momina project

i
Patient Knowledge and Quality of
Life in Hypertensive Patients
By
Dr. Momina Khan jadoon
FA10-PHM-028/ATD
Pharm-D (Doctor of Pharmacy)
Project
In
Clinical Pharmacy
COMSATS Institute of Information Technology
Abbottabad – Pakistan

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Table of Contents
1: INTRODUCTION ..............................................................................................................................6
Background:...................................................................................................................................6
1.1.Patient quality of life:................................................................................................................6
1.1.2.Hypertension and HRQoL:.......................................................................................................6
1.1.3.Patient's knowledge: ..............................................................................................................6
1.1.4.Hypertension andits classification:..........................................................................................7
1.2.Epidemiology:...........................................................................................................................8
1.3. Prevalence:..............................................................................................................................9
Pakistan:........................................................................................................................................9
1.4. Pathophysiology:....................................................................................................................10
1.5 .Prevention:............................................................................................................................11
Signs and tests:.............................................................................................................................11
1.6.1.Medications:........................................................................................................................13
1.6.2. Hypertension diagnosis........................................................................................................13
1.7. Society and culture:................................................................................................................14
2.1. AIMS & OBJECTIVES:...............................................................................................................15
3.METHODS: ....................................................................................................................................15
3.1.Study Design:..........................................................................................................................15
3.2.Site and Participants:...............................................................................................................15
3.3.Inclusion Criteria:....................................................................................................................15
3.4.Exclusion Criteria:....................................................................................................................16
3.5.Scheme of Audit Population:....................................................................................................16
3.6.Data collection tool:................................................................................................................17
3.5.Accessment of Health related quality of life (HRQoL).................................................................17
3.5.1.Accessment of knowledge about HTN....................................................................................17
3.6. Data collection procedure.......................................................................................................17
3.7.Pilot study:..............................................................................................................................17
3.8.Outcome measures: ................................................................................................................18

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3.9.Proposed Timetable: ...............................................................................................................18
4.1. Quality of Life of Hypertensive Patients: ..................................................................................18
5.1. Characteristics of the audit population: ...................................................................................20
5.2.Corelation of EQ5D with different variables:.............................................................................20
5.3.General knowledge about symptoms of hypertension:..............................................................22
5.4. General knowledge about hypertension: .................................................................................23
5.5. Patient perception about risk factors of hypertension ..............................................................23
5.6. Patient knowledge about diagnosis of hypertension:................................................................24
5.7. Treatment options for hypertension:.......................................................................................24
Figure 6: showing treatment options for hypertension:.....................................................................24
5.8. Knowledge about hypertension control: ...................................................................................25
Figure 7:showing Knowledge about hypertension control ................................................................25
6. Discussion:...................................................................................................................................29
6.1. HTN knowledge, awareness and attitude:................................................................................29
7.Conclusion:....................................................................................................................................31
8. Limitations:...................................................................................................................................31
List of Tables:
Table 1: Table showing time frame of study period.............................................................................18
Table 2: Demographics .....................................................................................................................20
Table 3: correlation of EQ5D with other variables ..............................................................................21
List of Figures:
Figure 1: hypertension prevalance in pakistan.....................................................................................10
Figure 2: showing general knowledge about symptoms of hypertension ...............................................22
Figure 3: showing General knowledge about hypertension ..................................................................23
Figure 4: showing Patient perception about risk factors of hypertension ..............................................23
Figure 5 : showing Patient knowledge about diagnosis of hypertension: ...............................................24
Figure 6: showing treatment options for hypertension: ........................................................................24
Figure 7:showing Knowledge about hypertension control....................................................................25
Figure 8:showing mobility of patients ................................................................................................26
Figure 9: Showing self-care...............................................................................................................26
Figure 10: showing Usual Activities ..................................................................................................27

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Figure 11: showing Pain/ Discomfort.................................................................................................27
Figure 12 showing anxiety or depression............................................................................................28
Figure 13: showing patient health ......................................................................................................28

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ABSTRACT
The development of chronic conditions with decreased life expectancy can be disturbing for the
patients. Hypertension is apprehension significant chronic disease. It adversely affects patients’
every day activities and, hence it is reported that hypertensive patients have reduced HRQoL
scores. This study aimed to examine the association between disease related knowledge and
HRQoL in patients with HTN in Pakistan. The research was conducted to access patient’s
knowledge about hypertension, the information they have received on their medication,
hypertension control and quality of life of hypertensive patient. This study was designed as a
descriptive cross sectional analysis, which was conducted using a standard questionnaire. It
proved to be an effective way to achieve the objectives as it was easy to fill by the patient and
less time consuming. A prevalence based sample of 100 HTN patients was selected from
outpatient clinic of three tertiary care public hospitals of Abbottabad . The survey was distributed
over a period of four months. The Hypertension Fact Questionnaire (HFQ) and the European
Quality of Life scale (EQ-5D) were used for data collection. Extracted data was analyzed using
SPSS 16 (Statistical package for social sciences).

