Determinants of hypertension care and control among peri-urban Black South Africans: The HIHI study

Objective: To examine determinants of hypertension (HTN) care and control among peri-urban hypertensive Black South Africans. Design: Cross-sectional, descriptive. Setting: Public and private primary care sites in three townships near Cape Town, South Africa. Participants: 403 hypertensive Black patients (183 men, 220 women), ages 35-65 years. Methods: The Precede-Proceed Model guided the study. Self-report sociodemographics, medical history, health behaviors, health service utilization, quality of life, social support, and exposure to life threats and illness were assessed. Blood pressure (BP) was measured and height and weight recorded. Results: Mean BP (mm Hg) was 151/99 for men, 142/88 for women with BP controlled (<140/90 mm Hg) among 33% of men, 44% of women. Patient-related barriers to HTN care included limited HTN-related knowledge, poor quality of life and stressors such as family death. An unhealthy lifestyle involving smoking cigarettes, physical inactivity and using alcohol excessively was common. In regression models of select socioeconomic, lifestyle risk and HTN care variables, significant predictors of lower SBP and DBP or BP control included: fewer antihypertensive medications, better compliance to HTN recommendations, younger age, female, higher education level, not using alcohol excessively, and private sector healthcare. Conclusion: This study identified a high level of barriers to HTN control and the need for comprehensive multilevel interventions to improve HTN care and control in this high-risk population. Furthermore, the data illustrate that the Hill-Bone compliance scale can be a practical tool in primary healthcare settings to identify patient-related factors and guide counseling to improve adherence in HTN care.