Prevalence and correlates of uncontrolled hypertension and cardiovascular morbidity among patients with hypertension at the largest tertiary care hospital in Sri Lanka

Introduction
Hypertension is the leading preventable cause of cardiovascular morbidity and
mortality globally, with a disproportionate impact on low- and middle-income countries
like Sri Lanka. Effective blood pressure (BP) control improves outcomes in patients
with hypertension. This study aimed to assess the prevalence of uncontrolled
hypertension, and its correlates among Sri Lankan patients with hypertension in clinic
settings.
Methods
A cross-sectional study was done at the largest tertiary care hospital in Sri Lanka and
patients with hypertension presenting to its medical clinics over a 6-month period were
recruited. An interviewer-administered questionnaire captured socio-demographic,
morbidity, and medication details from records. BP measurements were taken following
standard guidelines with OMRON-X7 BP monitors. Multivariate logistic regression was
used to identify significant associations (p<0.05).
Results
Among 600 patients (mean age 64±9 years, 43% male), 55% had uncontrolled
hypertension. Most (62%) were on ≤2 antihypertensives, primarily renin-angiotensin
blockers (91%), with minimal (<10%) thiazide use. Uncontrolled hypertension was less
common among furosemide (10.5%) and spironolactone (21.5%) users but frequent
among those on alpha-blockers (16.3%). Coronary artery disease (58%), heart failure
(9%), and stroke (17%) were more common in males and those with longstanding
hypertension. Beta-blockers were favoured in those with cardiac comorbidities, and
dihydropyridines in those with stroke. Potential treatment resistance, seen in 11%, was
associated with increased cardiac morbidity, while socio-demographic factors and
family history had no significant impact on BP control or cardiovascular morbidity.
Conclusions
Uncontrolled hypertension and cardiovascular morbidity were highly prevalent. The
data suggest the need for optimised anti-hypertensive regimens, with reduced use of
alpha-blockers and early and prioritised incorporation of diuretics.