Uncontrolled hypertension among hypertensive patients in Sub-Saharan Africa: A systematic review and meta-analysis

Tigabu Munye Aytenew; Amare Kassaw; Amare Simegn; Gedefaye Nibret Mihretie; Sintayehu Asnakew; Yohannes Tesfahun Kassie; Solomon Demis; Demewoz Kefale; Shegaw Zeleke; Worku Necho Asferie

doi:10.1371/journal.pone.0301547

Abstract

Introduction

Hypertension is a major global public health problem. It currently affects more than 1.4 billion people worldwide, projected to increase to 1.6 billion by 2025. Despite numerous primary studies have been conducted to determine the prevalence of uncontrolled hypertension and identify its associated factors among hypertensive patients in Sub-Saharan Africa, these studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of uncontrolled hypertension and identify its associated factors.

Methods

We have searched PubMed, Google Scholar, and Web of Science databases extensively for all relevant studies. A manual search of the reference lists of included studies was performed. A weighted inverse-variance random-effects model was used to compute the overall pooled prevalence of uncontrolled hypertension and the effect size of its associated factors. Variations across the included studies were checked using forest plot, funnel plot, I² statistics, and Egger’s test.

Results

A total of twenty-six primary studies with a sample size of 11,600 participants were included in the final meta-analysis. The pooled prevalence of uncontrolled hypertension was 50.29% (95% CI: 41.88, 58.69; I² = 98.98%; P<0.001). Age of the patient [AOR = 1.57: 95% CI: 1.004, 2.44], duration of diagnosis [AOR = 2.57: 95% CI: 1.18, 5.57], non-adherence to physical activity [AOR = 2.13: 95% CI: 1.15, 3.95], khat chewing [AOR = 3.83: 95% CI: 1.59, 9.24] and habitual coffee consumption [AOR = 10.79: 95% CI: 1.84, 63.24] were significantly associated with uncontrolled hypertension among hypertensive patients.

Conclusions

The pooled prevalence of uncontrolled hypertension was considerably high. Older age, duration of diagnosis, non-adherence to physical activity, khat chewing and habitual coffee consumption were independent predictors of uncontrolled hypertension. Therefore, health professionals and other responsible stakeholders should encourage hypertensive patients to adhere to regular physical activity, and abstain from khat chewing and habitual coffee consumption. Early identification of hypertension and management of comorbidities is crucial, and it should be emphasized to control hypertension easily.

Citation: Aytenew TM, Kassaw A, Simegn A, Nibret Mihretie G, Asnakew S, Tesfahun Kassie Y, et al. (2024) Uncontrolled hypertension among hypertensive patients in Sub-Saharan Africa: A systematic review and meta-analysis. PLoS ONE 19(6): e0301547. https://doi.org/10.1371/journal.pone.0301547

Editor: Guoying Wang, Johns Hopkins University Bloomberg School of Public Health, UNITED STATES

Received: May 18, 2023; Accepted: March 18, 2024; Published: June 13, 2024

Copyright: © 2024 Aytenew et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and Supporting Information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: CKD, Chronic kidney diseases; CVDs, Cardio-vascular diseases; DBP, Diastolic blood pressure; DM, Diabetes miletus; HIV, Human immune deficiency virus; JBI, Joanna Briggs Institute; LMICs, Low and middle-income countries; PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analysis; SBP, Systolic blood pressure; SSA, Sub-Saharan Africa

Introduction

Hypertension is a major global public health problem [1–3]. It currently affects more than 1.4 billion people worldwide, and this is expected to project to 1.6 billion by 2025 [4,5]. Of these, 82% of the population live in low and middle-income countries(LMICs) [6]. The global prevalence of hypertension was estimated to be almost 40% among adults aged 25 years and above, and Africa accounts for the highest prevalence (46%) [7].

Nowadays, hypertension is increasingly emerging in LMICs where the health resources are scarce and stretched by a high burden of infectious diseases such as human immune deficiency virus (HIV), malaria, and tuberculosis, and where awareness and treatment levels of hypertension control are still very low [8]. The burden is high in Sub-Saharan Africa (SSA [2], affects nearly 25% of the adult population [9], and an estimated of 74.7 million individuals are hypertensive, and this number will also be projected to increase by 68% to 125.5 million individuals by 2025 [10–12].

Hypertension is the leading cause of cardiovascular diseases (CVDs) morbidity, mortality, and disabilities accounting for around 7.5 million deaths annually worldwide [4,5,9,13–16]. It doubles the risk of developing CVDs including coronary heart disease, congestive heart failure, stroke, renal failure, and peripheral arterial disease [1,10,12]. It is also an overwhelming global challenge and a third-ranked cause of disability-adjusted life year [17–19]. It is an essential contributor to the rising burden of CVDs in SSA which is expected to nearly double by 2030 [2].

Although hypertension is a preventable and modifiable risk factor of CVDs, its prevention and control have not yet received due attention in many developing countries [14,20,21]. If hypertension is left uncontrolled, it causes stroke, heart failure, dementia, coronary heart disease, peripheral vascular disease, renal impairment, retinal hemorrhage, and blindness, imposing severe financial and service burdens on the healthcare systems [18,22–25]. Though uncontrolled hypertension is a significant public health challenge in developed and developing countries [9,22], it has become higher in SSA than in Western countries over the past few decades, accounting for 70% of the total disease burden in the region [6].

