CHAPTER ONE

INTRODUCTION

1.1 Background

 Hypertension is a major risk factor of cardiovascular and cerebrovascular diseases and is associated with high degree of morbidity and mortality (Leonakis et al., 2012). Risk factors include unhealthy diets “with excessive salt consumption high saturated fats, low intake of fruits and vegetables”, physical inactivity, consumption of tobacco and alcohol, being overweight or obese, family history, age over 65 co existing disease like diabetes or kidney disease, which leads to cardiovascular diseases, It has no signs and symptoms but when the symptoms occur they include, morning headaches, nosebleed, irregular heart rhythms, blur visions and buzzing in the ears severe hypertension comes with nausea vomiting, confusion, anxiety, chest pain and muscle tremors(WHO 2021)

World Health Organization revealed on august 24 2021U that “the vast majority of people with high blood pressure, or hypertension, a serious medical condition that significantly increases the risk of heart, brain, kidney and other diseases live in low and middle incomes countries” Although it is straight forward to diagnose hypertension and relatively easy to treat the condition with low cost drugs, the study significant gaps in diagnosis and treatment, about 580million people with hypertension were unaware of their condition because they were never diagnosed. The study also indicated that more than half of people with hypertension, or total of 720million people, were not receiving the treatment that they needed (U.N 2021)

Globally, in 2015, 1.13 billion adults had hypertension and it contributed about 211.8 million disability adjusted life years (DALYS) (E.Gakidou et al., 2017). The mean blood pressure has been increasing in low- and middle-income countries while being declining or remaining unchanged in developed countries during period between 1975 and 2015. In 2015, sub-Saharan Africa had the highest burden of raised blood pressure compared with countries with the highest income (Roba, et al., 2019).

The global prevalence of high blood pressure (BP) in adults aged 18 years and older is 31.1%. Compared to developed countries, in low-to-middle-income countries, the incidence of hypertension (HTN) is increased, and awareness, treatment, and control of the disease are at low levels. (Tilea et al., 2018).

 Blood pressure control involves the implementation of a number of lifestyle modifications as well as the use of one or more antihypertensive drugs. Lifestyle modifications include (amongst others) adjustment of the diet, cessation of smoking, reduction of alcohol intake, weight reduction or control, increase in physical exercise, and stress management. Although lifestyle modifications are important, patients may also require one or more antihypertensive drug(s) to achieve effective blood pressure control. These drugs will have to be taken by the patient throughout his/her life. The most common complications of hypertension include stroke (cerebrovascular accident), ischemic heart disease, retinopathy, nephropathy, and peripheral vascular disease, which can be prevented or delayed by effective blood pressure control. In a study in Douala (2014), hypertension was found to be the most common risk factor for stroke in patients in Cameroon, with 81.2% of stroke victims found to have a positive history of hypertension (Akoko et al., 2017).

Between June 2016 and April 2017 the echocardiography register of the Buea Regional Hospital a  surveyed data was extracted on the age, sex and echocardiographic diagnosis. Out of 529 patients who underwent echocardiography, 239 (45.2%) had a definite heart disease. There were 137 (57.3%) females. The meanagewas58years(range3–94years).The most common echocardiographic diagnoses were hypertensive heart disease (43.2%), dilated cardiomyopathies (17.6%), ischemic heart diseases (9.6%) ,and corpulmonale (8.8%).Rheumatic heart disease affected 6.7% of the patients. The most common rheumatic heart disease was mitral stenosis followed by mitral regurgitation. Congenital heart disease represented 2.1% and 5 patients (2.1%) had pulmonary hypertension. Hypertensive heart disease is the most common cardiac disease in this semi-urban region in Cameroon. Rheumatic heart disease still affects a sizable proportion of patients. Prevention of cardiac disease in our setting should focus on mass screening, the treatment and control of hypertension (Nkoke et al., 2017)

1.2 Problem Statement

Worldwide hypertension affects approximately 25% of adult population and diabetes about 8.5%. Lack of adherence to prescribed treatment regimen remains a problem among patients undergoing long term treatment, showing high non adherence rates at estimated range 36 and 93% (Sandra et al., 2019). Also Studies on hypertension in sub-Saharan Africa have not targeted the elderly but generally agree on an increasing high prevalence that is higher among the aged (Dakoun et al., 2019) This research therefore sought to assess the factors that hinder adherence to hypertensive treatment by the elderly at the R.H.B.

1.3. Research Questions

1. What Knowledge do elderly patients aged 65 and above have on the adherence to hypertensive treatment
2. Do elderly patient that receive hypertensive treatment at the R.H.B adhere to their treatment regimen?
3. What are the factors that hinder adherence to treatment among elderly patients aged 65 and above receiving antihypertensive treatment at the R.H.B?

1.4. Objective

1.4.1 General Objective

 Assessing factors that hinder adherence to hypertensive treatment by elderly patients aged 65 and above at R.H.B

1.4.2. Specific Objectives

1. To assess the Knowledge on the adherence to hypertensive treatments by the elderly patients aged 65 and above at the R.H.B
2. To assess the adherence to treatment regimen of hypertensive patients at the R.H.B
3. Identifying factors that hinders adherence to treatment of hypertensive elderly patients at R.H.B