Role of family support and self-care practices in blood pressure control in individuals with hypertension; results from a cross sectional study in Kollam District, Kerala.

Background:
Despite the availability of effective drugs, blood pressure (BP) control rate
is sub-optimal in individual with hypertension in low and middle-income
countries (LMIC). The role of self-care in management of BP is less studied in
LMIC settings.

Methods:
We conducted a community-based, cross-sectional study in individuals with hypertension
in Kollam district, Kerala. A multistage cluster sampling method was used for
selection of study participants. We measured self-care by using an adapted
Hypertension self-care activity level effects (H-SCALE) scale. Descriptive
statistics were used to summarise the data and logistic regression analysis was
conducted to identify factors associated with BP control.

Results:
In total, 690 individuals with hypertension (women=60%) and a mean age of 57±8
years participated in the study. More than half (54%) of the participants were
adherent to anti-hypertensive medications. However, the adherence rate was much
lower for the DASH diet (12.8%), recommended level of physical activity (24%)
and weight management (11.4%). Overall BP control was achieved in two of five
individuals (38.4%, 95%CI: 34.7-42.0%). Among self-care activities, adherence
to medications (AOR: 1.8, 95%CI: 1.3-2.5), DASH diet (AOR: 1.5, 95%CI:
1.0-2.4),and non-smoking status (AOR: 3.3, 95%CI: 1.7-6.4) were associated with
control of BP. Additionally, family support to self-care (AOR: 1.9, 95% CI:
1.1-3.1) was associated with control of BP.

Conclusion: In individuals with hypertension, the BP
control rate is achieved in two of five individuals. Adoption of self-care
activities are sub-optimal. Both family support and adherence to self-care
activities are associated with BP control. Family based interventions to improve
adherence to self-care activities could have a significant public health impact
in achieving better population-level BP control rates in Kerala, India.