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1: INTRODUCTION
Background:
1.1.Patient quality of life:
Health Related Quality of Life (HRQoL) is defined as “a person’s perceived quality of life
representing satisfaction in those areas of life likely to be affected by health status” [1]. The
concept of HRQoL has being used by health care professionals to describe factors other than
illness affecting human health and its status . These different health dimensions help healthcare
professionals to understand patient perceptions of illness [2]. The development of chronic
conditions with decreased life expectancy can be disturbing for the patients [3]. The composite
nature of diseases has a traumatic effect on social and economic status of patients. Although
categorized as “controlled”, the feeling of being ill heavily imbalances HRQoL in patients
suffering from chronic illnesses. This in return, results in decreased patient satisfaction with
daily life activities. HRQoL has become an important tool for the assessment of treatment
outcomes from a patient perspective [4].
1.1.2.Hypertension and HRQoL:
Within the context of chronic diseases, hypertension (HTN) in particular is counted as a major
factor in decreasing life expectancy and disability-accustomed life years [5]. An estimated one
billion of the world’s population was diagnosed with HTN in year 2000 and this fraction is
estimated to increase to 29% by the year 2025 [6]. It is also estimated that around 7.1 million
people die each year due to complications of HTN [7]. This rising frequency of HTN is
becoming a major public health challenge for both developed and developing countries [8].
Hypertension is apprehension significant chronic disease because of its high incidence and risk
of developing associated cardiovascular disorders [9]. HTN adversely affects patients’ every day
activities and results in a decrease in self-confidence [10], hence it is reported that hypertensive
patients have reduced HRQoL scores [11-13].
1.1.3.Patient's knowledge:
In recent years, a growing demand to educate patients with chronic disorders has been reported
in the literature [14-16]. Several methods have been utilized to improve patients’ knowledge

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including; patient groups, published literature, specialist clinics, and the uptake of information
technology [17]. Although the provision of disease-related information to patients has been
considered good practice, it is not clear whether disease related knowledge has any impact on
patients’ HRQoL scores [17]. Therefore, the study aimed to examine the association between
disease related knowledge and HRQoL in patients with HTN in Pakistan.
1.1.4.Hypertension and its classification:
Blood pressure is usually classified based on the systolic and diastolic blood pressures. Systolic
blood pressure is the blood pressure in vessels during a heartbeat. Diastolic blood pressure is the
pressure between heartbeats. A systolic or the diastolic blood pressure measurement higher than
the accepted normal values for the age of the individual is classified as pre-hypertension or
hypertension.
Essential Hypertension:
Essential hypertension is the term for high blood pressure with unknown cause. It accounts for
about 95% of cases. Essential hypertension is the most prevalent hypertension type, affecting
90–95% of hypertensive patients. Although no direct cause has been identified, there are many
factors such as sedentary lifestyle, smoking, stress, visceral obesity, potassium deficiency
(hypokalemia), obesity(more than 85% of cases occur in those with a body mass index greater
than 25), salt (sodium) sensitivity, alcohol intake, and vitamin D deficiency that increase the risk
of developing hypertension. Risk also increase with aging, some inherited genetic mutations, and
having a family history of hypertension. An elevated level of rennin, a hormone secreted by the
kidney, is another risk factor, as is sympathetic nervous system over activity. Insulin resistance is
also thought to contribute to hypertension. Recent studies have implicated low birth weight as a
risk factor for adult essential hypertension [9] [10] [11].
Secondary hypertension:
Secondary hypertension by definition results from an identifiable cause. This type is important to
recognize since it's treated differently to essential hypertension, by treating the underlying cause
of the elevated blood pressure. Hypertension results in the compromise or imbalance of the
pathophysiological mechanisms, such as the hormone-regulating endocrine system, that regulate
blood plasma volume and heart function. Many conditions cause hypertension. Some are

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common, well-recognized secondary causes such as Reno vascular hypertension and Cushing's
syndrome, which is a condition where the adrenal glands overproduce the hormone cortisol.
Secondary hypertension is the term for high blood pressure with a known direct cause, such as
kidney disease, tumors, or birth control pills.
Additional classifications:
Hypertension has several sub-classifications, including hypertension stage I, hypertension stage
II, and isolated systolic hypertension. Isolated systolic hypertension refers to elevated systolic
pressure with normal diastolic pressure and is common in the elderly. These classifications are
made after averaging a patient's resting blood pressure readings taken on two or more office
visits. Individuals older than 50 years are classified as having hypertension if their blood
pressure is consistently at least 140 mmHg systolic or 90 mmHg diastolic. Patients with blood
pressures higher than 130/80 mmHg with concomitant presence of mellitus or kidney disease
require further treatment.
Hypertension is also classified as resistant if medications do not reduce blood pressure to normal
levels [9].
Exercise hypertension is an excessively high elevation in blood pressure during exercise. The
range considered normal for systolic values during exercise is between 200 and 230 mm Hg.
Exercise hypertension may indicate that an individual is at risk for developing hypertension at
rest [9] [10] .
1.2.Epidemiology:
In the year 2000 it is estimated that nearly one billion people or ~26% of the adult population
had hypertension worldwide. It was common in both developed (333 million) and undeveloped
(639 million) countries. However rates vary markedly in different regions with rates as low as
3.4% (men) and 6.8% (women) in rural India and as high as 68.9% (men) and 72.5% (women) in
Poland [22].
In 1995 it is estimated that 43 million people in the United States had hypertension or were
taking antihypertensive medication, almost 24% of the adult population. The prevalence of
hypertension in the United States is increasing and reached 29% in 2004 [18]. It is more common

