International Journal of Research in Medical Sciences

Bollampally M et al. Int J Res Med Sci. 2016 Aug;4(8):3299-3304

www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012

DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20162283
Research Article

Assessment of patient’s knowledge, attitude and practice

regarding hypertension
Manasa Bollampally*, Preethika Chandershekhar, Kodishala Pradeep Kumar,
Aruna Surakasula, Sharadha Srikanth, T. Rama Mohan Reddy

Department of Pharm. D, CMR College of Pharmacy, Kandlakoya (V) Hyderabad – 501401, Telangana, India

Received: 07 June 2016

Accepted: 01 July 2016

*Correspondence:
Dr. Manasa Bollampally,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Hypertension is not a disease but it is an important risk factor for cardiovascular complications.
Approximately 77.9 million American adults (1 in 3 people) and one billion people worldwide have high blood
pressure. Hypertension can be described as the ‘sleeping snake’ which bites when it wakes up. There is need to
investigate KAP among the general population which helps in the future development programmes for effective
health education The main aim of this study was to assess the patients Knowledge, Attitude and Practice regarding
hypertension.
Methods: This is a prospective observational study conducted in the In-patient Departments of Gandhi hospital,
Secunderabad for a period of 6 months (August 2015 - January 2016) which was approved by institutional ethics
committee. A total of 160 hypertensive patients with or without comorbid condition were included. . Adults of age
less than 30 years, paediatrics, Pregnant and lactating women were excluded. Patients were selected by simple
random sampling method. A suitably designed and validated KAP questionnaire was administered to hypertensive
patients. This questionnaire was filled in at face to face interview along with inform consent Statistical analysis was
performed using Graph pad prism software version 5. Data was analysed using unpaired t-test.
Results: We observed a good score towards knowledge, attitude and poor score towards practice.
Conclusions: Our study signifies that patients require support and guidance for practicing better disease management.
Clinical activities such as patient counselling, Home Medication Review, Pharmaceutical care program help to
increase the patients practice in disease management.

Keywords: Hypertension, KAP, Home medication review

INTRODUCTION Hypertension. Increased blood pressure is estimated to

cause 7.5 million deaths accounts for 57 million disability
Hypertension is not a disease but it is an important risk adjusted life years (DALYs).2 A survey in 2004 revealed
factor for cardiovascular complications. It can be defined that the prevalence of hypertension in India was 25% in
as a condition where blood pressure is elevated to an urban and 10% in rural population, and it leads to 57% of
extent where clinical benefit is obtained from blood all stroke deaths and 42% of deaths due to cardiovascular
pressure lowering.1 Approximately 77.9 million disease.3
American adults (1 in 3 people) and one billion people
worldwide have high blood pressure. It is estimated that The increasing prevalence of hypertension is attributed to
by 2025, 1.56billion adults will be living with ageing of population, urbanisation sedentary habits, lack

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of physical activity, obesity, alcohol consumption and test. Unpaired t-test was applied to compare differences
exposure to persistent stress. Complications of in two groups. P values <0.01 were considered
hypertension account for 9.4 million deaths worldwide statistically significant, P- values <0.001 were considered
every year. In India, 23.10% of men and 22.60% of very significant.
women over 25 years suffer from hypertension.4
RESULTS
Hypertension is labelled as ‘silent killer’ because it
progressively and permanently damages organs before A total of 160 cases of hypertension were examined of
occurrence of any diagnosable external presentation. which males were 52.5% and females 47.5%. Age ranges
Therefore, the patients should be alert of the preventive from 33- 87 years in which most of the respondents were
strategy of hypertension management and therefore below 60years constituted about 81.25% of the total
should strictly adhere to the therapy.5 study population.

Hypertension can be described as the ‘Sleeping snake’ Table 1: Distribution of patients according to
which bites when it wakes up.6 In this context, economic status, literacy and social habits.
hypertension presents a major area of intervention
because it is a frequent condition and is amenable to Variable Frequency Percentage
control through both nonpharmacological lifestyle factors Economic status
and pharmacological treatment. Lifestyle measures for Low 54 33.75
lowering BP include reduced alcohol intake, reduced Medium 106 66.25
sodium chloride intake, increased physical activity, and Literacy
control of overweight.7 Literate 74 46.25
Illiterate 86 53.75
A proper assessment and understanding of KAP factors is Social habits
particularly helpful in the area of chronic conditions such Alcoholic 29 18.13
as hypertension, for which prevention and control Smoker 7 4.37
necessitate a lifelong adoption of healthy lifestyles.8 Both 22 13.75
There is need to investigate KAP among the general None 102 63.75
population which helps in the future development
programmes for effective health education.9 The
knowledge and attitudes of the patients have an impact on
the management of the disease condition which helps in
improving the medication adherence, the blood pressure
control, morbidity and mortality of the patients.

