Global Journal of Health Science; Vol. 8, No.

2; 2016
ISSN 1916-9736 E-ISSN 1916-9744
Published by Canadian Center of Science and Education

Knowledge, Awareness and Self-Care Practices of Hypertension

among Cardiac Hypertensive Patients
Muhammad Bilal1, Abdul Haseeb1, Sehan Siraj Lashkerwala1, Ibrahim Zahid1, Khadijah Siddiq1, Muhammad
Saad2, Mudassir Iqbal Dar3, Mohammad Hussham Arshad4, Waqas Shahnawaz5, Bilal Ahmed5 & Aimen Yaqub5
1
Dow University of Health Sciences, Karachi, Pakistan
2
Department of Pulmonology, Jinnah Postgraduate Medical Center, Karachi, Pakistan
3
Cardiac Surgery Department, Civil Hospital, Karachi, Pakistan
4
Aga Khan University Hospital, Karachi, Pakistan
5
The Lyceum, Karachi, Pakistan
Correspondence: Muhammad Bilal, Dow University of Health Sciences, Karachi, Pakistan, A/215, Block: 5,
Gulshan-e-Iqbal, Karachi, Pakistan. Tel: 92-324-222-0872. E-mail: [email protected]

Received: March 24, 2015 Accepted: April 24, 2015 Online Published: June 1, 2015
doi:10.5539/gjhs.v8n2p9 URL: http://dx.doi.org/10.5539/gjhs.v8n2p9

Abstract
Introduction: The most prevalent form of hypertension is systolic blood pressure (SBP) and it is considered to
be predisposing risk factor for cardiovascular disease. The objective of the study was to assess self-care practices,
knowledge and awareness of hypertension, especially related to SBP among cardiac hypertensive patients.
Methodology: A Cross sectional study was conducted on 664 cardiac hypertensive patients, which were selected
by non-probability convenience sampling from cardiology outpatient department of three tertiary care hospitals.
Face to face interviews were conducted using a pre designed questionnaire. Data was entered and analyzed by
SPSS (V17).
Results: 81.8%, did not know that hypertension is defined as high blood pressure. 97.1% of the sample
population did not know that top measurement of blood pressure was referred to as systolic and only 25.0%
correctly recognized normal systolic blood pressure to be less than 140mmHg. 7.4% of the patients consulted
their doctor for hypertension once or twice in a month. Risk factor for high blood pressure most commonly
identified by the participants was too much salt intake
Conclusions: The results state that there is an inadequate general knowledge of hypertension among cardiac
patients and they do not recognise the significance of elevated SBP levels. There is a need to initiate programs
that create community awareness regarding long term complications of uncontrolled hypertension, particularly
elevated SBP levels so that there is an improvement in self-care practices of the cardiacpatients.
Keywords: systolic blood pressure, hypertension, cardiac patients, outpatient department, tertiary care hospitals
1. Introduction:
Considered as the silent killer (Hoel & Howard, 1997), high arterial Blood Pressure (BP) is the greatest causative
agent for the mortality involved in cardiovascular diseases, renal failure and stroke (Rahimi&Rahimi, 2006). The
studies conducted on global burden of Hypertension (HTN) reported that 25% of adults are having HTN and
9.2 % of the total deaths are because of high BP related events (Lawes, Vander Hoom, & Rodgers, 2008). As
indicated by the epidemiological data, hypertension accounts for 35% of all atherosclerotic events and 49% of all
cases of heart failure. It increases two to three folds of an individual's risk for cardiovascular disease (Padwal,
Strauss, & McAlister, 2001). Worldwide analysis show that the number of people with uncontrolled hypertension
(>140/90 mm of Hg) rose from 600 million in 1980 to nearly 1 billion in 2008 and this number is expected to
increase to 1.56 billion by 2025, which will approximately be 29% of the worldwide adult population (Sarafidis
et al., 2008).
In Pakistan one in every three individual over the age of 45 years is hypertensive as revealed by the National
Health Survey (NHS) (Nishtar, Faruqui, Mattu, Mohamud, & Ahmed, 2004). According to the “Sixth Report of
the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure”,

