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Perception of Arterial Hypertension in Hypertensive Patients Undergoing Routine Consultation and Hospitalisation in Bangui

Received: 4 January 2025     Accepted: 7 March 2025     Published: 28 July 2025
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Abstract

High blood pressure (HTA) has long been considered the preserve of wealthy countries. However, it also affects low-income countries such as the Central African Republic. The aim of this study was to assess the level of knowledge of patients suffering from hypertension and their perception of prevention and management of the disease. It was a cross-sectional analytical study carried out in the three university hospitals and urban health centers of Bangui from April 15 to May 31, 2022. All consenting hypertensive patients were included. A total of 201 outpatients and inpatients with hypertension. Age ranged from 30 to 88 years, with an average of 43 years (±6.8 years), and 60.2% of the population was under 60. Of the 201 people surveyed, 78% were unfamiliar with the risk factors for the disease, 75% were unaware of the complications of hypertension, and 87% did not know how to prevent the disease or its complications. As for the perception of treatment, 23.8% thought that medication (oral antihypertensives) was ineffective and 51.3% thought it was restrictive. Diet was considered effective by 91.3%, but restrictive by 89% (high cost and complexity). The use of pharmacopoeias in addition to prescribed oral antihypertensives was reported by 36.3%. This study highlighted patients' low level of knowledge about the disease and the high cost of treatment and diet. Hence the importance of information, education and communication about this disease.

Published in Science Journal of Public Health (Volume 13, Issue 4)
DOI 10.11648/j.sjph.20251304.13
Page(s) 189-195
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Perception, Hypertension, Hypertensive Patients, Bangui

1. Introduction
Noncommunicable diseases (NCDs) cause more than 36 million deaths each year, nearly two-thirds of all deaths worldwide, including 17 million deaths from cardiovascular disease (CVD) . Of the CVD deaths that occur each year, an estimated 9.4 million are due to complications of hypertension, in this case stroke, myocardial infarction, heart failure and renal failure. Approximately 80% of these deaths occur in low- and middle-income countries . More than a quarter (26.4%) of the world's adult population has high blood pressure, and if nothing is done, this figure will rise to 29.2% by 2025. What's more, nearly three-quarters of these patients will live in developing countries . Long considered the prerogative of wealthy countries, hypertension also affects low-income countries such as the Central African Republic (CAR), where its prevalence is poorly documented despite its inclusion in national priorities . In addition, hypertension has an unsustainable economic impact on African countries, ranging from high medical costs to reduced productivity, at both the individual and national levels .
For low-income countries, primary prevention remains the best solution, given that hypertension, like other NCDs, requires lifelong treatment that ultimately impoverishes individuals, households and states . To reduce cardiovascular disease and its impact on overall mortality and economic development, it is necessary to control the disease by acting on its modifiable risk factors. The Programme National de Lutte contre les Maladies Non Transmissibles en RCA (PNLMNT) (National Program for the Control of Non-Communicable Diseases in CAR), which includes hypertension, aims to overcome the lack of information on hypertensive disease, to promote early detection and management of the disease, and to encourage the adoption of a health-promoting lifestyle, notably physical activity and a healthy, balanced diet . The aim of our study was to assess patients' level of knowledge and perceptions of disease prevention and management, in order to develop appropriate strategies for disease control in our context.
2. Methodology
This was a cross-sectional, analytical study carried out in 03 Centres Hospitaliers Universitaires de Bangui (CHUB) and 17 Centres de Santé Urbain de Bangui (CSUB) from April 15 to May 31, 2021, i.e. 1.5 months. All hypertensive patients over 18 years of age were included in the study. We conducted an exhaustive survey of hypertensive patients attending outpatient or inpatient clinics at the above-mentioned facilities during the study period. Data were collected using a pre-designed survey form that had been pre-tested for clarity. The data collection form enabled us to gather information concerning:
1. Socio-demographic characteristics of respondents.
2. Level of knowledge of the disease (risk factors, complications, means of preventing complications and evolution).
3. Perception of treatment (medication, diet, physical activity).
Our dependent variable was knowledge of disease risk factors, and the independent variables were socio-demographic characteristics (age, level of education and patient occupation). Informed consent was signed by participants before all interviews, and data were treated with strict confidentiality. Data entry and analysis were carried out using Epi-Info version 7 software. Proportions were used to describe qualitative variables. We used the Chi-2 test of independence to compare proportions in the case of crosses between two categorical variables. We used a significance level of α = 5% (0.05). For any significance level p<0.05, we concluded that there was a statistically significant association between the dependent variable and the independent variables. The identification of associated factors was done first by a univariate analysis between the dependent variable and the independent variables of interest. Measures of association were estimated by odds ratio (OR) and their 95% confidence interval (CI).
3. Results
Socio-demographic characteristics of the study population: Age ranged from 30 to 88 years, with a mean of 43 (± 6.8) years, and a median age of 42. Patients under 40 were in the majority (39.80%). The sex ratio was 0.63. Slightly more than half (61.20%) had secondary education or higher. Almost half (24.38%) were unemployed or students.
Table 1. Distribution of the study population by socio-demographic characteristics in Bangui in 2022.