Despite effective therapeutic options, hypertension remains uncontrolled in both developed and developing countries [6,12,26]. Although controlling hypertension is crucial in reducing hypertension-associated CVDs, it remains inadequately controlled in clinical practice [4,27]. Adequate control of hypertension requires the identification of factors associated with it [28]. Therefore, timely diagnosis, patient awareness, and access to effective treatment are important components in achieving hypertension control in the population [29].

Despite numerous primary studies have been made to determine the prevalence of uncontrolled hypertension and identify its associated factors among hypertensive patients in SSA, these studies presented inconsistent findings. Therefore, this systematic review and meta-analysis aimed to determine the overall pooled prevalence of uncontrolled hypertension and identify its associated factors.

Methods

Reporting and registration protocol

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist [30] was used to report the results of this systematic review and meta-analysis (S1 Table in S1 File). The review protocol was registered with Prospero database (PROSPERO, 2023: CRD42023422846).

Databases and search strategy

The adapted PICO format was used to retrieve the relevant primary studies. The adapted PICO consists of population (P), exposure (E), context (C), and outcome (O) as detailed below.

Population: Hypertensive patients in SSA
Exposure: Associated factors, risk factors, determinants, and predictors i.e. gender, increased age, lower educational level, duration of hypertension, comorbidity, duration of antihypertensive medications, durations of appointment, high cholesterol level, Khat chewing, habitual coffee consumption, salt intake, non-adherence to antihypertensive medications, non-adherence to physical activity, and obesity.
Context (Setting): SSA, Ethiopia, Sudan, Kenya, Tanzania, Nigeria, Cameroon, and South Africa.
Outcome: Uncontrolled hypertension

Using the above adapted PICO, we developed the following review questions which were focused on retrieving all the relevant primary studies.

What is the prevalence of uncontrolled hypertension in SSA?
What are the factors associated with uncontrolled hypertension in SSA?

We have searched PubMed, Google Scholar, and Web of Science databases extensively for all available primary studies using the following search terms and phrases: (ʺBurdenʺ OR ʺMagnitudeʺ OR ʺPrevalenceʺ OR ʺIncidenceʺ) AND (ʺUncontrolled hypertensionʺ OR ʺHypertension controlʺ) AND (ʺPredictorsʺ OR ʺAssociated factorsʺ OR ʺRisk factorsʺ OR ʺDeterminantsʺ) AND ʺSub-Saharan Africaʺ. A manual search of the reference lists of included studies was performed. The searched studies were published between 2014 and 2023 in SSA and published in English language.

Eligibility criteria

All observational (cross-sectional and retrospective cohort) studies that were conducted among adult (aged ≥18 years) hypertensive patients in SSA, and reported uncontrolled hypertension, and written in English language were included in the review. However, citations without abstracts and/or full texts, anonymous reports, editorials, systematic reviews and meta-analyses, outdated studies and qualitative studies were excluded from the review.

Study selection

All the retrieved studies were exported to the EndNote version 7 reference manager to remove duplicate studies. Initially, two independent reviewers (TMA and AK) screened the titles and abstracts, followed by the full-text reviews to determine the eligibility of each study. The disagreement between the two reviews was solved through discussion.

Data extraction

Two independent reviewers (TMA and WNA) extracted the data using a structured data extraction form. Whenever variations were observed in the extracted data, the phase was repeated. If discrepancies between the data extractors continued, the third reviewer (AK) was involved. The name of the first author, year of publication, country, study design, sample size, objective of the study, scale, statistical model, and effect size were collected.

Primary outcome measure of interest

The primary outcome of interest of this review was the pooled prevalence of uncontrolled hypertension among hypertensive patients on anti-hypertensive medications in SSA.

Operational definition of variables

Uncontrolled hypertension is defined as if SBP is ≥140mmHg and/or DBP ≥90mmHg for the general hypertensive population or if SBP is ≥130mmHg and/or DBP ≥80mmHg in patients with established diabetes miletus (DM) or chronic kidney disease (CKD) [14,24,25,28,31].

Data analysis

The extracted data were exported to STATA version 17 for analysis. A weighted inverse-variance random-effects model [32] was used to compute the overall pooled prevalence of uncontrolled hypertension and the effect size of its predictors. The publication bias was checked by observing the symmetry of the funnel plot, and Egger’s test with a p-value of <0.05 was also employed to determine a significant publication bias [33]. The percentage of total variation across studies due to heterogeneity was assessed using I² statistics [34]. The I² statistic of 0, 25, 50 and 75% values represented no, low, moderate, and high heterogeneity respectively [34]. A p-value of I² statistic <0.05 was used to declare a significant heterogeneity [35,36].

To identify the influence of a single study on the overall meta-analysis, sensitivity analysis was performed. Subgroup analysis based on the study area was employed to adjust the variations in the pooled estimate. A forest plot was used to estimate the effect of independent factors on the outcome variable, and a measure of association at 95% CI was also reported. The adjusted odds ratio (AOR) was the most frequently reported measure of association in the eligible primary studies, and a random-effects model was used to estimate the pooled AOR effect. The qualities of the studies were evaluated using JBI criteria. The findings were presented using figures, tables, and texts.