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Blood pressure is classified on the basis of Systolic blood pressure (SBP) and Diastolic blood pressure (DBP)
(Lloyd-Jones, Evans, Larson, O'Donnell, & Levy, 1999). The most prevalent form of HTN is SBP and people
aged above 60 years are more prone to it. Studies have shown that it is more important to control systolic blood
pressure (SBP) than diastolic blood pressure (DBP) (Levine et al., 2003). Also, SBP alone is a predisposing risk
factor for cardiovascular disease (CVD).Treatment and control of BP reduces the risk for cardiovascular diseases
(Verdecchia, Angeli, Gentile, Mazzotta, & Reboldi, 2011). The 1990 to 1994 National Health Survey of Pakistan
also showed that about 70% to 85% of Pakistani hypertensive patients were unaware of their disease, indicating
limited awareness of hypertension (National Health Survey of Pakistan 1990-1994).Since there is no information
available if the patients know the importance of their SBP level (Izzo, Levy, & Black, 2000), an opportunity
exists to find the knowledge and awareness of the patients in controlling their SBP level.
Local data in relation to cardiac hypertensive patients is scarce, which made it necessary to conduct this study in
this area to determine the association of knowledge of SBP and CVD in cardiac hypertensive population. This
can help us modify the treatment options, reduce adverse outcomes and provide better health care services. The
objective of the study was to assess self-care practices, knowledge and awareness of hypertension, especially
related to SBP among cardiac hypertensive patients attending cardiology outpatient department (OPD) of tertiary
care hospitals.
2. Methodology
A descriptive, cross-sectional study was conducted to evaluate the knowledge, awareness and self-care practices
of hypertension among cardiac hypertensive patients. Six-sixty four patients were interviewed from the
cardiology outpatient department to obtain the required information. The sample size of 664 was determined
assuming percentage knowledge of HTN among cardiac patients to be 50% (taking 99% level of significance
and 1% confidence limit). The blood pressure of patients was inquired by directly asking them. The study was
performed after the approval from the Institutional Review Board of the Dow University of Health Sciences.
A multi-center study was conducted at the cardiology OPD of National Institute of Cardio-Vascular Diseases
(NICVD), Abbasi Shaheed Hospital and Civil Hospital, Karachi. The NICVD being the largest cardiovascular
tertiary care hospital of Karachi, receives patients from all over Karachi, and even from the remote areas of
Sindh; while the other two, located at the two ends of the district, make it possible to cover patients from
different areas of Karachi. The patients from the OPD were selected by non-probability convenience sampling,
over a period of one week to prevent repetition of participants in the sample. Patients aged below 18 and
pregnant women were excluded from the population, and so were the patients presenting with complications of
hypertension like stroke, cerebrovascular accidents etc. and patients presenting with co morbidities like diabetes
mellitus and renal failure. While the inclusion criteria included patients who were 18 and above, suffering from
known pathology of valvular, ischemic heart disease or both. A patient was considered as hypertensive if he has
BP > 140/90 mm of Hg or a lower BP on anti-hypertensive drugs. An interview based questionnaire was
presented to each of the participant by the researcher in the homogeneous manner to limit interview biases. The
first part of the questionnaire comprised of patients demographics followed by the clinical history of the patient;
the second part dealt with the knowledge and awareness of hypertension with special relation to SBP, and the last
part was regarding the self-care practices and management of hypertension.
The collected data was entered on SPSS (V17) software. The same software was used for data management and
analysis. Mean and standard deviation were calculated for all quantitative variables like age, SBP and DBP etc.
Frequency and percentages were calculated for all qualitative variables like gender etc. Chi-square test was used
to find out the association benefits of study between outcome variable (knowledge of HTN) and other factors
like gender, education and socio-economic status.
3. Results
A total of 664 cardiac hypertensive patients were included in the study consisting of 422 males and 242 females,
giving a male to female ratio of 1.7:1. Table 1 depicts the demographic characteristics of cardiac hypertensive
patients. Out of these 664 patients, 582 were married. The mean age of the patients was 54.4±12.5 years. Three
hundred and sixty three (54.7%) of the participants were either illiterate or with level of education less than
Matriculation (equivalent to grade 10). One hundred and thirty three (20.0%) of the participants were labor by
profession. Consequently, monthly household income of 152 (22.9%) participants was between Rs.5000 and
Rs.20000.
Table 2 shows the clinical history of cardiac hypertensive patients. Patients undergone angioplasty or coronary
artery bypass graft surgery (CABG) were 16.3% (N=108) of the sample population and 42.8% (N=284) have
been admitted in the hospital at least once in their lifetime due to uncontrolled blood pressure. Majority of the

