","institution":"Herat Regional Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Naser","lastName":"Naseri","suffix":""},{"id":523722617,"identity":"15fcd16a-932f-4efc-bfa9-f72990f4a543","order_by":1,"name":"Bilal Ahmad Rahimi","email":"","orcid":"","institution":"Kandahar 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1","display":"","copyAsset":false,"role":"figure","size":64599,"visible":true,"origin":"","legend":"\u003cp\u003eDomains of the quality of life in the study participants (n=351).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7433783/v1/6e0975adf5adce044bf559af.png"},{"id":98423656,"identity":"07378e3f-0e06-4f42-a8ab-38c67286cf60","added_by":"auto","created_at":"2025-12-17 16:32:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":867051,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7433783/v1/471da8d8-d0e9-47ca-b0fb-5400b8d11469.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Hypertension and quality of life among Afghan type-2 diabetic patients: A cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDiabetes mellitus (DM) is a chronic metabolic disease. Globally, the prevalence of DM has increased from 200\u0026nbsp;million people in 1990 to 830\u0026nbsp;million in 2022, the majority living in low- and middle-income countries. In 2021, more than two million people globally died due to DM (World Health Organization, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHypertension is a condition in which the blood pressure (BP) of a person is abnormally high, i.e., systolic BP\u0026thinsp;\u0026ge;\u0026thinsp;140 mmHg and/or diastolic BP\u0026thinsp;\u0026ge;\u0026thinsp;90 mmHg (Chobanian et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2003\u003c/span\u003e)(Haile et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Globally, approximately 1.28\u0026nbsp;billion adults aged 30\u0026ndash;79 years are suffering from hypertension, with two-thirds of these patients living in low- and middle-income countries. Nearly half (46%) of the adults with hypertension are unaware that they have hypertension (World Health Organization, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSeveral studies from countries with healthcare systems and sociodemographic profiles comparable to Afghanistan report high burden of hypertension among people with type-2 diabetes and substantial impairments in health-related quality of life (HRQoL). Studies in Iran have documented important gaps in diabetes self-management and suboptimal control of cardiovascular risk factors among disadvantaged populations, including slum dwellers, which contributes to elevated risk of hypertension and poor HRQoL (Ghammari et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) (Ghammari et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHypertension among DM patients is a global public health challenge and one of the main modifiable risk factors for other cardiovascular diseases and death (Lopez-Jaramillo et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The prevalence of hypertension among type 2 DM patients is 32% to 82%, i.e., higher than that of age- and sex-matched patients without DM (Baskar et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Meanwhile, compared to other cardiovascular disorders, hypertension is the most common comorbidity among DM patients (Kahya Eren et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn general, the quality of life (QoL) decreases in DM patients regardless of gender (Jorgetto et al., 2018). Patients with complications of DM suffer from different types of lifestyle problems. Finally, it affects the renal system by causing nephropathy, loss of vision, cardiac disorders, erectile dysfunction, and peripheral neuropathies which negatively affect the QoL (Prajapati et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough there are few published articles from Afghanistan on hypertension (Saeed, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017a\u003c/span\u003e)(Rahimi, Hemat, et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and DM (Saeed, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2017b\u003c/span\u003e)(Rahimi, Mako, et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) separately, to our knowledge, only two researches have been published where hypertension is studied among DM patients, i.e., one is from Kabul (the capital city of Afghanistan) (Naseri et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and the other from Southern Afghanistan (Kandahar and Lashkar Gah cities) (Stanikzai et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Understanding the prevalence and determinants of hypertension and quality of life among outpatients with diabetes is essential for developing effective outpatient management programs and reducing long-term complications. However, there is no published study from the entire Western Afghanistan. Also, no published study from the entire Afghanistan has studied hypertension and quality of life among diabetic outpatients. Therefore, the main objectives of this study were to study the prevalence and associated factors of hypertension and quality of life among diabetic outpatients in the Herat province of Afghanistan.