Results

Search results

A total of 1572 studies were retrieved from PubMed (n = 857), Google Scholar (n = 695), Web of Science (n = 05), a manual search (n = 12), and 03 studies from a research repository online library. After removing the duplicated studies (n = 64) and irrelevant studies based on their titles and abstracts (n = 1152), 356 studies were selected for full-text review. During full-text review, 291 studies with no accessible full texts were removed. Of the remaining 65 studies, 39 studies were excluded (full texts were not written in English, different study settings, and the outcomes were not well defined).

Finally, 26 studies were extracted to determine the pooled prevalence of uncontrolled hypertension and identify its associated factors in SSA. We traced the PRISMA flow chart [37] to show the selection process from initially identified records to finally included studies (Fig 1).

Download:

Fig 1. PRISMA flow chart showing the studies selection process, 2023.

https://doi.org/10.1371/journal.pone.0301547.g001

Characteristics of the included studies

The twenty-four studies [1,3,6,7,9,11,12,14,18,21–26,28,29,31,38–43] and two studies [10,44] were conducted using cross-sectional and retrospective cohort study designs respectively. Regarding geographical region, nineteen studies were found in Ethiopia [1,3,6,9,10,14,18,21,22,24,26,28,38–44], one study in Kenya [23], Nigeria [7], Cameroon [12], Sudan [25], South Africa [31], Tanzania [11], and selected SSA countries [29]. The total sample size of the included studies was 11,600, where the smallest sample size was 131 in Ethiopia (Jimma University Medical Center) and the largest sample size was 2,198 in selected SSA countries. The overall pooled prevalence of uncontrolled hypertension was obtained from all twenty-six included primary studies [1,3,6,7,9–12,14,18,21–26,28,29,31,38–44], while the data regarding the predictors of uncontrolled hypertension were obtained from the twenty-three studies [1,3,6,9–12,14,18,22,24–26,28,29,31,38–44] with a response rate ranging from 75.72 to 100% (Table 1).

Download:

Table 1. General characteristics of the included primary studies, 2023.

https://doi.org/10.1371/journal.pone.0301547.t001

Quality assessment of the included studies

Two independent reviewers (TMA and WNA) appraised the quality of the included studies, and scored for the validity of the results. The quality of each study was evaluated using the Joanna Briggs Institute (JBI) quality appraisal criteria [45]. Twenty-four studies [1,3,6,7,9,11,12,14,18,21–26,28,29,31,38–43] and two studies [10,44] were assessed using JBI checklist for cross-sectional and cohort studies respectively. Thus, among the twenty-four cross-sectional studies, sixteen studies scored seven of the eight questions, 87.5% (low risk), five studies scored six of the eight questions, 75% (low risk), and the remaining three studies also scored five of the eight questions, 62.5% (low risk). Likewise, among the two cohort studies, one study scored eight of the ten questions, 80% (low risk), and the second cohort study scored seven of the ten questions, 70% (low risk) (S2 Table in S2 File).

Studies were considered low risk whenever they scored 50% and above on the quality assessment indicators. Therefore, from our quality appraisal, we generally found that all the included primary studies were reliable in their methodological quality scores, ranging from 5 to 7 of a total of 8 points for the cross-sectional studies, and 7 to 8 of a total of 10 points for the cohort studies. Thus, all the included studies [1,3,6,7,9–12,14,18,21–26,28,29,31,38–44] had high quality.

Risk of bias assessment

The adopted assessment tool [46] was used to assess the risk of bias. It consists of ten items that assess four areas of bias: internal validity and external validity. Items 1–4 evaluate selection bias, non-response bias, and external validity. Items 5–10 assess measure bias, analysis-related bias, and internal validity. Accordingly, of the twenty-six included studies, twenty-two studies scored eight of ten questions, and the four studies scored seven of ten questions.

Studies were classified as ʺlow riskʺ if eight and above of the ten questions received ʺYesʺ, as ʺmoderate riskʺ if six to seven of the ten questions received ʺYesʺ and as ʺhigh riskʺ if five or lower of the ten questions received ʺYesʺ. Therefore, all the included studies [1,3,6,7,9–12,14,18,21–26,28,29,31,38–44] had a low risk of bias (high quality) (S3 Table in S2 File).

Meta-analysis

Pooled prevalence of uncontrolled hypertension

Consequently, 26 eligible primary studies were included in the final meta-analysis. The prevalence of uncontrolled hypertension among hypertensive patients ranges from 11.42% in Ethiopia [28] to 77.40% in a study conducted among selected SSA countries [29], and the pooled prevalence of uncontrolled hypertension was 50.29% (95% CI:41.88, 58.69; I² = 98.98%; P<0.001) (Fig 2).

Download:

Fig 2. Forest plot showing the pooled prevalence of uncontrolled hypertension in SSA, 2023.

https://doi.org/10.1371/journal.pone.0301547.g002

Publication bias

The symmetry of the included primary studies on the funnel plot suggests the absence of a significant publication bias (Fig 3). The p-value of Egger’s regression test (P = 0.458) also indicated the absence of publication bias.