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participants, 597(89.9%), were using medications for hypertension. Most of the cardiac hypertensive patients,
169 (25.5%), said that they were hypertensive from a time period of 6 months-2 years. Out of 664 participants,
347 (52.3%) were aware of their blood pressure reading on their last visit which had a mean systolic blood
pressure (SBP) of 144.6 mm Hg (SD=33.2 mm Hg) and mean diastolic blood pressure (DBP) of 94.0 mm Hg
(SD=23.7 mm Hg). No family history of any disease was found in 48.5% (N=322) of the participants, however
majority of the remaining participants had a family history of cardiovascular disease, (n=214, 32.2%).
Furthermore, 85.8% (N=570) of the patients claimed hypertension to be very dangerous and 89.6% (N=595)
agreed that controlling blood pressure can improve a person's health. Five hundred and forty three (81.8%) did
not know that hypertension is defined as high blood pressure. Five hundred and twenty (78.3%) believed that it’s
very important to take medicines to keep blood pressure under control. Majority of the sample population, 97.1%
(N=645), did not know that top measurement of blood pressure was referred to as systolic and 96.8% (N=643)
did not know that bottom measurement of blood pressure was referred to as diastolic. Participants who either did
not know or identified normal systolic blood pressure (SBP) to be equal to 140mm Hg or greater than 140mm
Hg were 50.2% of the sample population. In case of normal diastolic blood pressure (DBP), 52.6% of the
participants did not know or identified the value to be equal to 90mm Hg or greater than 90mm Hg. When asked,
which measure do you think is important, 70.9% were unaware. A similar outcome was seen when asked about
the number responsible in causing cardiovascular disease, and 83% (N=551) of them did not know. Two hundred
and thirty seven patients (35.7%) claimed to have high blood pressure at their last checkup. Results of questions
relating to hypertension knowledge in cardiac hypertensive patients are given in table 3.
Table 4 gives the data regarding the awareness of cardiac hypertensive patients in relation to hypertension risk
factors and complications. Risk factor most commonly identified by the participants was too much salt intake
(N=523, 78.8%). Heart attack and stroke as a complication was recognized by 374 (56.3%) and 185 (27.9%)
participants, respectively.
Table 5 show answers to the questions related to the self-care practices of hypertension carried out by the sample
population. When asked, do you regularly check your blood pressure, 459 (69.1%) claimed to check it regularly
with most of them checking monthly, 234 (35.2%). Three hundred and forty three (51.7%) patients get their
blood pressure checked at the nearest health care facility. Five hundred and forty six (82.2%) do not have a
sphygmomanometer at home and 220 (33.1%) of them reasoned that they did not feel the need to have it. Most
of the patients, 265 (39.9%), consulted doctor of hypertension every 3-6 months and 180 (27.1%) consulted their
cardiologist more than every 12 months. Majority of the participants, 213 (32.1%) get their ECG examined more
than every 6 months and 239 (36%) get their cholesterol checked more often than every 6 months. Taking
medication was the single most important practice carried out by most of the cardiac hypertensive patients
(n=329, 49.5%).
Further analyses were performed using demographic characteristics in which these outcomes were statistically
analyzed. In general, there were no specific differences in knowledge, awareness, or self-care practices among
the subgroups. Patients who had a master’s degree showed better understanding of hypertension than
comparatively less educated patients. These patients specifically showed a better knowledge of the definition of
hypertension (e.g., 31.6% of the participants with masters education knew that hypertension is high blood
pressure compared to participants with less than master’s degree; P<0.001). In addition, businessmen tend to
report better knowledge of hypertension compared to patients with other professions (e.g. 26.3% of the
businessmen knew that hypertension means high blood pressure compared to patients with other professions;
P<0.001).Participants with a better socioeconomic status were seen to carry out more self-care practices
compared to people with low monthly household income (e.g. 76.2% of participants with monthly household
income > Rs.20000 regularly checked their blood pressure compared to participants with monthly household
income <Rs.20000; P<0.001).