The main aim of this study was to assess the patients

Knowledge, Attitude and Practice regarding
hypertension.

METHODS
Figure 1: Scores of knowledge attitude and practice
This is a prospective observational study conducted in the questions.
In-patient Departments of Gandhi hospital, Secunderabad
for a period of 6 months (August 2015 - January 2016). A Table 2: The most commonly prescribed drugs for
total of 160 hypertensive patients with or without hypertension.
comorbid condition were included. Adults of age less
than 30 years, paediatrics, Pregnant and lactating women Mostly prescribed drugs Frequency Percentage
were excluded. Patients were selected by simple random Amlodipine 49 30.62
sampling method. A suitably designed and validated KAP
Telmisartan + 23 14.37
questionnaire was administered to hypertensive patients.
hydrochlorthiazide
Atenolol 19 11.87
The questionnaire consists total of 21questions, with 8
questions related to knowledge about hypertension, 6 Ramipril 14 8.75
questions to assess the attitude of the patient towards Enalpril 09 5.63
hypertension and 7 questions regarding practice. This Losartan 01 0.63
questionnaire was filled in at face to face interview along Combination therapy 45 28.12
with inform consent.
30% of the patients were between the age group of 51-
Statistical analysis was performed using Graph pad prism 60years, followed by 28.75% were between 41- 50 years
software version 5. Data was analysed using unpaired t- and 22.5% were between 31- 40 years remaining 18.75%

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were above 61 years. 57.5% of hypertensive patients 21 years. 65.62% of respondents were without comorbid
were with duration of 1- 5 years followed by 6-10 years conditions, remaining 34.48% were with comorbid
33.75%, 5.62% with duration of 11- 15 years, 1.88% with conditions.
duration of 16-20 years and 1.25% with duration of above

Table 3: Knowledge related questions.

Questions Answers Frequency Percentage

How did you come to know about your htn Clinical 135 84.37
voluntary 25 15.62
Do you have any relatives with history of htn- Yes 42 26.25
No 118 73.75
Do you know what are the complications of Yes 38 23.75
htn No 112 76.25
Do you know normal level of blood pressure Yes 83 51.88
No 77 48.12
Do you know the symptoms of htn Yes 52 32.5
No 108 67.5
Do you think smoking and alcohol consumption Yes 91 56.88
cause htn No 69 43.12
Do you think obesity is associated with htn Yes 74 46.25
No 86 53.75
Do you know the names of your prescribed Yes 48 30
drugs No 112 70

Table 4: Attitude questions.

Do you think regular medications will improve the disease Yes 143 89.37
No 17 10.62
Do you think medications alone can control HTN Yes 144 90
No 16 10
Do you think diet control will improve the condition Yes 93 58.13
No 67 41.87
Do you think salt reduction can control hypertension Yes 106 66.25
No 54 33.75
Do you think regular physical activity is essential Yes 58 36.25
No 102 63.75
Avoiding extra cooking oil Yes 87 54.38
No 73 45.62

Table 5: Practice related questions.

Where you was first diagnosed with HTN Government 73 45.62

Private 87 54.37
Regular Follow up Yes 103 64.38
No 57 35.62
Did you ever experienced any side effect Did you ever experienced any side effect
Did you ever taken double dose Yes 5 3.12
No 155 96.88
Are you avoiding extra added salt Yes 98 61.25
No 62 38.75
Are you doing any physical exercise daily Yes 26 16.25
No 134 83.75
Are you taking your drugs regularly Yes 103 64.38
No 57 35.62

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Table 6: Knowledge attitude and practice of patients regarding hypertension.

Knowledge N Mean SD Lower 95% CI Upper 95% CI P value

Poor score 76 3.000 1.811 2.586 3.414 P<0.0001
Good score 84 6.833 0.8190 6.656 7.011
Attitude P<0.0001
Poor score 74 1.331 0.5476 1.316 1.559
Good score 86 1.051 0.8583 3.959 4.341
Practice P<0.0001
Poor score 94 4.123 0.6183 4.141 1.321
Good score 66 1.223 0.5178 1.286 1.569

Table 7: Practice of hypertension measurement.