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design, Participants, and Procedure\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted between January 1 and June 30, 2024, in Herat province, Afghanistan. The study population comprised adult patients with a confirmed diagnosis of type-2 diabetes mellitus who were visited hospitals during the study period. A convenience cluster sampling approach was used, where clusters were defined as hospitals. Three major public hospitals in Herat province were purposefully selected because they provide the majority of diabetes-related outpatient care in the region. Within these hospitals, all eligible diabetic outpatients present during the data collection shifts were invited to participate, ensuring consecutive recruitment to minimize selection bias. Eligibility criteria included: (1) confirmed diagnosis of type-2 diabetes mellitus (verified via medical records), (2) hospitalization within the selected hospitals, and (3) provision of written informed consent. Patients who were critically ill, pregnant, or unable to communicate were excluded. Of the 400 eligible patients approached, 351 consented and completed the questionnaire, yielding a response rate of 87.8%. Data collection was conducted through structured, interviewer-administered questionnaires, and trained data collectors followed standardized procedures to ensure reliability and completeness.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eThe study questionnaire comprised three sections: sociodemographic information, blood pressure measurement, and quality of life assessment. Sociodemographic data included information on age group, gender, marital status, residency, total number of children, education level, economic status, and body mass index (BMI) category. Participants were also asked about the occurrence of any adverse event in the past month, defined as any incident that had a negative impact on their mental well-being (e.g., family conflict, financial crisis, loss of a loved one). Responses were recorded as \u0026ldquo;yes\u0026rdquo; or \u0026ldquo;no.\u0026rdquo;\u003c/p\u003e\u003cp\u003eHealth-related quality of life among diabetic patients was assessed using the World Health Organization Quality of Life (WHOQOL-BREF-26) questionnaire. This validated instrument evaluates four key domains of quality of life: physical health, psychological well-being, social relationships, and environmental factors. Each item is rated on a 5-point Likert scale, with higher scores indicating better quality of life. The total scores for each domain were categorized into low, moderate, and high quality of life based on standard WHOQOL-BREF guidelines. The internal consistency of the instrument, as reflected by Cronbach\u0026rsquo;s alpha, was 0.86 in the present study.\u003c/p\u003e\u003cp\u003eBlood pressure measurements were obtained twice for each participant using a calibrated sphygmomanometer in the standard sitting position after at least 5 minutes of rest. The first measurement was taken before the interview and the second measurement after the interview, and the mean of these two readings was used as the final blood pressure value. Participants were classified as hypertensive if they had a systolic blood pressure of \u0026ge;\u0026thinsp;140 mmHg, a diastolic blood pressure of \u0026ge;\u0026thinsp;90 mmHg, or both. All participants were not on antihypertensive treatment, and none had pharmacologically controlled blood pressure during the study period.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were entered into Microsoft Excel 2016 and analyzed using IBM SPSS version 26.0 for Windows. Descriptive statistics (mean, standard deviation, frequency, and percentage) were used to summarize participant characteristics. Associations between categorical variables (e.g., hypertension status and sociodemographic factors) were assessed using Pearson\u0026rsquo;s Chi-square test. To identify independent predictors of hypertension, a multiple logistic regression model was constructed. Variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in bivariate analysis and clinically important factors (age, sex, BMI, income status) were included in the initial model. Backward stepwise selection was applied to derive the final model, and adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. All participants were interviewed in person, and questionnaires were completed in full. There were no missing data for any of the study variables.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 351 diabetic patients participated in the study, with the majority aged 50\u0026ndash;95 years (59.3%) and females (61.5%). Most were married (83.5%) and resided in urban areas (62.1%). Nearly half had more than five children (49.6%), and a significant proportion were illiterate (64.7%), with only 6.0% having attained university education. Economic status was predominantly low, with 74.9% classified as low-income. In terms of BMI, 43.9% were overweight, 19.1% were obese, 33.6% had normal weight, and 3.4% were underweight. Additionally, 51.0% of participants reported experiencing a significant negative event in the past month. \u003cb\u003e[\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e]\u003c/b\u003e\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\u003eCharacteristics distribution of the study participants (n\u0026thinsp;=\u0026thinsp;351).\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=\"char\" char=\".