Socio-demographic characteristics

Number (n)

Percentage (%)

Age (in year)

< 40

80

39.80

40 - 60

45

22.39

≥ 60

76

37.81

Gender

Male

78

38.80

Female

123

61.20

Education level

No education/Primary

78

38.80

Secondary

77

38.31

Higher

46

22.89

Occupation

Informal sector

47

23.38

Manual worker

32

15.92

Salaried/civil servant

73

36.32

Unemployed

49

24.38

Patients' level of knowledge about the disease: The majority (78%) of patients had poor knowledge of the disease's risk factors and of ways to prevent it (87%).
Table 2. Patients' level of knowledge about the disease in Bangui in 2022.

Level of knowledge about the disease

Number (n)

Percentage (%)

Knowledge of risk factors for hypertension

Cited five factors

20

10.00

Cited three factors

24

12.00

Cited only one factor

102

50.75

Cited none

55

27.25

Knowledge of ways to prevent hypertension

Cited at least two means of prevention

26

13.00

Cited one means of prevention

82

41.00

Cited none

92

46.00

Knowledge of complications of hypertension

Cited five complications

16

8.00

Cited three complications

35

17.00

Cited only one complication

78

39.0

Cited none

72

36.00

Knowledge of how to prevent complications of hypertension

Cited at least two means of prevention

26

13.00

Cited one means of prevention

68

34.00

Cited none

107

53.00

4. Participants' Perceptions of the Management of Hypertension
Table 3. Distribution of the study population according to their perception of care in Bangui in 2022.

Perception of care

Number (n)

Percentage (%)

Efficacy of oral antihypertensives

Effective

153

76.20

Not effective

48

23.80

Constraints of oral antihypertensives

Constraining α

103

51.30

Not restrictive

98

48.70

Effectiveness of diet in hypertension

Effective

184

91.30

Not effective

17

8.70

Constraints of the HTA diet

Restrictive β

179

89.00

Not restrictive

22

11.00

Effectiveness of physical activity

Daily physical activity

26

13.00

No physical activity

175

87.00

Use of pharmacopoeia medication in addition to oral antihypertensives

YES

73

36.30

NO

128

63.70

α = The constraints of antihypertensives mentioned were: the high cost of the drugs, their daily intake, adherence to dosing times and side effect
β = Diet constraints were related to the high cost of the diet and its complexity (no salt, no fat etc.)
Influence of sociodemographic characteristics on their level of knowledge of disease risk factors (RF): The factors associated with a high score for insufficient knowledge of disease risk factors were: patients' age, level of education and un-employed professional status (Table 4).
Table 4. Influence of socio-demographic characteristics on the level of knowledge of disease risk factors among patients in Bangui in 2022.