Download:

Fig 3. Funnel plot showing the publication bias of uncontrolled hypertension in SSA, 2023.

https://doi.org/10.1371/journal.pone.0301547.g003

Investigation of heterogeneity

The percentage of I² statistics of the forest plot indicates a marked heterogeneity among the included studies (I² = 98.98%, P<0.001) (Fig 2). Hence, sensitivity and subgroup analyses were performed to minimize the heterogeneity.

Sensitivity analysis

To determine the influence of a particular primary study on the overall meta-analysis, we conducted a sensitivity analysis. The forest plot showed that the estimate of a single primary study is closer to the combined estimate, which implied the absence of a single study effect on the overall pooled estimate. Thus, we declared that a single primary study has no significant impact on the overall outcome of the meta-analysis (Fig 4).

Download:

Fig 4. Sensitivity analysis of uncontrolled hypertension in SSA, 2023.

https://doi.org/10.1371/journal.pone.0301547.g004

Subgroup analysis using the study area

The highest pooled prevalence of uncontrolled hypertension was found among studies conducted out of Ethiopia [59.49: 95% CI: 49.47, 69.52; I² = 97.65%; P<0.001], followed by studies conducted in Ethiopia [46.88: 95% CI: 38.66, 55.09; I² = 98.29%; P<0.001].

Factors associated with uncontrolled hypertension

The pooled analysis of the study finding showed that age of the patient [AOR = 1.57: 95% CI: 1.004, 2.44], duration of diagnosis [AOR = 2.57: 95% CI: 1.18, 5.57], non-adherence to physical activity [AOR = 2.13: 95% CI: 1.15, 3.95], khat chewing [AOR = 3.83: 95% CI: 1.59, 9.24] and habitual coffee consumption [AOR = 10.79: 95% CI: 1.84, 63.24] were significantly associated with uncontrolled hypertension.

Thus, patients who were habitual coffee consumers (>3 cups/day) were 10.79 times more likely to encounter uncontrolled hypertension compared to patients who were not habitual coffee consumers.

Patients who chew khat were also 3.83 times more likely to have uncontrolled hypertension than those who didn’t [7,39,42].

Similarly, patients with five years and above of duration of diagnosis of hypertension were 2.57 times more likely to get uncontrolled hypertension than patients with less than five years of duration of diagnosis [18,40].

Moreover, patients who were non-adherent to physical activity were 2.13 times more likely to face uncontrolled hypertension than their counterparts [6,9,10,18,22,31,41,43].

Additionally, patients with the age of 50 years and above were around 1.57 times more likely to have the chance of getting uncontrolled hypertension than patients with the age of less than 50 years old [1,3,6,9,18,26,39,40,42–44].

Discussion

In this review, the pooled prevalence of uncontrolled hypertension was 50.29% (95% CI: 41.88, 58.69); I² = 98.98%; P<0.001), which was higher than the finding of a systematic review and meta-analysis conducted in Ethiopia, 48% [4]. In addition, the mean prevalence of uncontrolled hypertension in this study was 49.55% [95% CI: 45.63, 53.47], which was lower than a study conducted in rural communities of South Asia, 58% [47]. This variation could be explained due to differences in study design, population characteristics, and sample size, and measurement methods. It’s also possible that variations in healthcare systems and access to healthcare services across regions could play a significant role.

Likewise, patients who were habitual coffee consumers (>3 cups/day) were 10.79 times more likely to encounter uncontrolled hypertension compared to patients who were not habitual coffee consumers. This might be justified that caffeine has been hypothesized to raise blood pressure by several mechanisms, such as sympathetic stimulation, adenosine receptor antagonism, and elevated norepinephrine release by direct effects on the adrenal medulla, renal effects, and renin-angiotensin system activation; as a result, it may make the progress of treatment more challenging.

On the other hand, patients who chew khat were also 3.83 times more likely to have uncontrolled hypertension than patients who didn’t chew. This is because Khat contains certain compounds that can affect the heart and blood vessels, causing them to function abnormally over time. As a result, individuals who regularly chew Khat may be at a greater risk of developing hypertension and other related health conditions.

Similarly, patients with five years and above duration of diagnosis of hypertension were 2.57 times more likely to get uncontrolled hypertension than patients with less than five years of duration of diagnosis. The gradual deterioration caused by the disease and a decrease in the patients’ tendency to seek medical attention over time could be the reasons behind this situation. Essentially, the condition might be getting worse over time and the patients may not be seeking the necessary medical help as often as they should.

Moreover, patients who were non-adherent to physical activity were 2.13 times more likely to face uncontrolled hypertension than their counterparts. This could be justified because regular physical activity controls hypertension easily by enhancing heart and renal function and preventing weight gain.

Additionally, patients with the age of 50 years and above were also around 1.57 times more likely to have the chance of getting uncontrolled hypertension than patients with the age of less than 50 years old [1,3,6,9,18,26,39,40,42–44]. It could be explained that as age increases, it induces an increase in visceral fat and circulating leptin, which in turn increases the level of hypertension and makes it more challenging to control with treatment modalities.