\" 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\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;49 years\u003c/p\u003e\u003cp\u003e50\u0026ndash;95 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e143\u003c/p\u003e\u003cp\u003e208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.7\u003c/p\u003e\u003cp\u003e59.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\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=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e135\u003c/p\u003e\u003cp\u003e216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.5\u003c/p\u003e\u003cp\u003e61.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003cp\u003eMarried\u003c/p\u003e\u003cp\u003eWidow/divorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e293\u003c/p\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003cp\u003e83.5\u003c/p\u003e\u003cp\u003e15.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e218\u003c/p\u003e\u003cp\u003e133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.1\u003c/p\u003e\u003cp\u003e37.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal number of children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003cp\u003e1\u0026ndash;5\u003c/p\u003e\u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e166\u003c/p\u003e\u003cp\u003e174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.1\u003c/p\u003e\u003cp\u003e47.3\u003c/p\u003e\u003cp\u003e49.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003cp\u003eSecondary school\u003c/p\u003e\u003cp\u003eHigh school\u003c/p\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e227\u003c/p\u003e\u003cp\u003e63\u003c/p\u003e\u003cp\u003e18\u003c/p\u003e\u003cp\u003e22\u003c/p\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64.7\u003c/p\u003e\u003cp\u003e17.9\u003c/p\u003e\u003cp\u003e5.1\u003c/p\u003e\u003cp\u003e6.3\u003c/p\u003e\u003cp\u003e6.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomic status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh-income\u003c/p\u003e\u003cp\u003eMiddle-income\u003c/p\u003e\u003cp\u003eLow-income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e77\u003c/p\u003e\u003cp\u003e263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.2\u003c/p\u003e\u003cp\u003e21.9\u003c/p\u003e\u003cp\u003e74.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnderweight\u003c/p\u003e\u003cp\u003eNormal weight\u003c/p\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003cp\u003eObesity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003cp\u003e118\u003c/p\u003e\u003cp\u003e154\u003c/p\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.4\u003c/p\u003e\u003cp\u003e33.6\u003c/p\u003e\u003cp\u003e43.9\u003c/p\u003e\u003cp\u003e19.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBad event occurring in the past month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e179\u003c/p\u003e\u003cp\u003e172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51.0\u003c/p\u003e\u003cp\u003e49.0\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\u003eRegarding the quality of life domains, the physical domain showed the highest proportion of participants in the low category (80.3%), with only 14.0% and 5.7% in the moderate and high categories, respectively. In the psychological domain, 59.8% of participants reported a low quality of life, while 29.6% and 10.5% had moderate and high scores, respectively. The social domain demonstrates a more even distribution, with 27.4% in the low category, 31.6% in the moderate, and 41.0% in the high category. The environment domain follows a similar pattern, with 53.8% of participants reporting a low quality of life, 41.3% moderate, and only 4.8% high. \u003cb\u003e[\u003c/b\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e]\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eHypertension was prevalent in 62.4% of participants, with no significant association observed with age (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.618), gender (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.236), marital status (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.520), residency (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.254), or education level (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.548). However, significant associations were found between hypertension and the number of children (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.031), economic status (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.029), BMI (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.018), and experiencing a negative event in the past month (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.013). Participants with more than five children (66.1%) and those from low-income backgrounds (65.0%) had a higher prevalence of hypertension. Additionally, overweight (66.9%) and obese (71.6%) individuals exhibited higher hypertension rates compared to those with normal weight (53.4%) or underweight (41.7%). Furthermore, those who experienced a significant negative event in the past month had a higher prevalence of hypertension (68.7%) compared to those who did not (55.8%). \u003cb\u003e[\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e]\u003c/b\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\u003eAssociation of hypertension with sociodemographic characteristics of the study participation (n\u0026thinsp;=\u0026thinsp;351).