Characteristics

Level of knowledge of disease risk factors

OR [IC 95%]

p

Total

Good α

Bad β

(201)

(n=44)

(n=157)

N

n

%

n

%

Age (in year)

< 40

45

24

53.33

21

46.67

1

40 - 60

80

11

13.75

69

86.5

7.14 [3 - 17]

<0.001

≥ 60

76

9

11.84

67

88.16

14.17 [5.9 – 33.90]

<0.001

Level of education

None/Primary

78

10

12.82

68

87.18

1

Secondary and above

123

34

27.65

89

72.35

0.39 [0.17 – 0.83]

<0.001

Occupation

Informal sector

48

7

14.58

41

85.42

1

Manual worker

31

4

12.90

27

87.10

1.15 [0.26 – 5.80]

1

Salaried/civil servant

76

12

15.79

64

84.2

0.91 [0.33 – 2.50]

>0.05

Unemployed

46

21

45.65

25

54.35

0.20 [0.07 – 0.54]

<0.001

α = Cited at least three risk factors for hypertension
β = Cited only one or none of the risk factors for hypertension
5. Discussion
Two hundred and one (201) outpatients and inpatients with hypertension were included in our study. This number is higher than that reported by another similar hospital-based study conducted in Burkina Faso in 2018, which reported a sample size of 88 patients
Socio-demographic characteristics: The average age in our study was 43 years (±6.8). This finding has been reported by several authors. Indeed, ageing has been identified as a risk factor for hypertension . This could be explained by the physiological change in blood vessels that occurs as the age of the individual increases. Our study included 61.20% (123) women and 38.80% (78) men. The sex ratio was 0.63. Results on the study of gender as a risk factor for hypertension are divergent. Several authors have found that the prevalence of hypertension is higher in men . In terms of participants' occupation, salaried employees/civil servants were the most represented (36.32%), followed by the unemployed (24.28%) and the informal sector (23.28%). Wage-earners/civil servants are stressful occupations that can contribute to high blood pressure. Patients with high-pressure jobs are more likely to develop unhealthy behaviors, such as poor diet or excessive alcohol consumption, to cope with stress, which are factors conducive to high blood pressure. Many of the participants in this category work in offices, and with the effects of new technology (computers and NICTs) are increasingly sedentary with less physical activity, which is a risk factor for hypertension. On the other hand, jobs requiring regular physical activity can help maintain healthy blood pressure. Several authors have highlighted the link between stress and sedentary lifestyle in relation to the occupation of hypertensive people and the disease .
Knowledge of the disease: An assessment of knowledge levels in the study population as a whole revealed that people with hypertension are not well informed about their disease and its risks. Of the 201 people surveyed, only 22% identified at least 3 risk factors for the disease. However, a quarter (25%) identified at least 3 types of complications. In most cases, patients with hypertension try to compensate for this lack of information by turning to unreliable or unscrupulous sources that may provide erroneous or even dangerous information for their management. Studies conducted in Africa have also found that the majority of people with hypertension have no idea what factors contribute to the development of the disease . Patients often refer to hypertension as "the disease of the obese," which leads them to automatically associate the origin of the disease with excessive consumption of sugary foods, overlooking other risk factors such as sedentary lifestyle, stress, etc. Fezeu et al have also reported this lack of information on risk factors in Cameroon, with the population focusing on obesity.
Perception of oral antihypertensives: In our study, 76.2% of people recognized the efficacy of the medication, and 51.3% thought it was very restrictive. The main constraints cited by patients related to the high cost of the drugs, taking them every day, adherence to dosing times and side effects. Several authors have also reported that the poor therapeutic compliance frequently noted in daily practice is largely explained by the high cost of medication .
Perception of regular physical activity for disease prevention: In our series, 87% of patients were not physically active. This can be explained by the fact that the majority of patients and those around them are not sufficiently informed about the benefits of physical exercise in preventing complications of hypertension. To this must be added the influence of environmental factors such as ease of transport, dense traffic, lack of green space, etc. Many authors have asserted that, in large cities, people walk little and take cabs from home to work . Some authors have reported that individuals who engage in vigorous daily physical activity have a reduced risk of developing hypertension, with lower blood pressure figures than those who do not engage in vigorous physical activity . The reduction of oxidative stress and psychological stress by physical activity are some of the mechanisms evoked by a systematic review to explain the effect of physical activity on blood pressure .
Perception of a balanced diet for disease prevention: Almost all (91.3%) of those questioned felt that the diet was effective. However, 89% thought the diet was restrictive. Adequate consumption of fruit and vegetables protects against hypertension. Studies have demonstrated the important role played by the antioxidants contained in fruit and vegetables (carotenoids, polyphenols and other antioxidant compounds) in neutralizing the free radicals produced especially during the arteriosclerosis process. Thus, Stewart de Ramirez et al. in their study carried out in three sub-Saharan African countries (Malawi, Rwanda, Tanzania) observed that high frequency of fruit and vegetable consumption was significantly associated with low systolic and diastolic blood pressure and low mean arterial pressure . To this end, the WHO recommends that countries take action to promote better dietary quality and a healthy lifestyle through regular physical activity, in order to combat hypertension and protect the population against its cardiovascular consequences .
Perception of pharmacopoeia for the treatment of hypertension: In our study, 36.3% of those surveyed resorted to traditional medicine. This may be interpreted as insufficient access to information, medicines and customary beliefs. Numerous authors in Africa and elsewhere have reported that more than three-quarters of patients suffering from a chronic disease such as hypertension admit to using a traditional treatment as part of the management of their illness, notably based on plants such as Morinaga oleifera, commonly known as “nébédaye” .
Influence of sociodemographic characteristics on their level of knowledge of disease risk factors: Sociodemographic characteristics, notably age, level of education and occupation (job) have an influence on the knowledge of hypertensive people. In our study, older people, those with a higher level of education and those with stable jobs had better knowledge of the disease, with a statistically significant difference (P<0.05). Several studies have shown this to be true .
6. Conclusion
This study revealed a low level of knowledge among patients about the disease, with its restrictive treatment and diet. The results of this study should lead us to translate the suggestions made into action, in order to put in place strategies that can contribute to improving the quality of life of people living with this disease, and to prevention.
Abbreviations