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in blacks and Native Americans and less in whites and Mexican Americans, rates increase with
age, and is greater in the southeastern United States. Hypertension is more prevalent in men
(though menopause tends to decrease this difference) and those of low socioeconomic status [2].
Over 90–95% of adult hypertension is essential hypertension [2]. One of the most common
causes of secondary hypertension is primary aldosteronism [23]. The incidence of exercise
hypertension is reported to range from 1–10% [11].
1.3. Prevalence:
Globally, the overall prevalence of raised blood pressure in adults aged 25 and over was around
40% in 2008. The proportion of the world’s population with high blood pressure, or uncontrolled
hypertension, fell modestly between 1980 and 2008. However, because of population growth and
ageing, the number of people with uncontrolled hypertension rose from 600 million in 1980 to
nearly 1 billion in 2008
Across the WHO regions, the prevalence of raised blood pressure was highest in Africa, where it
was 46% for both sexes combined. Both men and women have high rates of raised blood
pressure in the Africa region, with prevalence rates over 40%. The lowest prevalence of raised
blood pressure was in the WHO Region of the Americas at 35% for both sexes. Men in this
region had higher prevalence than women (39% for men and 32% for women). In all WHO
regions, men have slightly higher prevalence of raised blood pressure than women. This
difference was only statistically significant in the Americas and Europe.
Pakistan:
According to the National health survey conducted in 1990-94, 23% of urban population and
18% of rural population more than 15 years of age suffer from hypertension (systolic blood
pressure ≥ 140 mm of Hg and diastolic ≥ 90 mm of Hg). Ethnic subgroup differences depict that
it is most prevalent in Baluchistan followed by Pashtuns, Muhajirs, Punjabis and lowest amongst
Sinddhis (Figure 1). 1 Extrapolating this burden to the population of Pakistan at present,
approximately 21 million people has hypertension at present.
Prevalence studies of hypertensive patients

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Figure 1: hypertension prevalance in pakistan
1.4. Pathophysiology:
Most of the mechanisms associated with secondary hypertension are generally fully understood.
However, those associated with essential (primary) hypertension are far less understood. What is
known is that cardiac output is raised early in the disease course, with total peripheral resistance
(TPR) normal; over time cardiac output drops to normal levels but TPR is increased. Three
theories have been proposed to explain this:
 Inability of the kidneys to excrete sodium, resulting in natriuretic factors such as
Atrial Natriuretic Factor being secreted to promote salt excretion with the side
effect of raising total peripheral resistance.
 An overactive Renin-angiotensin system leads to vasoconstriction and retention of
sodium and water. The increase in blood volume plus vasoconstriction leads to
hypertension.
 An overactive sympathetic nervous system, leading to increased stress responses
[13].
It is also known that hypertension is highly heritable and polygenic (caused by more than one
gene) and a few candidate genes have been postulated in the etiology of this condition [14].

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If blood pressure is successfully lowered, it is wise to have frequent checkups and to take
preventive measures to avoid a relapse of hypertension.
1.5 .Prevention:
Hypertension can best be prevented by adjusting your lifestyle so that proper diet and exercise
are key components. It is important to maintain a healthy weight, reduce salt intake, reduce
alcohol intake and reduce stress.
In order to prevent damage to critical organs and conditions such as stroke, heart attack, and
kidney failure that may be caused by high blood pressure, it is important to screen, diagnose,
treat, and control hyper tension in its earliest stages. This can also be accomplished by increasing
public awareness and increasing the frequency of screenings for the condition [15]
Signs and tests:
Our health care provider will check our blood pressure several times before diagnosing us with
high blood pressure. It is normal for our blood pressure to be different depending on the time of
day.
Blood pressure readings taken at home may be a better measure of our current blood pressure
than those taken at our doctor's office. Make sure we get a good quality, well-fitting home
device. It should have the proper sized cuff and a digital readout.
Our doctor will perform a physical exam to look for signs of heart disease, damage to the eyes,
and other changes in our body.
Tests may be done to look for:
• High cholesterol levels
• Heart disease, such as an echocardiogram or electrocardiogram
• Kidney disease, such as a basic metabolic panel and urinalysis or ultrasound of the
kidneys
Complications:
When blood pressure is not well controlled, we are at risk for:

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• Bleeding from the aorta, the large blood vessel that supplies blood to the abdomen,
pelvis, and legs
• Chronic kidney disease
• Heart attack and heart failure
• Poor blood supply to the legs
• Stroke
• Problems with our vision
1.6. Treatment:
Lifestyle modifications
The first line of treatment for hypertension is identical to the recommended preventive lifestyle
changes and includes:
 Dietary changes
 Physical exercise
 Weight loss
These have all been shown to significantly reduce blood pressure in people with hypertension. If
hypertension is high enough to justify immediate use of medications, lifestyle changes are still
recommended in conjunction with medication. Drug prescription should take into account the
patient's absolute cardiovascular risk (including risk of myocardial infarction and stroke) as well
as blood pressure readings, in order to gain a more accurate picture of the patient's cardiovascular
profile [5]. However, in general claims of efficacy are not supported by scientific studies, which
have been in general of low quality. [16].
It also generally encourages the consumption of nuts, whole grains, fish, poultry, fruits and
vegetables while lowering the consumption of red meats, sweets, and sugar. It is also "rich in
potassium, magnesium, and calcium, as well as protein" [17].