Strengths and limitations of the study

This review was the first study that combined the results of several studies conducted in Sub-Saharan Africa giving stronger evidence on uncontrolled hypertension. It was also able to include a large number of study participants (n = 11,600), which was much more than the sample sizes of the included primary studies. Though all of the studies are of good quality, most of the included studies were cross-sectional, and only articles written in the English language were reviewed.

Conclusions

The overall pooled prevalence of uncontrolled hypertension was considerably high. Moreover, the review showed that older age, duration of diagnosis, non-adherence to physical activity, khat chewing, and habitual coffee consumption were the independent predictors of uncontrolled hypertension. Therefore, health professionals and other responsible stakeholders should advance encouraging hypertensive patients to their weight management, increase their awareness/educational level, and take anti-hypertensive medications continuously as ordered. Early identification of hypertension and management of comorbidities among hypertensive patients is crucial, and it should be emphasized to control hypertension easily.

Supporting information

S1 File. S1 Table PRISMA checklist.

https://doi.org/10.1371/journal.pone.0301547.s001

(DOCX)

S2 File. S2 and S3 Tables quality and risk of bias assessment of the included studies.

https://doi.org/10.1371/journal.pone.0301547.s002

(DOCX)

References

1. Abdu O, Diro E, Balcha A, Abdulkadir M, Ayanaw D, Getahun S, Mitiku T, Mebrehatom M, Gesssesse Z. Blood pressure control among hypertensive patients in University of Gondar Hospital, Northwest Ethiopia: a cross sectional study. Clinical Medicine Research. 2017 Apr;6(3):99–105.
- View Article
- Google Scholar
2. Ataklte F, Erqou S, Kaptoge S, Taye B, Echouffo-Tcheugui JB, Kengne AP. Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis. Hypertension. 2015 Feb;65(2):291–8.
- View Article
- Google Scholar
3. Yazie D, Shibeshi W, Alebachew M, Berha AB. Assessment of blood pressure control among hypertensive patients in Zewditu Memorial Hospital, Addis Ababa, Ethiopia: a cross-sectional study. Journal of Bioanalysis & Biomedicine. 2018 Jun 30;10.
- View Article
- Google Scholar
4. Amare F, Hagos B, Sisay M, Molla B. Uncontrolled hypertension in Ethiopia: a systematic review and meta-analysis of institution-based observational studies. BMC cardiovascular disorders. 2020 Dec;20:1–9.
- View Article
- Google Scholar
5. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016 Aug 9;134(6):441–50. pmid:27502908
- View Article
- PubMed/NCBI
- Google Scholar
6. Abdisa L, Girma S, Lami M, Hiko A, Yadeta E, Geneti Y, Balcha T, Assefa N, Letta S. Uncontrolled hypertension and associated factors among adult hypertensive patients on follow-up at public hospitals, Eastern Ethiopia: A multicenter study. SAGE Open Medicine. 2022 Jun;10:20503121221104442. pmid:35769491
- View Article
- PubMed/NCBI
- Google Scholar
7. Douglas KE, Alabere ID. Blood pressure control and associated factors among hypertensive patients in University of Port Harcourt teaching hospital in South-South Nigeria. Nigerian Journal of Medicine. 2018;27(3):234–44.
- View Article
- Google Scholar
8. van de Vijver S, Akinyi H, Oti S, Olajide A, Agyemang C, Aboderin I, Kyobutungi C. Status report on hypertension in Africa-Consultative review for the 6th Session of the African Union Conference of Ministers of Health on NCD’s. Pan African Medical Journal. 2014 May 6;16(1).
- View Article
- Google Scholar
9. Aberhe W, Mariye T, Bahrey D, Zereabruk K, Hailay A, Mebrahtom G, Gemechu K, Medhin B. Prevalence and factors associated with uncontrolled hypertension among adult hypertensive patients on follow-up at Northern Ethiopia, 2019: cross-sectional study. Pan African Medical Journal. 2020 Jul 15;36(1). pmid:32952831
- View Article
- PubMed/NCBI
- Google Scholar
10. Animut Y, Assefa AT, Lemma DG. Blood pressure control status and associated factors among adult hypertensive patients on outpatient follow-up at University of Gondar Referral Hospital, northwest Ethiopia: a retrospective follow-up study. Integrated blood pressure control. 2018 Apr 23:37–46.
- View Article
- Google Scholar
11. Maginga J, Guerrero M, Koh E, Holm Hansen C, Shedafa R, Kalokola F, Smart LR, Peck RN. Hypertension control and its correlates among adults attending a hypertension clinic in Tanzania. The Journal Of Clinical Hypertension. 2016 Mar;18(3):207–16. pmid:26279168
- View Article
- PubMed/NCBI
- Google Scholar