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Table 1. Demographic characteristics of cardiac hypertensive patients (N = 664)

Demographic characteristics N %
Age (years) Mean± SD 54.4±12.5 -
Gender
Male 422 63.6
Female 242 36.4
Marital Status
Single 31 4.7
Married 582 87.7
Divorced 1 0.2
Widowed 50 7.5
Level of education
Matriculation (grade 10) 157 23.6
Intermediate (grade 12) 71 10.7
Bachelors 54 8.1
Masters 19 2.9
No education 363 54.7
Profession
Labor 133 20.0
Businessman 19 2.9
Government employee 39 5.9
Private employee 101 15.2
Housewife 186 28.0
Retired 186 28.0
Monthly household income
Less than 5000 49 7.4
5000-20000 152 22.9
20001-50000 94 14.2
50001-100000 6 0.9
Greater than 100000 5 0.8
Not applicable 358 53.9

Table 2. Clinical history of cardiac hypertensive patients (N = 664)

Clinical history N %
Are you currently on HTN medication?
Yes 597 89.9
No 67 10.1
For how long have you been suffering from HTN?
< 6 Months 149 22.4
6 Months - 2 Years 169 25.5
2.1 - 5 Years 149 22.4

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5.1 - 15 Years 130 19.6

> 15 Years 67 10.0
History of angioplasty/CABG
Yes 108 16.3
No 556 83.7
Have you ever been admitted to the hospital because of uncontrolled BP?

Yes 284 42.8

No 380 57.2
Family history of any disease
Cardiovascular disease 214 32.2
Diabetes 100 15.1
Hyperlipidemia/Dyslipidemia 8 1.2
Cerebrovascular disease 7 1.1
Renal disease 13 2.0
None 322 48.5
Are you aware of your BP reading from your last visit?
Yes 347 52.3
No 317 47.7
SBP/mm of Hg 144.6±33.2
DBP/mm of Hg 94.0±23.7

Table 3. Hypertension knowledge (N = 664)

Hypertension Knowledge N %
What is the definition of HTN?
High BP 53 8.0
High level of stress/tension 29 4.4
Nervous condition 19 2.9
High Blood Sugar 4 0.6
Over activity 16 2.4
Don’t Know 543 81.8
How dangerous is HTN to your health?
Very dangerous 570 85.8
Not dangerous at all 94 14.2
Can lowering high BP improve a person’s health?
Yes 595 89.6
No 69 10.4
What does the top number of blood pressure represent?
Systolic 19 2.9
Diastolic 3 0.5
Both 2 0.3
Don’t know 640 96.4

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What does the bottom number of blood pressure represent?

Systolic 4 0.6
Diastolic 16 2.4
Both 1 0.2
Don’t know 643 96.8
What should be the normal top number?
<140 166 25.0
140 66 9.9
>140 153 23.0
Don’t know 279 42.0
What should be the normal bottom number?
<90 315 47.4
90 199 30.0
>90 7 1.1
Don’t know 143 21.5
Which measure do you think is important?
Top 54 8.1
Bottom 338 50.9
Both 133 20.0
Don’t know 139 21.0
Which number is responsible in causing Cardiovascular disease?
Top 59 8.9
Bottom 26 3.9
Both 28 4.2
Don’t know 551 83.0
What do you think your BP was at the last visit?
High 237 35.7
Normal 200 30.1
Low 11 1.7
Don’t know 216 32.5
How important do you think medicine is to keep BP under control?
Very important 520 78.3
Not important at all 25 3.8
Don’t know 119 17.9
Is high BP(HTN) a lifelong disease?
Yes 420 63.3
No 244 36.7
Do you think high BP(HTN) is something that you can cure?
Yes 605 91.1
No 59 8.9

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Table 4. Awareness about risk factors and complications of hypertension

Are you aware of the following risk factors of HTN? N %
Too much salt intake is a risk factor of HTN 523 78.8
Tension is a risk factor of HTN 354 53.3
Lack of exercise is a risk factor of HTN 90 13.6
Inheritance is a risk factor of HTN 64 9.6
High cholesterol is a risk factor of HTN 314 47.3
Obesity is a risk factor of HTN 168 25.3
Smoking is risk factor of HTN 155 23.3
Aging is a risk factor of HTN 104 15.7
Diabetes is a risk factor of HTN 123 18.5
Alcohol abuse is a risk factor of HTN 62 9.3
Which of the following complications of HTN are you aware of?
Heart attack is a complication of HTN 374 56.3
Stroke is a complication of HTN 185 27.9
Aneurysm is a complication of HTN 20 3.0
Narrowed blood vessels in kidney is a complication of HTN 66 9.9
Narrowed blood vessels in eye is a complication of HTN 98 14.8
Metabolic syndrome is a complication of HTN 21 3.2
Trouble with memory or understanding is complication of HTN 107 16.1