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1.6.1.Medications:
Several classes of medications, collectively referred to as antihypertensive drugs, are currently
available for treating hypertension. Reduction of the blood pressure by 5 mmHg can decrease the
risk of stroke by 34%, of ischemic heart disease by 21%, and reduce the likelihood of dementia,
heart failure, and mortality from cardiovascular disease [18]. The aim of treatment should be to
reduce blood pressure to <140/90 mmHg for most individuals, and lower for individuals with
diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80
mmHg) [19]. If the blood pressure goal is not met, a change in treatment should be made as
therapeutic inertia is a clear impediment to blood pressure control. Co morbidity also plays a role
in determining target blood pressure, with lower BP targets applying to patients with end-organ
damage or proteinuria [5].
The first line antihypertensive supported by the best evidence is a low dose thiazide-based
diuretic [20].
Often multiple medications are needed to be combined to achieve the goal blood pressure.
Commonly used prescription drugs include: ACE inhibitors, alpha blockers, angiotensin II
receptor antagonists, beta blockers, calcium channel blockers, diuretics (e.g.
hydrochlorothiazide), direct renin inhibitors and Glyceryltrinitrates which has the activity of
vasodilatation, thus controlling high blood pressure.
1.6.2. Hypertension diagnosis
Hypertension may be diagnosed by a health professional who measures blood pressure with a
device called a sphygmomanometer - the device with the arm cuff, dial, pump, and valve. The
systolic and diastolic numbers will be recorded and compared to a chart of values. If the pressure
is greater than 140/90, you will be considered to have hypertension.
If hypertension seems reasonable, tests such as electrocardiograms (EKG) and echocardiograms
will be used in order to measure electrical activity of the heart and to assess the physical
structure of the heart. Additional blood tests will also be required to identify possible causes of
secondary hypertension and to measure renal function, electrolyte levels, sugar levels, and
cholesterol levels.

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1.7. Society and culture:
Economics:
The National Heart, Lung, and Blood Institute (NHLBI) estimated in 2002 that hypertension cost
the United States $47.2 billion [22].
High blood pressure is the most common chronic medical problem prompting visits to primary
health care providers, yet it is estimated that only 34% of the 50 million American adults with
hypertension have their blood pressure controlled to a level of <140/90 mm Hg [22]. Thus, about
two thirds of Americans with hypertension are at increased risk for heart disease. The medical,
economic, and human costs of untreated and inadequately controlled high blood pressure are
enormous. Adequate management of hypertension can be hampered by inadequacies in the
diagnosis, treatment, and/or control of high blood pressure . Patients also face the challenges of
adhering to medicine schedules and making lifestyle changes. Nonetheless, the achievement of
blood pressure goals is possible, and most importantly, lowering blood pressure significantly
reduces the risk of death due to heart disease, the development of other debilitating conditions,
and the cost associated with advanced medical care [23].
Awareness:
The World HealthOrganizationattributeshypertension,or high blood pressure, as the leading cause of
cardiovascular mortality. The World Hypertension League (WHL), an umbrella organization of 85
national hypertension societies and leagues, recognized that more than 50% of the hypertensive
populationworldwide is unaware of their condition [42]. To address this problem, the WHL initiated a
global awareness campaign on hypertension in 2005 and dedicated May 17 of each year as World
HypertensionDay(WHD).In2007, there wasrecord participationfrom47 membercountriesof the WHL.
Duringthe weekof WHD, all these countries –in partnershipwiththeirlocal governments, professional
societies,nongovernmental organizations and private industries – promoted hypertension awareness
among the public through several media and public rallies. Using mass media such as Internet and
television, the message reached more than 250 million people. As the momentum picks up year after
year, the WHL is confident that almost all the estimated 1.5 billion people affected by elevated blood
pressure can be reached.

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2: Subjects & Methods:
2.1. AIMS & OBJECTIVES:
Aims:
The aim of this research project is assessment of patient’s knowledge about hypertension and to
assess quality of life of hypertensive patient.
Objectives:
To assess patient knowledge about general knowledge of hypertension, diagnosis, risk factors,
treatment alternatives and control of hypertension.
• To assess patient quality of life using hypertension fact questionnaire and EQ-5D a validated
form constituted by European quality of life scale to access a person’s quality of life.
• To assess the effect of patient knowledge on the quality of life.
3.METHODS:
3.1.Study Design:
This study was designed as a descriptive cross sectional study, using a standard questionnaire.
3.2.Site and Participants:
Sample of 100 HTN patients was collected from hospitals i.e., Ayub Hospital Abbottabad ,DHQ
ATD, AL SYED Hospital ATD.
3.3.Inclusion Criteria:
•Patients above 20 years of age were included in the study, with confirmed diagnosis of HTN.
•Patients who were prescribed antihypertensive drugs.
•Patients who had minimum qualification of primary education (class 5) were included in this
study who could understand the questionnaire.