12. Menanga A, Edie S, Nkoke C, Boombhi J, Musa AJ, Mfeukeu LK. Factors associated with blood pressure control amongst adults with hypertension in Yaounde, Cameroon: a cross-sectional study. Cardiovasc Diagn Ther [Internet]. 2016 Oct; 6 (5): 439–45. pmid:27747167
- View Article
- PubMed/NCBI
- Google Scholar
13. Dzudie A, Kengne AP, Muna WF, Ba H, Menanga A, Kouam CK, Abah J, Monkam Y, Biholong C, Mintom P, Kamdem F. Prevalence, awareness, treatment and control of hypertension in a self-selected sub-Saharan African urban population: a cross-sectional study. BMJ open. 2012 Jan 1;2(4):e001217. pmid:22923629
- View Article
- PubMed/NCBI
- Google Scholar
14. Lemessa F, Lamessa M. Uncontrolled hypertension and associated factors among hypertensive adults in Bale Zone Public Hospitals, Ethiopia. J Hypertens Manag. 2021 Mar 30;7(1):185–90.
- View Article
- Google Scholar
15. Adeniyi OV, Yogeswaran P, Longo-Mbenza B, Goon DT. Uncontrolled hypertension and its determinants in patients with concomitant type 2 diabetes mellitus (T2DM) in rural South Africa. PloS one. 2016 Mar 1;11(3):e0150033. pmid:26930050
- View Article
- PubMed/NCBI
- Google Scholar
16. Shukrala F, Gabriel T. Assessment of prescribing, dispensing, and patient use pattern of antihypertensive drugs for patients attending outpatient department of Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia. Drug design, development and therapy. 2015 Jan 17:519–23. pmid:25632220
- View Article
- PubMed/NCBI
- Google Scholar
17. Ambaw AD, Alemie GA, W/Yohannes SM, Mengesha ZB. Adherence to antihypertensive treatment and associated factors among patients on follow up at University of Gondar Hospital, Northwest Ethiopia. BMC public health. 2012 Dec;12:1–6.
- View Article
- Google Scholar
18. Fekadu G, Adamu A, Gebre M, Gamachu B, Bekele F, Abadiga M, Mosisa G, Oluma A. Magnitude and determinants of uncontrolled blood pressure among adult hypertensive patients on follow-up at Nekemte Referral Hospital, Western Ethiopia. Integrated blood pressure control. 2020 Apr 21:49–61. pmid:32368134
- View Article
- PubMed/NCBI
- Google Scholar
19. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. The lancet. 2005 Jan 15;365(9455):217–23. pmid:15652604
- View Article
- PubMed/NCBI
- Google Scholar
20. Kibret KT, Mesfin YM. Prevalence of hypertension in Ethiopia: a systematic meta-analysis. Public health reviews. 2015 Dec;36:1–2.
- View Article
- Google Scholar
21. Lichisa G, Tegegne G, Gelaw B, Defersha A, Woldu M, Linjesa J. Blood pressure control and its contributing factor among ambulatory hypertensive patients in Adama Hospital medical college, East Shoa, Adama, Ethiopia. Int J Pharm Biol Sci Res Dev. 2014;2(7):1–5.
- View Article
- Google Scholar
22. Gebremichael GB, Berhe KK, Zemichael TM. Uncontrolled hypertension and associated factors among adult hypertensive patients in Ayder comprehensive specialized hospital, Tigray, Ethiopia, 2018. BMC cardiovascular disorders. 2019 Dec;19:1–0.
- View Article
- Google Scholar
23. Magara GM. Prevalence of Uncontrolled Hypertension and Associated Factors among Hypertensive Patients Attending Medical Outpatient Clinic, Thika Level 5 Hospital, Kiambu County, Kenya (Doctoral dissertation, JKUAT-COHES).
- View Article
- Google Scholar
24. Negash AI, Siyoum D, Hailemariam T, Kidanu BH, Gebremdhin G. Uncontrolled hypertension and associated factors among adult hypertensive patients in public hospitals of central Zone, Tigray, Ethiopia, 2018: a cross-sectional study. International Journal of Endocrinology Research and Reviews. 2023;3(1):1–9.
- View Article
- Google Scholar
25. Omar SM, Elnour O, Adam GK, Osman OE, Adam I. Assessment of blood pressure control in adult hypertensive patients in eastern Sudan. BMC cardiovascular disorders. 2018 Dec;18:1–6.
- View Article
- Google Scholar
26. Sheleme T, Jilo O, Bekele F, Olika W, Safera B, Babu Y. Uncontrolled blood pressure and contributing factors among patients with hypertension at outpatient care of Bedele General Hospital, Southwest Ethiopia: A cross-sectional study. SAGE Open Medicine. 2022 Sep;10:20503121221126333. pmid:36187360
- View Article
- PubMed/NCBI
- Google Scholar
27. Amare F. Blood Pressure control and Associated Factors among Hypertensive Patients Attending Health Centers of Addis Ababa (Doctoral dissertation, Addis Ababa University).
- View Article
- Google Scholar
28. Abegaz TM, Abdela OA, Bhagavathula AS, Teni FS. Magnitude and determinants of uncontrolled blood pressure among hypertensive patients in Ethiopia: hospital-based observational study. Pharmacy Practice (Granada). 2018 Jun;16(2). pmid:30023028
- View Article
- PubMed/NCBI
- Google Scholar