\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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eBlood Pressure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNormotensive\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHypertensive\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;49-years\u003c/p\u003e\u003cp\u003e50\u0026ndash;95-years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56 (39.2)\u003c/p\u003e\u003cp\u003e76 (36.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87 (60.8)\u003c/p\u003e\u003cp\u003e132 (63.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.\u003c/b\u003e618\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\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\u003e56 (41.5)\u003c/p\u003e\u003cp\u003e76 (35.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79 (58.5)\u003c/p\u003e\u003cp\u003e140 (64.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.236\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003cp\u003eMarried\u003c/p\u003e\u003cp\u003eWidow/divorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (66.7)\u003c/p\u003e\u003cp\u003e111 (37.9)\u003c/p\u003e\u003cp\u003e19 (34.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (33.3)\u003c/p\u003e\u003cp\u003e182 (62.1)\u003c/p\u003e\u003cp\u003e36 (65.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.520\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87 (39.9)\u003c/p\u003e\u003cp\u003e45 (33.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e131 (60.1)\u003c/p\u003e\u003cp\u003e88 (66.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.254\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal number of children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003cp\u003e1\u0026ndash;5\u003c/p\u003e\u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (82.7)\u003c/p\u003e\u003cp\u003e65 (39.2)\u003c/p\u003e\u003cp\u003e59 (33.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (27.3)\u003c/p\u003e\u003cp\u003e101 (60.8)\u003c/p\u003e\u003cp\u003e115 (66.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.031\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003cp\u003eSecondary school\u003c/p\u003e\u003cp\u003eHigh school\u003c/p\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90 (39.6)\u003c/p\u003e\u003cp\u003e22 (34.9)\u003c/p\u003e\u003cp\u003e6 (33.3)\u003c/p\u003e\u003cp\u003e5 (22.7)\u003c/p\u003e\u003cp\u003e9 (42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e137 (60.4)\u003c/p\u003e\u003cp\u003e41 (65.1)\u003c/p\u003e\u003cp\u003e12 (66.7)\u003c/p\u003e\u003cp\u003e17 (77.3)\u003c/p\u003e\u003cp\u003e12 (57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.548\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomic status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh-income\u003c/p\u003e\u003cp\u003eMiddle-income\u003c/p\u003e\u003cp\u003eLow-income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (72.7)\u003c/p\u003e\u003cp\u003e32 (41.6)\u003c/p\u003e\u003cp\u003e92 (35.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (27.3)\u003c/p\u003e\u003cp\u003e45 (58.4)\u003c/p\u003e\u003cp\u003e171 (65.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.029\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnderweight\u003c/p\u003e\u003cp\u003eNormal weight\u003c/p\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003cp\u003eObesity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (58.3)\u003c/p\u003e\u003cp\u003e55 (46.6)\u003c/p\u003e\u003cp\u003e51 (33.1)\u003c/p\u003e\u003cp\u003e19 (28.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (41.7)\u003c/p\u003e\u003cp\u003e63 (53.4)\u003c/p\u003e\u003cp\u003e103 (66.9)\u003c/p\u003e\u003cp\u003e48 (71.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.018\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBad event occurring in the past month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56 (31.3)\u003c/p\u003e\u003cp\u003e76 (44.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e123 (68.7)\u003c/p\u003e\u003cp\u003e96 (55.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e132 (37.6)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e219 (62.4)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eNo significant associations were observed between hypertension and overall self-rated quality of life (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.430), health satisfaction (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.654), or physical (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.068), psychological (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.710), and environmental (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.630) quality of life domains. However, a significant association was found in the social relationship domain (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.040), where individuals with low social relationship scores had a lower prevalence of hypertension (52.1%) compared to those with moderate (64.0%) and high (68.1%) scores. \u003cb\u003e[\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e]\u003c/b\u003e\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\u003eAssociation of quality of life with the presence of hypertension in the study participants (n\u0026thinsp;=\u0026thinsp;351).