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3.4.Exclusion Criteria:
•Patients who were illiterate or unwilling to complete the questionnaire.
•Patients aged below 20years and immigrants from other countries , pregnant/nursing women
.and emergency patients were excluded from study.
3.5.Scheme of Audit Population:
All patients meeting on
Inclusion criteria (100)
Patients who did not
returned
the form or were lost
on
follow-up
(1)

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3.6.Data collection tool:
The Hypertension Fact Questionnaire (HFQ) and the European Quality of Life scale (EQ-5D)
were used for data collection. Demographic and disease related information was also collected.
All instruments were pre-tested for reliability and validity. Data from the pre-test evaluation was
not included in the final analysis. The data obtained were verified and scrutinized for
completeness and accuracy.
3.5.Accessment of Health related quality of life (HRQoL)
EQ-5D is a standardized instrument for use as a measure of health outcome and provides a
simple descriptive profile and a single index value for health status [21]. It is composed of two
portions. The EQ-5D tool consists of five domains (mobility, self-care, usual activities,
pain/discomfort, and anxiety/depression). Three levels of severity (no problems/some or
moderate problems/extreme problems) are able to be selected from within a particular EQ-5D
dimension. The second portion of the EQ-5D consists of a health virtual analogue the best
imaginable health state (score of 100) and the worst imaginable health state (score of 0) and is
known as the VAS (visual analog scale) [21]
3.5.1.Accessment of knowledge about HTN
The HFQ was originally constructed in English and translated into Urdu by an independent
professional translator. As the process of development and validation was completed, the final
version was reviewed and approved by the researchers. The HFQ consists of 15 items which was
used to assess patients’ knowledge towards causes, treatment and management of HTN. The
instrument was constructed after an intensive literature review [22, 23] and measured knowledge
with a cut off scores of < 8 as poor, 8-12 average and 13-15 as an adequate knowledge [24]. The
mean knowledge of the cohort was calculated for the final analysis
3.6. Data collection procedure:
Our survey involved patients who are meeting our inclusion criteria and are able to respond
properly. At the end of data collection procedure, survey will be enter into SPSS for analysis.
3.7.Pilot study:
Pilot study was conducted to see any difficulty faced. No changes were made in questioner

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3.8.Outcome measures:
 Patient knowledge about hypertension.
 Patient perceptions about control of hypertension.
 Hypertensive patient quality of life
 The effect of patient knowledge on the quality of life
3.9.Proposed Timetable:
This audit will be completed within 4 months period. When each component will be conducted is
predicted in Table 2 below.
Table 1: Table showing time frame of study period
# Steps Time Frame
1
Preparation of study design,
methodology and data collection tool
2th
April, 2015
2 Survey data collection and entry 21st
May, 2015
3
Analysis of survey results and report
writing
9th June, 2015
4 Final submission June, 2015
4.1. Quality of Life of Hypertensive Patients:
The WHO conceptualizes quality of life as “an individual’s perception of their position in life, in
the context of culture and system of values in which they live and in relation to their goals,
expectations, standards and concerns.” QOL serves as an indicator in clinical trials for specific
diseases, assesses the physical and psychosocial impact that the disorders may have on affected
individuals, allowing a better knowledge about the patient and their adaptation to their unhealthy
condition. There is a variety of instruments to assess Health-Related Quality of Life (HRQOL).

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These allow us to evaluate the impact of a chronic illness on the patient’s life and offer a type of
treatment outcome based on the individual’s own perception of their general health condition.
The objective of this study is to identify and measure the QOL of hypertensive patients in
treatment, using two instruments. Assessing QOL is of essence, as this concept serves as an
indicator in clinical trials for specific diseases, assesses the physical and psychosocial impact that
the disorders may have on affected individuals, allowing a better knowledge about the patient
and their adaptation to their unhealthy condition. It has been reported that hypertensive patients
had a significant reduction in QOL compared to normotensive patients.
As the results indicate all the patients included in the study had BP higher than 120/80mmHg
even they had HTN not less than year in most of the cases and were on medication. More than
half of the population selected for study mentioned that their life’s normal activities were
affected by the disease. The major function affected was their physical functioning along with
mental health, emotional role and social functioning.
The study suggested that most of people had signs and symptoms like headache, facial flushing,
fatigue and excessive sweating which is indicative of the fact that their quality of life is
compromised due to the disease.
If the quality of life is related with the awareness it can be well understood that the compromise
on QOL is majorly attributed with little awareness about the HTN and is management. Although
most of the people were on medication but the beneficial effects of therapy were not observed
from their QOL which is indicative of their lack of knowledge about various factors that
contribute towards the failure of therapy to provide utmost goals of better living.
The study is suggestive that if a link is created between the awareness of disease and quality of
life it could be interpreted that the knowledge has direct impact on overall quality of life. If a
patient is not aware what conditions he is going through and what means he can adopt to live
with that disease and still have a quality life no treatment regimen can help him alone to achieve
that. This study indicated that very important information regarding diet and physical activity
which could help to manage HTN and improve QOL is not known by majority of population.