29. Antignac M, Diop IB, Macquart de Terline D, Kramoh KE, Balde DM, Dzudie A, Ferreira B, Houenassi MD, Hounsou D, Ikama MS, Kane A. Socioeconomic status and hypertension control in sub-Saharan Africa: the Multination EIGHT study (Evaluation of Hypertension in Sub-Saharan Africa). Hypertension. 2018 Apr;71(4):577–84. pmid:29378852
- View Article
- PubMed/NCBI
- Google Scholar
30. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj. 2021 Mar 29;372.
- View Article
- Google Scholar
31. Masilela C, Pearce B, Ongole JJ, Adeniyi OV, Benjeddou M. Cross-sectional study of prevalence and determinants of uncontrolled hypertension among South African adult residents of Mkhondo municipality. BMC Public Health. 2020 Dec;20:1–0.
- View Article
- Google Scholar
32. DerSimonian R, Kacker R. Random-effects model for meta-analysis of clinical trials: an update. Contemporary clinical trials. 2007 Feb 1;28(2):105–14. pmid:16807131
- View Article
- PubMed/NCBI
- Google Scholar
33. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Comparison of two methods to detect publication bias in meta-analysis. Jama. 2006 Feb 8;295(6):676–80. pmid:16467236
- View Article
- PubMed/NCBI
- Google Scholar
34. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj. 2003 Sep 4;327(7414):557–60. pmid:12958120
- View Article
- PubMed/NCBI
- Google Scholar
35. Borenstein M, Hedges LV, Higgins JP, Rothstein HR. A basic introduction to fixed‐effect and random‐effects models for meta‐analysis. Research synthesis methods. 2010 Apr;1(2):97–111. pmid:26061376
- View Article
- PubMed/NCBI
- Google Scholar
36. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in medicine. 2002 Jun 15;21(11):1539–58. pmid:12111919
- View Article
- PubMed/NCBI
- Google Scholar
37. Stovold E, Beecher D, Foxlee R, Noel-Storr A. Study flow diagrams in Cochrane systematic review updates: an adapted PRISMA flow diagram. Systematic reviews. 2014 Dec;3:1–5.
- View Article
- Google Scholar
38. Abegaz TM, Tefera YG, Abebe TB. Antihypertensive drug prescription patterns and their impact on outcome of blood pressure in Ethiopia: a hospital-based cross-sectional study. Integrated Pharmacy Research and Practice. 2017 Jan 27:29–35. pmid:29354548
- View Article
- PubMed/NCBI
- Google Scholar
39. Asgedom SW, Gudina EK, Desse TA. Assessment of blood pressure control among hypertensive patients in Southwest Ethiopia. PloS one. 2016 Nov 23;11(11):e0166432. pmid:27880781
- View Article
- PubMed/NCBI
- Google Scholar
40. Muleta S, Melaku T, Chelkeba L, Assefa D. Blood pressure control and its determinants among diabetes mellitus co-morbid hypertensive patients at Jimma University medical center, South West Ethiopia. Clinical hypertension. 2017 Dec;23:1–9.
- View Article
- Google Scholar
41. Solomon M, Negussie YM, Bekele NT, Getahun MS, Gurara AM. Uncontrolled blood pressure and associated factors in adult hypertensive patients undergoing follow-up at public health facility ambulatory clinics in Bishoftu town, Ethiopia: a multi-center study. BMC Cardiovascular Disorders. 2023 May 17;23(1):258. pmid:37198582
- View Article
- PubMed/NCBI
- Google Scholar
42. Tesfaye B, Haile D, Lake B, Belachew T, Tesfaye T, Abera H. Uncontrolled hypertension and associated factors among adult hypertensive patients on follow-up at Jimma University Teaching and Specialized Hospital: cross-sectional study. Research Reports in Clinical Cardiology. 2017 Mar 30:21–9.
- View Article
- Google Scholar
43. Teshome DF, Demssie AF, Zeleke BM. Determinants of blood pressure control amongst hypertensive patients in Northwest Ethiopia. PloS one. 2018 May 2;13(5):e0196535. pmid:29718964
- View Article
- PubMed/NCBI
- Google Scholar
44. Berhe DF, Taxis K, Haaijer-Ruskamp FM, Mulugeta A, Mengistu YT, Mol PG. Hypertension treatment practices and its determinants among ambulatory patients: retrospective cohort study in Ethiopia. BMJ open. 2017 Aug 1;7(8):e015743. pmid:28775184
- View Article
- PubMed/NCBI
- Google Scholar
45. Burusie A, Deyessa N. Determinants of mother to child HIV transmission (HIV MTCT); a case control study in Assela, Adama and Bishoftu Hospitals, Oromia Regional State, Ethiopia. Cell Dev Biol. 2015;4(2):1000152.
- View Article
- Google Scholar
46. Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, Baker P, Smith E, Buchbinder R. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. Journal of clinical epidemiology. 2012 Sep 1;65(9):934–9. pmid:22742910
- View Article
- PubMed/NCBI
- Google Scholar
47. Jafar TH, Gandhi M, Jehan I, Naheed A, de Silva HA, Shahab H, Alam D, Luke N, Wee Lim C, COBRA-BPS Study Group. Determinants of uncontrolled hypertension in rural communities in South Asia—Bangladesh, Pakistan, and Sri Lanka. American journal of hypertension. 2018 Oct 15;31(11):1205–14. pmid:29701801
- View Article
- PubMed/NCBI
- Google Scholar