\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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eQuality of life\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eBlood Pressure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eNormotensive\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eHypertensive\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow would you\u003c/p\u003e\u003cp\u003erate your quality of\u003c/p\u003e\u003cp\u003elife?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery poor\u003c/p\u003e\u003cp\u003ePoor\u003c/p\u003e\u003cp\u003eNeither poor nor good\u003c/p\u003e\u003cp\u003eGood\u003c/p\u003e\u003cp\u003eVery good\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (35.0)\u003c/p\u003e\u003cp\u003e35 (33.7)\u003c/p\u003e\u003cp\u003e44 (36.4)\u003c/p\u003e\u003cp\u003e38 (46.3)\u003c/p\u003e\u003cp\u003e1 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26 (65.0)\u003c/p\u003e\u003cp\u003e69 (66.3)\u003c/p\u003e\u003cp\u003e77 (63.6)\u003c/p\u003e\u003cp\u003e44 (53.7)\u003c/p\u003e\u003cp\u003e3 (75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.430\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow satisfied are you with your health?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery dissatisfied\u003c/p\u003e\u003cp\u003eDissatisfied\u003c/p\u003e\u003cp\u003eNeither satisfied nor dissatisfied\u003c/p\u003e\u003cp\u003eSatisfied\u003c/p\u003e\u003cp\u003eVery satisfied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (26.5)\u003c/p\u003e\u003cp\u003e49 (38.6)\u003c/p\u003e\u003cp\u003e48 (38.4)\u003c/p\u003e\u003cp\u003e25 (41.0)\u003c/p\u003e\u003cp\u003e1 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (73.5)\u003c/p\u003e\u003cp\u003e78 (61.4)\u003c/p\u003e\u003cp\u003e77 (61.6)\u003c/p\u003e\u003cp\u003e36 (59.0)\u003c/p\u003e\u003cp\u003e3 (75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.654\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical domain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98 (34.8)\u003c/p\u003e\u003cp\u003e23 (46.9)\u003c/p\u003e\u003cp\u003e11 (55.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e184 (65.2)\u003c/p\u003e\u003cp\u003e26 (53.1)\u003c/p\u003e\u003cp\u003e9 (45.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.068\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological domain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79 (37.6)\u003c/p\u003e\u003cp\u003e37 (35.6)\u003c/p\u003e\u003cp\u003e16 (43.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e131 (62.4)\u003c/p\u003e\u003cp\u003e67 (64.4)\u003c/p\u003e\u003cp\u003e21 (56.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.710\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial relationship domain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (47.9)\u003c/p\u003e\u003cp\u003e40 (36.0)\u003c/p\u003e\u003cp\u003e46 (31.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50 (52.1)\u003c/p\u003e\u003cp\u003e71 (64.0)\u003c/p\u003e\u003cp\u003e98 (68.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnvironment domain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68 (36.0)\u003c/p\u003e\u003cp\u003e56 (38.6)\u003c/p\u003e\u003cp\u003e8 (47.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e121 (64.0)\u003c/p\u003e\u003cp\u003e89 (61.4)\u003c/p\u003e\u003cp\u003e9 (52.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.630\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e132 (37.6)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e219 (62.4)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, 80.3%, 59.8%, 27.4%, and 53.8% of the patients demonstrated low quality of life in the physical, psychological, social, and environmental domains, respectively. Increased chances of hypertension were present in DM patients with moderate and high social relationship scores.\u003c/p\u003e\n\u003cp\u003eIn a study conducted among 609 DM patients in Kandahar and Lashkar Gah cities of Southern Afghanistan, the prevalence of hypertension among DM patients was 55.3%. The main factors associated with hypertension among DM patients were female gender (adjusted odds ratio [AOR] 1.73, 95% CI 1.09–2.74), aged ≥ 50 years (AOR 4.35, 95%CI 2.78–2.6.81), having diabetes for\u0026nbsp;³5 years (AOR 2.13, 95%CI 1.37–3.31), poor glycemic control (AOR 1.80, 95%CI 1.18–2.75), and presence of depressive symptoms (AOR 3.25, 95%CI 2.59–4.80) (Stanikzai et al., 2025).\u003c/p\u003e\n\u003cp\u003eIn a cross-sectional study conducted among 321 DM patients in Kabul city of Afghanistan, the prevalence of hypertension among DM patients was 70.5%. hypertension was more prevalent in women (76.8%), with mean systolic and diastolic blood pressures of 146.9 mmHg and 89.6 mmHg, respectively. Moreover, the mean duration of DM, HbA1c values, and body mass index (BMI) of the study participants were 7.1 years, 9.3%, and 28.8, respectively (Naseri et al., 2022).\u003c/p\u003e\n\u003cp\u003eA hospital-based cross-sectional study conducted in Al-Kharj, Saudi Arabia, among 1178 diabetic patients revealed that the prevalence of uncontrolled hypertension among DM patients was 71.8%. The main factors associated with uncontrolled hypertension were age \u0026gt;65 years (OR 2.0, 95%CI 1.1–3.8), male gender (OR 1.5, 95%CI 1.0–2.2), and obesity (OR 2.4, 95%CI 1.6–3.5) (Almalki et al., 2020).