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The statistics achieved after this study were quite alarming as according to exclusion criteria no
illiterate patient was included in the study if this much high percentage of patients among the
sample group who are literate are unaware of their condition and its impact on their QOL than
the in illiterate people which constitute more than half of population of Pakistan this would be
alarming condition
5.1. Characteristics of the audit population:
Table 2: Demographics
Variables Variable
respondents
(1)
Variable
respondents
( 2)
Variable
respondents
(3)
Variable
respondents
(4)
Age 17%
(20-40yrs)
42%
(40-60yrs)
41%
(>60years)
Gender 38%
(Male)
62%
(female)
Martial status 79%
(married)
19%
(unmarried)
2%
(divorced)
No of children 24%
(1-2)
31%
(3-4)
45%
(>4)
Live with family or
not
98%
(yes)
2%
(no)
Education 33%
(primary)
32%
(secondary)
35%
(Graduate)
Occupation 22%
(house wife)
34%
(teachers)
44%
(others)
Income 24%
(<10,000)
27%
(10-25000)
49%
(>25000)
Locality 33%
(DHQ ATD)
44%
(ATH)
23%
(ALSAYED)
Years ofdisease 37%
(1-5yrs)
30%
(5-10yrs)
21%
(10-20yrs)
12%
(>20yrs)
5.2.Corelation of EQ5D with different variables:
Using Spss 19.0 we applied Chi square to obtain p value which signifies or not signifies the
relationship of EQ5-D scored with different variables to show whether they are dependent or
independent of each other. Firstly we set the confidence interval at 95%, and concluded a null

21
hypothesis that mans if p<5% that is 0.05 the relationship will be significant and null hypothesis
H̊ will be rejected which means both variables are independent of each other
Table 3: correlation of EQ5D with other variables
EQ5D SCORE
Variables p-value p<0.05 Significant/not
significant
Conclusion
Years 0.001 0.001<0.05 Significant Dependent
Age 0.000 0.000<0.05 significant Dependent
Gender 0.284 0.284>0.05 Not-significant Independent
Income 0.094 0.094>0.05 Not-significant Independent
Live with family
or without
family
0.065 0.065>0.05 Not-significant Independent
Education 0.160 0.160>0.05 Not-significant Independent
Comorbidities 0.678 0.678>0.05 Not-significant Independent
Average B.P 0.755 0.755>0.05 Not-significant Independent
As our questioner was divided into different portions to check patient knowledge about
 General knowledge about hypertension
 General knowledge about symptoms of hypertension
 Patient perceptions about symptoms of hypertension
 Patient knowledge about diagnosis of hypertension
 What treatment patient think is best to treat hypertension
 Patient knowledge about hypertension control

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 And patient quality of life: This sections consist of five domains including MOBILITY
,SELF CARE , USUAL ACTIVITIES, PAIN/ DISCOMFORT ,
ANXIETY/DEPRSSION.
5.3.General knowledge about symptoms of hypertension:
Figure 2: showing general knowledge about symptoms of hypertension
86
28
45
85
73
66
63
14
51
37
15
27 26 24
21
18
8
13
0
10
20
30
40
50
60
70
80
90
100
headache nose bleed facial flushing fatigue nervousness excssive
sweating
frequent
urination
yes no don’t know

23
5.4. General knowledge about hypertension:
Figure 3: showing General knowledge about hypertension
5.5. Patient perception about risk factors of hypertension
Figure 4: showing Patient perception about risk factors of hypertension
88
69
80
12
24
12
7 8
0
10
20
30
40
50
60
70
80
90
100
Blood pressure Normal range checking of b.p
yes no don’t know
42
12
20
51
30
59
23
32
15
23
37
71
32
46
31
23
33
17
3
7
34
3
100
33
0
20
40
60
80
100
120
women man youngsters old people pragnant
women
familial disease
strongly agree agree don’t know disagree strongly disagree

24
5.6. Patient knowledge about diagnosis of hypertension:
Figure 5 : showing Patient knowledge about diagnosis of hypertension:
5.7. Treatment options for hypertension:
Figure 6: showing treatment options for hypertension:
15
10
59
2121
11
39
21
42
52
2
44
16
21
8
6 6 6
0
10
20
30
40
50
60
70
Blood test chest X-ray blood pressure machine urine test
89
29
34
94
74
9
34 36
6
60
2
37
30
10
0
10
20
30
40
50
60
70
80
90
100
doctor medication homeopathic
medication
herbal medication prayers and
reciting Quran
taweez damm and
spirtual he
agree don’t know disagree

