Time to achieve blood pressure control and its predictors among hypertensive patients treated at public hospitals in Afar region, North-Eastern Ethiopia: A retrospective cohort study

Abstract

<title>Abstract</title> <bold>Background</bold> The timeframe from antihypertensive medication initiation to blood pressure (BP) control is an important yet underutilized measure of hypertension management. In Ethiopia, while studies have explored BP control rates, data on the time required to achieve control are limited. This study aimed to estimate time to BP control and identify predictors in Afar region of Ethiopia.<bold>Method</bold> A facility-based retrospective cohort study was conducted among adult hypertensive patients aged 18 years and older in five public hospitals between September 7, 2019 and January 8, 2023. Data were collected using a structured questionnaire, entered into EpiData version 3.1, and analyzed using Stata version 14.2. Kaplan-Meier survival analysis was used to estimate time to BP control. Cox regression analysis was applied to identify predictors of time to BP control. The adjusted hazard ratios (AHRs) and 95% confidence intervals (CIs) were computed at p &lt; 0.05<bold>Result</bold> A total of 443 hypertensive individuals were retrospectively followed, of which, 410 (92.6%) met the inclusion criteria. The median duration of follow-up was 10 month. The median age of the participants was 56 year. The median time to achieve BP control was 13 months (95% CI: 11⎼15). Factors associated with quicker BP control included combination therapy (AHR = 1.849, 95% CI: 1.276–2.679) and the absence of comorbidities (AHR = 1.86, 95% CI: 1.276–2.679). In contrast, factors leading to delayed BP control included age ≥ 60 years (AHR = 0.378, 95% CI: 0.236–0.605), severe hypertension (AHR = 0.626, 95% CI: 0.467–0.839), creatinine ≥ 1.5 mg/dL (AHR = 0.371, 95% CI: 0.173–0.799), and fasting blood sugar (FBS) ≥ 126 mg/dL; AHR = 0.335, 95% CI: 0.152–0.738).<bold>Conclusion</bold> The median time to BP control in this study exceeds recommendations from clinical trials and prior estimates. Combination therapy and the absence of comorbidities significantly reduce time to BP control, while advanced age, higher baseline BP, and elevated creatinine and FBS levels are linked to delayed BP control. Our findings highlight the necessity for enhanced counseling, management of comorbidities, regular end-organ evaluation, and use of combination therapies to expedite timely BP control.