\u003c/p\u003e\n\u003cp\u003eIn Southwest Ethiopia, a hospital-based cross-sectional study was conducted among 366 DM patients. The prevalence of hypertension among DM patients was 37.4%. The main factors associated with hypertension among DM patients were age ≥50 years (AOR 4.8, 95% CI 1.4–16.4], overweight/obese (AOR 3.1, 95% CI 1.6–6.1), and khat chewing (AOR 19.3, 95% CI\u003c/p\u003e\n\u003cp\u003e10.3–36.4) (Abdissa et al, 2020).\u003c/p\u003e\n\u003cp\u003eIn the current study, overweight/obesity was a statistically significant risk factor for hypertension among DM patients. This finding is in agreement with the existing literature showing the higher probability of hypertension among obese adults (Dua et al., 2014)(Drøyvold et al., 2005)(Chorin et al., 2015)(Abebe et al., 2015). In the literature, the association between obesity and hypertension is poorly understood, i.e., mechanisms through which obesity directly causes hypertension and increases disease progression are complex and have still been intensively studied\u0026nbsp;(Hall et al., 2000)(Haynes et al., 1997)(Kotsis et al., 2010).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, fortunately, obesity among adult DM patients can be controlled by designing an effective prevention plan, such as increasing public health awareness and encouraging DM patients to bring lifestyle changes, including specific diet and exercise recommendations, which could help in decreasing weight and raise their levels of blood pressure control.\u003c/p\u003e\n\u003cp\u003eIn Bantul, Indonesia, a cross-sectional study was conducted to evaluate the level of adherence and quality of life of 143 DM patients with hypertension. For measuring the level of treatment adherence, the Modified Morisky Medication Adherence Scale was used, while the SF36 questionnaire was used to measure the quality of life. The majority (76.3%) of respondents had moderate (39.2%) and low (37.1%) levels of adherence. The mean score of quality of life was 61.96±12.48. Relatively low medication adherence and quality of life were observed among DM patients with hypertension. DM patients who were male and college-educated had higher medication adherence (OR \u0026gt;1, \u003cem\u003ep\u003c/em\u003e-value \u0026lt;0.05) (Akrom \u0026amp; Anggitasari, 2019).\u003c/p\u003e\n\u003cp\u003eThis study had a few limitations. First, data for this study was collected from Herat province only, one of the 34 provinces of Afghanistan. So, we cannot generalize our results to the diabetic patients of the entire Afghanistan. Second, we collected data through face-to-face interviews. Therefore, there are more chances of recall bias. Third, we did not include many important associated factors, such as the presence of comorbidities of diabetes mellitus, duration of the T2DM, complications of T2DM, and HbA1c levels of the study participants. Fourth, it was a cross-sectional study. So, the nature of the data did not allow for causal inferences regarding associated factors that might affect the prevalence of hypertension among DM patients. Fifth, due to very limited funding for this study, we could not assess dyslipidemia, a potential risk factor for hypertension among DM patients, in our study participants.\u003c/p\u003e"},{"header":"Conclusion and recommendation","content":"\u003cp\u003eThe results of this study are important and give useful information in order to guide policymakers for policies and interventions on hypertension among patients with diabetes who have been lacking adequate care. There is a high prevalence of hypertension and low quality of life among DM patients in Herat province of Afghanistan. Factors associated with depression were being female, having low economic status, and having had a bad event in the past month. The main factors associated with hypertension among DM patients were having \u0026gt;5 children, having low economic status, being overweight/obese, and experiencing a negative event in the past month. Meanwhile, increased chances of hypertension were present in DM patients with moderate and high social relationship scores. The findings of this study suggest that while most quality-of-life aspects were not significantly associated with hypertension, social relationships may play a role in its prevalence among diabetic patients.\u003c/p\u003e\n\u003cp\u003eIt is highly recommended that all diabetic patients who seek medical contact should be screened for hypertension and its complications as well as quality of life. Afghanistan Ministry of Public Health, as well as international donor agencies such as WHO and UNICEF, should work in collaboration to design appropriate preventive strategies targeting the modifiable risk factors associated with hypertension. There is an intense need for more studies, especially prospective cohort studies with larger sample sizes, to be conducted in all 34 provinces of Afghanistan (both rural and urban areas) to find out the real burden and risk factors of hypertension among DM patients in the Afghan population. Future studies should also investigate other factors that predispose DM patients to hypertension, such as dyslipidemia, medication adherence, dietary patterns, concomitant medical conditions, and corticosteroid use.