25
5.8. Knowledge about hypertension control:
Figure 7:showing Knowledge about hypertension control
83 83
92 92
96
6
10
6 6 4
11
7
2 2
0
20
40
60
80
100
120
daily exercise quitting smoke reducing salt
intake
by avioing meet
and fatty meals
by taking
medicines in time

26
5.9. Patient quality of life:
Figure 8:showing mobility of patients
Figure 9: Showing self-care
29 31 33
7
71 69 67
93
0
10
20
30
40
50
60
70
80
90
100
no problem in walking slight problem moderate problem unable to walk
yes no don’t know
36
24 21
17
2
64
76 79
83
98
0
20
40
60
80
100
120
no problem in
washing or
dressing
slight problem moderate problem severe problem unable to wash
yes no don’t know

27
Figure 10: showing Usual Activities
Figure 11: showing Pain/ Discomfort
27 25
37
100
11
73 75
63
1
89
0
20
40
60
80
100
120
no problem
indoing ususal
activities
slight problem moderat e
problem
severe problem unable to do my
usual activities
yes no don’t know
7
47
29
11
6
93
53
71
89
94
0
10
20
30
40
50
60
70
80
90
100
no pain slight pain moderate pain severe pain extreme pain
yes no don’t know

28
Figure 12 showing anxiety or depression
Figure 13: showing patient health
23
39
26
4
8
77
61
74
96
92
0
20
40
60
80
100
120
not anxious or
depressed
slightly moderate severe extremely
yes no don’t know
poor health moderate health good excellent
Column1 16 23 39 22
0
5
10
15
20
25
30
35
40
45
AxisTitle
Column1

29
6. Discussion:
6.1. HTN knowledge, awareness and attitude:
A descriptive survey was conducted to understand the current status of HTN knowledge,
awareness, and quality of life in a group of hypertensive patients. Our results suggest that
patients are knowledgeable about HTN in general, but are less knowledgeable about specific
factors related to their condition, and specifically their own level of BP control. The maximum
duration of HTN was 1-5 years, suggesting that their quality of life was not much effected.
Further, some patients did not know their BP value nor could they accurately report whether it
was elevated.
Few among all patients were knowledgeable about the meaning of HTN while about the
seriousness of the condition to their health many were aware but this awareness was variable
from patient to patient.These findings of data suggest that there has been an increase in BP
awareness comparative to the previously conducted surveys in Pakistan but not to the level that
is beneficial for proper management and control.
Improved recognition of the importance of awareness of disease and its impact on quality of life
has been identified in recent years as one of the major public health and medical challenges in
the prevention and treatment of HTN because of the potential impact on the morbidity and
mortality associated with other complication associated with HTN. This is the first study in KPK
that provides information on the current state of patient knowledge and awareness with respect to
that. The importance of hypertension awareness and knowledge and the potential impact of BP
education programs have been reported on recently worldwide. Patients who were aware that
elevated BP levels lead to reductions in life expectancy had a higher compliance level with
medication use and follow-up visits than patients without this awareness. Surveys of
hypertensive patients in three hospitals of Abbottabad showed that lack of knowledge concerning
effects on quality of life. Reductions and improved medication-use compliance can be achieved
through an education program that stress, in part, “knowing high BP and its management and
impact on life.” This report can be used as a starter to improvised community based awareness of
HTN to achieve ultimate goals of better quality life.

30
An opportunity exists to use pharmacies as the center for creating such kind of wide community
awareness about the disease by recognizing the role which pharmacist could play in creating
awareness about the condition and the integral help they can offer to improve quality of life. In
this study, physicians were important sources of information as reported by the patients. The
pharmacists have also been identified as a major source of patient information in studies
conducted worldwide and represents an important opportunity to influence patient knowledge,
awareness, and attitudes toward HTN control.
No other study to our knowledge has comprehensively accessed patient HTN knowledge,
awareness, attitudes, and actual BP readings with a focus on pharmacist role to achieve that in
this region.
There are several limitations to this study. The selection of a single region within the KPK in
which to conduct this study may limit the generalize ability of these findings to populations with
limited access to other areas. Furthermore, the hypertensive patient population represented in our
sample does not include those who were illiterate their knowledge and awareness may be very
different to what we achieved through this sample size nor we included the people who were
very sick and had life threatening diseases whose cause may be unmanaged HTN.
The method we used to screen and identify patients with HTN may have missed some patients
with HTN. However, our goal was not to access the prevalence of HTN but to identify a group of
hypertensive patients to describe awareness, knowledge, and attitudes. We have utilized this
approach to identify and define patients with HTN using medical records previously.
There is no standardized instrument available to access HTN knowledge, awareness, and
attitudes. We utilized the existing literature, practicing physicians, and experts in the field of
HTN and the suggested criteria to access patient quality of life. To design a data collection
instrument that would be comprehensive. We did not attempt to create an overall score or index
for the results of these data, as we believe each question provides important information related
to the study questions. Creating an overall score or index may impose an artificial significance
on the results of some questions.
To achieve the ultimate goal of improving health by controlling HTN, it is important to fully
understand the current status of patient knowledge, awareness, and attitudes with respect to