Table 5. Self-care practices of cardiac hypertensive patients (N= 664)

Self-care practices N %
Do you have a home sphygmomanometer?
Yes 118 17.8
No 546 82.2
Do you regularly check your BP?
Yes 459 69.1
No 205 30.9
If yes, how often do you check your BP?
Daily 66 9.9
Weekly 119 17.9
Monthly 234 35.2
Every 3 months 36 5.4
More than that 4 .6
If yes, from where do you get your BP checked?
At home 83 12.5
At tertiary hospital 33 5.0
Nearest health care facility 343 51.7

What are the barriers towards self-testing for BP?

Expensive 168 25.3
Lack of awareness 152 22.9

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Pain 6 0.9
Don’t feel the need 220 33.1
None 118 17.7
How often do you consult your doctor for HTN?
Once/twice in a month 49 7.4
Every 2 months 54 8.1
Every 3-6 months 139 20.9
Every 6-12 months 265 39.9
More than 12 months 157 23.6
How often do you consult your cardiologist for heart exam?
Once/twice in a month 50 7.5
Every 2 months 70 10.5
Every 3-6 months 130 19.6
Every 6-12 months 180 27.1
More than 12 months 234 35.2
How often do you get your ECG examined?
Once/twice in a lifetime
Monthly 189 28.5
Every 3 months 25 3.8
Every 6 months 118 17.8
More than that 213 32.1
Never 119 17.9
How often do you get your blood cholesterol checked?
Once/twice in a lifetime 148 22.3
Monthly 122 18.4
Every 3 months 11 1.7
every 6 months 54 8.1
More than that 239 36.0
Never 90 13.6
Which single most important practice do you carry out to control your high BP?
Taking medication
Rhythmic exercise 329 49.5
Less stress 67 10.1
Quitting smoking 46 6.9
Reducing salt content in diet 48 7.2
DASH diet ( diet approaches to stop HTN) 149 22.4
Losing weight 25 3.8

4. Discussion
A descriptive study was conducted to assess the up-to-date information on knowledge, awareness and self-care
practices of HTN among cardiac hypertensive patients in Karachi. We found that the awareness level of cardiac
hypertensive patients in general is inadequate. The patients are not informed about recently recommended
guidelines, cutoff values of SBP and association of their SBP levels with cardiovascular disease. Consequently,