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgment\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are cordially thankful to the officials and personnel of all the hospitals of Herat Province who helped us in this research. We are also grateful to all the study participants for their cooperation and participation in our study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current research received ethical approval from the Ethical Committee of the Afghanistan Center for Epidemiological Studies, with the assigned reference number #23.1.017. Before engaging participants, the study\u0026apos;s aims and procedures were thoroughly elucidated. Written informed consent was secured from all participants prior to their inclusion, and they were explicitly informed of their right to withdraw from the study at any point without consequence. All methodologies and processes were conducted in strict compliance with applicable ethical principles and regulatory frameworks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConflict of interest\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors assert that there are no conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eMNN designed the study.\u003c/li\u003e\n \u003cli\u003eMNN contributed to the data collection of this study.\u003c/li\u003e\n \u003cli\u003eAN analyzed the data.\u003c/li\u003e\n \u003cli\u003eBAR, NR, MN, NAK, PA, KI and AN prepared the draft of the manuscript.\u003c/li\u003e\n \u003cli\u003eAN critically reviewed, rewrote, edited, and finalized the manuscript.\u003c/li\u003e\n \u003cli\u003eAll authors reviewed the manuscript.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eClinical trial number\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData availability\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets utilized and/or analyzed in the course of the present study are accessible from the corresponding author upon reasonable inquiry.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbdissa, D., \u0026amp; Kene, K. 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Prevalence of Hypertension and Its Associated Factors Among Patients with Type 2 Diabetes in Southern Afghanistan: A Multi-Center Cross-Sectional Study. \u003cem\u003eDiabetes, Metabolic Syndrome and Obesity\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e, 715\u0026ndash;725. https://doi.org/10.2147/DMSO.S503725\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. (2023). \u003cem\u003eHypertension\u003c/em\u003e. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/hypertension\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. (2024). \u003cem\u003eDiabetes\u003c/em\u003e. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/diabetes\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hypertension, Diabetes Mellitus, Type 2, Outpatients, Quality of Life, Afghanistan, Cross-Sectional Studies","lastPublishedDoi":"10.21203/rs.3.rs-7433783/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7433783/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe main objectives of this study were to study the prevalence and associated factors of hypertension and quality of life among DM outpatients in the Herat province of Afghanistan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eIn this cross-sectional study, a total of 351 diabetic hospitalized patients were studied between January–June 2024. Health-related quality of life among diabetic patients was assessed using the World Health Organization Quality of Life (WHOQOL-BREF-26) questionnaire. Data were analyzed by using descriptive statistics, Chi-square tests, and multiple regression analysis. A two-tailed p-value below 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The majority of patients were aged ³50 years (59.3%), females (61.5%), illiterate (64.7%), and having low income (74.9%). Among these patients, 63.0% were overweight/obese and 51.0% experienced a significant negative event in the past month. \u0026nbsp;The prevalence of hypertension among DM patients was 62.4%. Statistically significant factors associations with hypertension among DM patients were having \u0026gt;5 children, having low economic status, being overweight/obese, and experiencing a negative event in the past month. Regarding the quality of life domains, 80.3%, 59.8%, 27.4%, and 53.8% of the study participants demonstrated low quality of life in the physical, psychological, social, and environmental domains, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe high prevalence of hypertension and poor quality of life among diabetic patients in Herat highlight the urgent need for integrated management strategies that address both blood pressure control and psychosocial well-being. Strengthening hospital-based screening, improving access to antihypertensive treatment, and implementing targeted interventions to improve quality of life could reduce the burden of diabetes-related complications in this population.\u003c/p\u003e","manuscriptTitle":"Hypertension and quality of life among Afghan type-2 diabetic patients: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 16:29:05","doi":"10.21203/rs.3.rs-7433783/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5b27e12a-24df-40c4-8f0d-efba1d76ad7e","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-11T07:54:50+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-03 16:29:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7433783","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7433783","identity":"rs-7433783","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}