Prevalence of suboptimal blood pressure, glycemic control, and associated factors among patients with diabetes and hypertension in primary health care facilities in Ghana: a multicenter retrospective cross-sectional study

Prevalence of suboptimal blood pressure, glycemic control, and associated factors among patients with diabetes and hypertension in primary health care facilities in Ghana: a multicenter retrospective cross-sectional study

Background
Hypertension and type 2 diabetes mellitus are major risk factors for cardiovascular disease and are common indications for adult in-patient admissions in Ghana. Primary health facility data on blood pressure (BP) and glycemic control are needed to model the impact of strategies to reduce the high burden of cardiovascular disease risk in Africa.

Methods
This retrospective cross-sectional study was conducted at four primary healthcare facilities in Ghana, from January 2023 to December 2023. Glycemic control was defined as fasting blood glucose < 7.0 mm/L, and BP control as < 140/90 mmHg for patients with only hypertension and < 130/80 mm/Hg for those with diabetes or both, per the Ministry of Health standard treatment guideline. Multivariate logistic regression analyses were conducted to assess associations between patient or facility-level factors and BP and glycemic control.

Results
Among the 1,503 adults, the mean age was 63 years (± 13.1). Participants were mostly females (1194; 79.4%) and had at least primary-level education (324; 32.7%). Most participants (866; 57.6%) had hypertension, less than half (506; 33.6%) had both hypertension and type 2 diabetes mellitus, and (131; 8.8%) had only type 2 diabetes mellitus. Median systolic blood pressure was 136.7 mmHg (IQR; 126.7 -149.7), and median diastolic blood pressure was 79.7 mmHg (IQR: (73.2–86.4), both higher in patients with hypertension and type 2 diabetes. Suboptimal BP and glycemic control were found in 58.3% (95% CI: 55.6–60.7%) and 72.6% (95% CI: 68.4–75.6%) of patients respectively. Complications affected 14.5% (n = 218) of patients, with peripheral neuropathy in 9.0%(n = 135) and 4.3% (n = 65) for retinopathy. In an adjusted multivariate analysis, education (AOR = 1.5, 95% CI: 1.1–2.0, p = 0.02), glycemic control status (AOR = 2.6, 95% CI: 2.0-3.5, P < 0.001) and facility ownership (AOR = 2.45, 95% CI: 1.91–3.101, p < 0.01) were associated with suboptimal BP control. For suboptimal glycemic control, associated factors included the presence of complications (AOR = 1.7, 95% CI: 1.0–2.9, p = 0.004), educational status (AOR = 1.9, 95% CI: 1.1–3.3, p = 0.01), and advanced age (> 60 years) (AOR = 1.5, 95% CI: 1.0–2.1, p = 0.04).

Conclusions
The prevalence of suboptimal blood pressure and glycemic control was high for patients accessing primary level healthcare. Age, education, and complications were associated with suboptimal blood pressure and glycemic control. Strategies to reduce the high burden of suboptimal blood pressure and glycemic control should address patient- and facility-level factors to improve treatment outcomes.