CIGLE

Signification

CAR

Central African Republic

CHUB

Centres Hospitaliers Universitaires de Bangui

CSUB

Centres de Santé Urbain de Bangui

PNLMNT

National Program for the Control of Non-Communicable Diseases in CAR

WHO

World Health Organization

Author Contributions
Doyama-woza Rodrigue Herman: Conceptualization, Data curation, Formal Analysis, Funding acquisition, Investigation, Methodology, Writing – original draft
Fandéma Emmanuel: Data curation, Formal Analysis, Investigation, Methodology, Writing – review & editing
Piamalé Germain: Investigation, Methodology, Visualization, Writing – review & editing
Woromogo Sylvain Honoré: Data curation, Formal Analysis, Methodology, Visualization, Writing – review & editing
Syazo Voto Chacunière Marguerite : Data collection.
Longo Jean de Dieu: Project administration, Validation, Visualization, Writing – review & editing
Diemer Saint-Calvaire Henri: Supervision, Validation, Visualization, Writing – review & editing
Acknowledgments
We would like to thank all those in charge of the health facilities for their collaboration.
Conflicts of Interest
The authors declare no conflicts of interest.
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    Herman, D. R., Emmanuel, F., Germain, P., Honoré, W. S., Marguerite, S. V. C., et al. (2025). Perception of Arterial Hypertension in Hypertensive Patients Undergoing Routine Consultation and Hospitalisation in Bangui. Science Journal of Public Health, 13(4), 189-195. https://doi.org/10.11648/j.sjph.20251304.13

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    Herman, D. R.; Emmanuel, F.; Germain, P.; Honoré, W. S.; Marguerite, S. V. C., et al. Perception of Arterial Hypertension in Hypertensive Patients Undergoing Routine Consultation and Hospitalisation in Bangui. Sci. J. Public Health 2025, 13(4), 189-195. doi: 10.11648/j.sjph.20251304.13

