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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 4, July/August 2021
198
AFRICA
Knowledge, attitude and practice towards therapeutic
lifestyle changes in the management of hypertension in
Khartoum State
Ahmed Ali Abdalla
Abstract
Background:
Hypertension has long been recognised as a
major risk factor for coronary artery disease, stroke and
kidney disease. Despite a multitude of new pharmacological
agents, in the Sudan, a significant proportion of hypertensive
patients’ blood pressure remains uncontrolled. An important,
often underutilised treatment approach is therapeutic lifestyle
changes (TLC). This study aimed to assess the knowledge,
attitude and practice of patients with regard to TLC in the
management of hypertension in a Khartoum locality in 2016.
Methods:
The study was cross sectional and descriptive. Data
were collected via structured interviews using a question-
naire. Full coverage of patients attending Ahmed Gasim
and Al-Shaab hospitals for follow up during August and
September 2016 was carried out. Descriptive and inferential
statistics were utilised for data analysis.
Results:
We identified 112 patients for participation in this study.
There was a slight preponderance of females (54.5%) and older
age, with 58% in the 55- to 70-year age group. When assessed
for knowledge on lifestyle and habits that affect blood pressure,
respondents were most familiar with the fact that salt consump-
tion affects blood pressure, 93.8% answering correctly. After
knowledge scores were calculated, only 31.3% of participants
had above-average knowledge on blood pressure and TLC.
The lifestyle change the respondents were least adherent to was
regular exercise, with 59.8% of participants struggling with this.
Participants’ most-cited obstacle was lack of motivation, the
same answer being most frequent for each lifestyle change.
Conclusion:
This study demonstrated that although the hyper-
tensive patients were generally aware of the importance of
TLC in its management, they struggled to implement this.
The researcher believes that novel approaches are needed
to help motivate patients who are diagnosed with hyperten-
sion in a third-world country such as Sudan, and apply their
knowledge regarding TLC.
Keywords:
hypertension, lifestyle changes, Sudan, exercise, blood
pressure
Submitted 13/11/20, accepted 21/3/21
Published online 15/4/21
Cardiovasc J Afr
2021;
32
: 198–203
www.cvja.co.zaDOI: 10.5830/CVJA-2021-011
Hypertension is generally defined as sustained blood pressure
at rest above 140/90 mmHg or the need for antihypertensive
medication.
1
It has long been recognised as a major risk
factor for coronary artery disease, stroke and kidney disease.
Responsible for up to 50% of deaths worldwide, the prevalence
of hypertension has a large impact on the health economies of
both developed and developing countries.
2
Available data suggest
that Sudan has one of the highest incidences of hypertension
in Africa, with prevalence rates of 20% reported in the general
population.
3
Despite a multitude of new pharmacological agents, a
significant proportion of hypertensive patients’ blood pressure
remains uncontrolled in the Sudan.
4
An important, often
underutilised treatment approach is therapeutic lifestyle changes
(TLC). This involves the modification of certain aspects of
a patient’s lifestyle, mainly restricting sodium-rich foods,
weight loss, increased physical activity, smoking cessation and
moderation of alcohol intake.
5
Hypertension is a common, treatabledisease,withuncontrolled
hypertension having serious multisystem sequelae.
6
Considering
this and the global and local trends of increasing prevalence
of hypertension, ensuring compliance with antihypertensive
measures should be a high priority. In addition, given the
economic constraints due to the high cost and side-effect profile
of antihypertensive drugs, adoption of a healthy lifestyle remains
the cornerstone of hypertension management.
Understanding, implementation of and compliance with
TLC are challenging aspects in the management of hypertension
due to varying socio-economic backgrounds, education levels
and time afforded for consultations. This study examined these
factors to elucidate their relative association with compliance as
well as patients’ overall understanding of TLC. Understanding
these will allow physicians to emphasise aspects of TLC that are
poorly understood by patients, as well as highlighting potential
barriers to TLC implementation, in order to advise public health
policy.
Methods
This was a cross-sectional, descriptive, analytical study.
Hypertension clinics in Ahmed Gasim Hospital and El-Shaab
Teaching Hospital were utilised as the study area. The Ahmed
Gasim Hospital is a state hospital located in Khartoum North.
It has three specialities, paediatrics, renal and cardiology, but
no accident and emergency unit. It accepts referrals from other
hospitals. It currently has three cardiology wards with a total
of 30 beds, and two coronary care units (CCU) with a total of
20 beds. Cardiology referral clinics and echocardiography are
carried out every day of the week.
The El-Shaab Teaching Hospital is a government hospital
Manchester University NHS Foundation Trust, Manchester,
UK; Faculty of Medicine, University of Khartoum, Sudan
Ahmed Ali Abdalla, MB BS,
ahmed.abdalla2@nhs.net