Gender 15 days 1 month 3 months ≥ 6 months No Chi P value

measurement square
Male 2 7 24 0 51
Female 7 11 21 8 29 9.7 < 0.01
Total 9 18 45 8 80

DISCUSSION In this study the patients are having good knowledge

about disease complications, normal B.P levels, signs and
Hypertension is considered as major health problem in symptoms, prescribed drug names and risk factors. This
India and other developing countries. In US the finding was similar to the previous study conducted by
prevalence rates varies from 4% in the age group 18-24 Sanjiv Bhatia et al.14 The reports of national Health and
years to 60% in the age group of 65-74 years.6 In our Nutrition Examination Survey (NHANES II and
study majority of the respondents were below the age of NHANES III) shows an increase in BP awareness during
60 years and this was similar to studies conducted by the time period 1976 - 1991 from 51% to 73%.15 We
Pragnesh et al.8 This showed that HTN was not only the found that patients had profound perception and positive
disease which is seen in elderly people but was also very attitude regarding the disease and its influential factors.
much prevalent among the adult age groups. Hence 89% of patients think regular medications will improve
measures such as healthier diet and lifestyle habits should the condition and 66% thinks that taking less salt will
be adopted to control the prevalence of the disease. control the blood pressure. This finding was similar to
the previous study conducted by Roopa et al and Sabouhi
Majority of the patients are suffering from HTN since 1- et al.16,17 We noticed that the patients were not executing
5 years and are at risk of developing comorbid the practice regarding lifestyle and diet. 83% of patients
conditions. Most of the patients were from medium socio are not doing any physical activity. This shows the poor
economic status and were illiterates. In a study from practice towards hypertension. This finding was similar to
Jaipur, high prevalence of hypertension was reported in the previous studies conducted by Sanjiv Bhatia et al., and
low education or illiterate groups.10 In our study majority Susan A Oliveria et al.14,18 We found that 50% of study
of respondents are not having any addictions (smoking population doesn’t practice regular measurement of
and alcohol consumption). Alcohol consumption has hypertension and in the remaining 50% of study
been consistently related to high blood pressure in cross- population practice regular measurement of hypertension.
sectional as well as prospective observational studies in
several populations.11 Amlodipine, Calcium channel Epidemiological studies suggest that exercise is
blockers (CCB) was the extensively used drug. efficacious in controlling the Blood Pressure. Exercise has
Combination therapy of different anti-hypertensive drugs multiple benefits for patients with hypertension there by
was preferred next to amlodipine. Other drugs used were reducing the risk of cardiovascular event and mortality.19
Telmisartan, Atenolol, Ramipril, Enalpril and Losartan. The serious spread of disease can cripple the fiscal and
human resources; therefore, it is the time to act now and
Patients level of education, skilled occupations and being do as much as possible to cover almost all aspects of the
health conscious have been previously shown to be disease. In the present study, the responses to knowledge
associated with improved compliance among patients and attitude were appealingly good but the practice was
with hypertension.12 In a study conducted by Williams not regular.
MV consisting of 402 hypertensive patients of which 189
patients had inadequate knowledge, 49patients had The role of pharmacist involvement in a chronic disease
marginal knowledge and 155 had adequate knowledge.13 care programme, including one for hypertension, is
clearly demonstrated in developed countries. Pharmacists

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 Bollampally M et al. Int J Res Med Sci. 2016 Aug;4(8):3299-3304

can reduce pressure on the healthcare system and helps in 3. Vanitha D, Anitha RM. Knowledge and practice on
the management of chronic diseases by providing lifestyle modifications among males with
information about medications and lifestyle modifications hypertension. IJCH. 2015;27(1):143-9.
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Our study signifies that patients require support and Ghongane BB. Survey of knowledge and awareness
guidance for practicing better disease management. in patients of hypertension and survey of
Hence we conclude that a clinical pharmacist can play information that patients receive from physician for
major role in improving patient’s knowledge and hypertension in a tertiary care hospital. WJPP.
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ACKNOWLEDGEMENTS epidemiological transition HJ.1998;31:1136-45.
8. Bollu M, Koushik K, Prakash AS, Lohith MN,
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Funding: No funding sources 13. Williams MV, Baker DW. Relationship of
Conflict of interest: None declared functional health literacy to patient’s knowledge of
Ethical approval: The study was approved by the their chronic disease. A study of patients with
Institutional Ethics Committee hypertension and diabetes. Arch Intern Med. 1998;
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