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48% of the patients could not recall their BP value and were unable to report whether their BP value is elevated
or normal. Our results also revealed insufficient self-care practices of cardiac patients towards their BP control.
However, prompt management leads to lower incidence of complications (Staessen, Wang, & Thijs, 2001) and
reducing the complications of HTN is an issue of great attention (Kearney, Whelton, Reynolds, Whelton, & He,
2004).
Alarmingly, very limited numbers of cardiac patients (8%) were aware about the correct definition of HTN and
majority of the patients (82%) did not know anything about this term. Less than 3% could identify the top and
bottom number of BP reading as systolic and diastolic correctly. This reveals poor awareness level of the
participants. This is fairly consistent with the findings of another Pakistani study which has also narrated
inadequate awareness among hypertensive patients (Zafar, Gowani, Irani, & Ishaq, 2008). However, this is
incompatible with the international studies conducted in China (Zhang et al., 2009) and USA (Ong & Cheung,
2007) which have reported improved awareness and knowledge. These differences in results could be attributed
to significant difference in literacy rates as more than half of the participants of our study had no education.
It was reassuring to see that majority of the patients were knowledgeable about the seriousness of the condition
to their health due to uncontrolled BP. Ninety percent of the patients knew that lowering BP would improve a
person's health and that they could lower their uncontrolled BP by adjusting their lifestyle. The results are in line
with the international study conducted by Susan et al. (Oliveria, Chen, McCarthy, Davis, & Hill, 2005). This
shows their willingness to improve their blood pressure, but due to inadequate knowledge they are unable to do
so.
During recent years, SBP has been recognized as the greatest causative agent for the morbidity and mortality
associated with CVD and stroke (Oliveria, Chen, McCarthy, Davis, & Hill, 2005). In several clinical trials it has
been demonstrated that a greater reduction in cardiovascular events occur with the treatment of elevated SBP
level (Staessen et al., 1997). The results of our study suggest that majority of our patients were unaware of the
importance of SBP with respect to management of their heart disease. When they were questioned about which
measure is more important, 51% reported DBP and only 8% answered SBP. Sixty-five percent of the patients did
not know the normal values of SBP or wrongly reported it as 140 mm Hg or greater. However, 77% of the
participants correctly quoted normal DBP as 90 mm Hg or less, which suggests that they are aware of the cut
point for DBP. Only very few people knew that top number is responsible for CVD. These findings are similar to
those of a study conducted on patients of Henry Ford Health System in Michigan (Oliveria, Chen, McCarthy,
Davis, & Hill, 2005). The results indicate that physicians must emphasize their patients on importance of
elevated SBP and cardiovascular risk.
A large number of participants considered salt intake as the risk factor to be associated with high BP, which is
evident from a study done on British population (Ashfaq, Anjum, Siddiqui, Shaikh, & Vohra, 2007) and in line
with findings of another Pakistani study (Beard, Blizzard, O'Brien, & Dwyer, 1997). Poor awareness was
associated with smoking, diabetes mellitus and alcohol intake which is further consistent with the study
conducted on hypertensive patients of Pakistan (Zafar, Gowani, Irani, & Ishaq, 2008). The local data has
reported an increase in alcohol consumption in Pakistan and regularity of smoking among adults (Ali,
Sathiakumar, & Delzell, 2006) and children (Rozi, Akhtar, Ali, & Khan, 2005). As a result, people must be
emphasized with the risk factors linked with diabetes mellitus, smoking and excess alcohol intake. A significant
number of patients were aware with the fact that stroke and CVD are complications of uncontrolled BP which is
similar to findings of Line Aubert (Aubert et al., 1998), Susan (Oliveria, Chen, Mccarthy, Davis, & Hill, 2005),
and a Pakistani study (Ashfaq, Anjum, Siddiqui, Shaikh, & Vohra, 2007). The results could be overestimated as
the study was conducted in cardiology OPD. Conversely, most of the patients were not aware about
complications related to eye, kidney, metabolic syndrome and trouble with memory which is consistent with
results of other researchers (Kearney et al., 2005). Prompt education of hypertensive patients on complications is
essential to increase their drug compliance. An international survey has revealed better drug compliance and
follow-up visit among patients who were aware with the morbidities and reduction in life expectancy associated
with high BP (Balazovjech & Hnilica, 1993).
Furthermore, patient’s regularity on visiting doctor for HTN and cardiologist for their cardiovascular exam,
including ECG and cholesterol level, and having home sphygmomanometer was found to be very low. The
results could be attributed to less affordability as most of the patients belonged to low socio-economic status.
The attitude of patients to bring about lifestyle changes like rhythmic exercise, weight reduction and less stress
was significantly less. This might be because of the perception that lifestyle changes have no impact on high BP
management as shown by Aubert (Kearney, Whelton, Reynolds, Whelton, & He, 2004). According to the study,
DASH diet and reduced salt intake improves BP control (Zafar, Gowani, Irani, & Ishaq, 2008) but participants of

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our study have shown extremely less compliance to these approaches. These results further evaluate insufficient
self-care practices of HTN among cardiac patients.
To the best of our knowledge, our research has comprehensively evaluated HTN knowledge especially related to
SBP among cardiac patients along with their self-care practices involved in the management of high BP.
However, there were a few limitations to our study. Most of the participants belonged to low socioeconomic
status and had no education. So the results cannot be generalized to the entire population. Secondly, our sample
does not include those who were unstable to attend cardiology OPD. Their views may vary over knowledge and
self-care practices of HTN. Apart from this we did not obtain the BP values from medical records for the
participants who could not recall their last BP reading.
5. Conclusion
According to our results, there is an inadequate general knowledge of hypertension in cardiac patients. Patients
do not recognize the significance of elevated SBP levels. The study helped us identify the areas that need to be
considered by the awareness programs. People should be encouraged to have their blood pressures checked
regularly, especially when they have a family history of hypertension. There is a need to initiate programs that
create community awareness regarding long-term complications of uncontrolled hypertension in cardiac patients,
particularly elevated SBP levels. Improvement in self-care practices can decrease the mortality rate associated
with hypertension.
Funding
There was no funding for this research.
Conflicts of Interest
The authors have no conflicts of interests to declare.
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