31
HTN. It is necessary to understand these patient factors to develop effective strategies and
interventions that enlist the patient as a participant in the management of their health.
7.Conclusion:
A sample of 100 patients was taken from which 16% patients were having poor quality of life,
23% of patients were having moderate quality of life,39% of patients were having good quality
of life,22% was having excellent quality of life.
Among all 42% were between 40-60 years of age,62% were female,79% were married,98% live
with family,35% were graduate,37% were suffered from 1-5 years.
Results shows that most of the patients were graduate and having less years of disease i.e. 1-5
years also have good knowledge about hypertension that’s why we can say that their quality of
life was good.
8. Limitations:
Time frame was insufficient that’s why we could not collect data of more than 100 patients.
Some of the patients were not willing to fill the questionnaire.
There was difficulty in patient understanding about the questions and therefore verbal
understanding was given to the patient which resulted in a time consuming lengthy encounter

32
9. References:
1. Kearney PM, Wheaton M, Reynolds K, Muntner P,Whelton PK, He J. Global burden of
hypertension: analysis of worldwide data. Lancet. 2005; 365: 217-223.
2. Singh RB, Suh IL, SinghVP, et al. Hypertension and stroke in Asia: prevalence, control and
strategies in developing countries for prevention. J Hum Hypertens. 2000; 14:749–763.
3. Susan A, Roland S, Bruce D, Catherine, Martha N. Hypertension Knowledge, Awareness,
and Attitudes in a Hypertensive Population. J Gen Intern Med. 2005; 20: 219–225.
4. Peter B, Michael B, Massimo V, Bobby V. A Global Perspective on Blood Pressure
Treatment and Control in a Referred Cohort of Hypertensive Patients. The Journal of Clinical
Hypertension.2010: 12,666–677.
5. Palaian S, Prabhu M, Shankar PR. Patient Counseling By Pharmacist -A Focus on Chronic
Illness. Pak. J.
6. Pharm. Sci. 2006; 19(1): 62-65.
7. Testa MA, Simonson DC. Assessment of quality-of life outcomes, Engl J Med. 1996; 334:
835–840.
8. Development of the World Health Organization WHOQOL-BREF quality of life assessment.
The WHOQOL Group Psychol Med. 1998; 28 (3): 551-8.
9. Ogunlana MO, Adedokun B, Dairo MD, Odunaiya NA. Profile and predictor of health-
related quality of life among hypertensive patients in south-western Nigeria. BMC
Cardiovascular Disorder. 2009; 9:25.
10. Cavalcante MA, Bombig MTN, Filho BL, Carvalho ACC, Paola AAV, Povao R et al.
Quality of Life of Hypertensive Patients Treated at an Outpatient Clinic. Arq Bras Cardiol.
2007; 89(4):245-50.
11. Wilson IR, Cleary PD. Linking Clinical Variables with Health related Quality of life: a
conceptual model of patient’s outcomes. JAMA 1995; 273:59-65.
12. Li W, Liu L, Puente JG, et al. Hypertension and health-related quality of life: an
epidemiological study in patients attending hospital clinics in China. J Hypertens 2005;
23(9):1635-6.
13. Hill MN, Bone LR, Kim MT, Miller DJ, Dennison CR, Levine DM. Barriers to hypertension
care and control in young urban Black men. Am J Hypertens. 1999; 12:951–958.
14. Miller NM, Hill MN, Kottke T, Oekene IS. The multilevel compliance challenge:
recommendations for a call to action. Circulation.1997; 95:1085–1090.
15. Opie LH, Seedat YK. Hypertension in Sub-Saharan African Populations. Circulation.2005;
112:3562–3568.
16. Campbell NR, So L, Amankwah E, Quan H, Maxwell C. Characteristics of hypertensive
Canadians not receiving drug therapy. Can J Cardiol. 2008; 24:485–90.
17. Neutel CI, Campbell NR. Changes in lifestyle after hypertension diagnosis in Canada. Can J
Cardiol. 2008; 24:199–204.

33
18. Cromwell J, Bartech WJ, Fiore MC, Hassel lad V, Baker T. Cost-effectiveness of the clinical
practice recommendations in the AHCPR guideline for smoking cessation. JAMA. 1997;
278:1759–66.
19. Appel LJ, Champagne CM, Harsha DW, et al. Effects of comprehensive lifestyle
modification on blood pressure control. Main results of the PREMIER clinical trial.JAMA.
2003; 289:2083–93.
20. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh
report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure. Hypertension. Dec 2003; 42(6):1206-52
21. American Diabetes Association. Standards of medical care in diabetes-2011. Diabetes Care.
Jan 2011; 34Suppl 1:S11-61.
22. Redon J, Cifkova R, Laurent S, Nilsson P, Narkiewicz K, Erdine S, et al. Mechanisms of
hypertension in the cardio metabolic syndrome. J Hypertens. Mar 2009; 27(3):441-51.
23. Bianchi S, Bigazzi R, Campese VM. Microalbuminuria in essential hypertension:
significance, pathophysiology, and therapeutic implications. Am J Kidney Dis. Dec 1999;
34(6):973-95.

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