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    AMA Style

    Herman DR, Emmanuel F, Germain P, Honoré WS, Marguerite SVC, et al. Perception of Arterial Hypertension in Hypertensive Patients Undergoing Routine Consultation and Hospitalisation in Bangui. Sci J Public Health. 2025;13(4):189-195. doi: 10.11648/j.sjph.20251304.13

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  • @article{10.11648/j.sjph.20251304.13,
      author = {Doyama-woza Rodrigue Herman and Fandéma Emmanuel and Piamalé Germain and Woromogo Sylvain Honoré and Syazo Voto Chacunière Marguerite and Longo Jean de Dieu and Diemer Saint-Calvaire Henri},
      title = {Perception of Arterial Hypertension in Hypertensive Patients Undergoing Routine Consultation and Hospitalisation in Bangui
    },
      journal = {Science Journal of Public Health},
      volume = {13},
      number = {4},
      pages = {189-195},
      doi = {10.11648/j.sjph.20251304.13},
      url = {https://doi.org/10.11648/j.sjph.20251304.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjph.20251304.13},
      abstract = {High blood pressure (HTA) has long been considered the preserve of wealthy countries. However, it also affects low-income countries such as the Central African Republic. The aim of this study was to assess the level of knowledge of patients suffering from hypertension and their perception of prevention and management of the disease. It was a cross-sectional analytical study carried out in the three university hospitals and urban health centers of Bangui from April 15 to May 31, 2022. All consenting hypertensive patients were included. A total of 201 outpatients and inpatients with hypertension. Age ranged from 30 to 88 years, with an average of 43 years (±6.8 years), and 60.2% of the population was under 60. Of the 201 people surveyed, 78% were unfamiliar with the risk factors for the disease, 75% were unaware of the complications of hypertension, and 87% did not know how to prevent the disease or its complications. As for the perception of treatment, 23.8% thought that medication (oral antihypertensives) was ineffective and 51.3% thought it was restrictive. Diet was considered effective by 91.3%, but restrictive by 89% (high cost and complexity). The use of pharmacopoeias in addition to prescribed oral antihypertensives was reported by 36.3%. This study highlighted patients' low level of knowledge about the disease and the high cost of treatment and diet. Hence the importance of information, education and communication about this disease.},
     year = {2025}
    }
    

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  • TY  - JOUR
    T1  - Perception of Arterial Hypertension in Hypertensive Patients Undergoing Routine Consultation and Hospitalisation in Bangui
    
    AU  - Doyama-woza Rodrigue Herman
    AU  - Fandéma Emmanuel
    AU  - Piamalé Germain
    AU  - Woromogo Sylvain Honoré
    AU  - Syazo Voto Chacunière Marguerite
    AU  - Longo Jean de Dieu
    AU  - Diemer Saint-Calvaire Henri
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    JF  - Science Journal of Public Health
    JO  - Science Journal of Public Health
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    AB  - High blood pressure (HTA) has long been considered the preserve of wealthy countries. However, it also affects low-income countries such as the Central African Republic. The aim of this study was to assess the level of knowledge of patients suffering from hypertension and their perception of prevention and management of the disease. It was a cross-sectional analytical study carried out in the three university hospitals and urban health centers of Bangui from April 15 to May 31, 2022. All consenting hypertensive patients were included. A total of 201 outpatients and inpatients with hypertension. Age ranged from 30 to 88 years, with an average of 43 years (±6.8 years), and 60.2% of the population was under 60. Of the 201 people surveyed, 78% were unfamiliar with the risk factors for the disease, 75% were unaware of the complications of hypertension, and 87% did not know how to prevent the disease or its complications. As for the perception of treatment, 23.8% thought that medication (oral antihypertensives) was ineffective and 51.3% thought it was restrictive. Diet was considered effective by 91.3%, but restrictive by 89% (high cost and complexity). The use of pharmacopoeias in addition to prescribed oral antihypertensives was reported by 36.3%. This study highlighted patients' low level of knowledge about the disease and the high cost of treatment and diet. Hence the importance of information, education and communication about this disease.
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