[ref1] 1. Abdu O, Diro E, Balcha A, Abdulkadir M, Ayanaw D, Getahun S, Mitiku T, Mebrehatom M, Gesssesse Z. Blood pressure control among hypertensive patients in University of Gondar Hospital, Northwest Ethiopia: a cross sectional study. Clinical Medicine Research. 2017 Apr;6(3):99–105.
View Article
Google Scholar

[2] View Article

[3] Google Scholar

[ref2] 2. Ataklte F, Erqou S, Kaptoge S, Taye B, Echouffo-Tcheugui JB, Kengne AP. Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis. Hypertension. 2015 Feb;65(2):291–8.
View Article
Google Scholar

[5] View Article

[6] Google Scholar

[ref3] 3. Yazie D, Shibeshi W, Alebachew M, Berha AB. Assessment of blood pressure control among hypertensive patients in Zewditu Memorial Hospital, Addis Ababa, Ethiopia: a cross-sectional study. Journal of Bioanalysis & Biomedicine. 2018 Jun 30;10.
View Article
Google Scholar

[8] View Article

[9] Google Scholar

[ref4] 4. Amare F, Hagos B, Sisay M, Molla B. Uncontrolled hypertension in Ethiopia: a systematic review and meta-analysis of institution-based observational studies. BMC cardiovascular disorders. 2020 Dec;20:1–9.
View Article
Google Scholar

[11] View Article

[12] Google Scholar

[ref5] 5. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016 Aug 9;134(6):441–50. pmid:27502908
View Article
PubMed/NCBI
Google Scholar

[14] View Article

[15] PubMed/NCBI

[16] Google Scholar

[ref6] 6. Abdisa L, Girma S, Lami M, Hiko A, Yadeta E, Geneti Y, Balcha T, Assefa N, Letta S. Uncontrolled hypertension and associated factors among adult hypertensive patients on follow-up at public hospitals, Eastern Ethiopia: A multicenter study. SAGE Open Medicine. 2022 Jun;10:20503121221104442. pmid:35769491
View Article
PubMed/NCBI
Google Scholar

[18] View Article

[19] PubMed/NCBI

[20] Google Scholar

[ref7] 7. Douglas KE, Alabere ID. Blood pressure control and associated factors among hypertensive patients in University of Port Harcourt teaching hospital in South-South Nigeria. Nigerian Journal of Medicine. 2018;27(3):234–44.
View Article
Google Scholar

[22] View Article

[23] Google Scholar

[ref8] 8. van de Vijver S, Akinyi H, Oti S, Olajide A, Agyemang C, Aboderin I, Kyobutungi C. Status report on hypertension in Africa-Consultative review for the 6th Session of the African Union Conference of Ministers of Health on NCD’s. Pan African Medical Journal. 2014 May 6;16(1).
View Article
Google Scholar

[25] View Article

[26] Google Scholar

[ref9] 9. Aberhe W, Mariye T, Bahrey D, Zereabruk K, Hailay A, Mebrahtom G, Gemechu K, Medhin B. Prevalence and factors associated with uncontrolled hypertension among adult hypertensive patients on follow-up at Northern Ethiopia, 2019: cross-sectional study. Pan African Medical Journal. 2020 Jul 15;36(1). pmid:32952831
View Article
PubMed/NCBI
Google Scholar

[28] View Article

[29] PubMed/NCBI

[30] Google Scholar

[ref10] 10. Animut Y, Assefa AT, Lemma DG. Blood pressure control status and associated factors among adult hypertensive patients on outpatient follow-up at University of Gondar Referral Hospital, northwest Ethiopia: a retrospective follow-up study. Integrated blood pressure control. 2018 Apr 23:37–46.
View Article
Google Scholar

[32] View Article

[33] Google Scholar

[ref11] 11. Maginga J, Guerrero M, Koh E, Holm Hansen C, Shedafa R, Kalokola F, Smart LR, Peck RN. Hypertension control and its correlates among adults attending a hypertension clinic in Tanzania. The Journal Of Clinical Hypertension. 2016 Mar;18(3):207–16. pmid:26279168
View Article
PubMed/NCBI
Google Scholar

[35] View Article

[36] PubMed/NCBI

[37] Google Scholar

[ref12] 12. Menanga A, Edie S, Nkoke C, Boombhi J, Musa AJ, Mfeukeu LK. Factors associated with blood pressure control amongst adults with hypertension in Yaounde, Cameroon: a cross-sectional study. Cardiovasc Diagn Ther [Internet]. 2016 Oct; 6 (5): 439–45. pmid:27747167
View Article
PubMed/NCBI
Google Scholar

[39] View Article

[40] PubMed/NCBI

[41] Google Scholar

[ref13] 13. Dzudie A, Kengne AP, Muna WF, Ba H, Menanga A, Kouam CK, Abah J, Monkam Y, Biholong C, Mintom P, Kamdem F. Prevalence, awareness, treatment and control of hypertension in a self-selected sub-Saharan African urban population: a cross-sectional study. BMJ open. 2012 Jan 1;2(4):e001217. pmid:22923629
View Article
PubMed/NCBI
Google Scholar

[43] View Article

[44] PubMed/NCBI

[45] Google Scholar

[ref14] 14. Lemessa F, Lamessa M. Uncontrolled hypertension and associated factors among hypertensive adults in Bale Zone Public Hospitals, Ethiopia. J Hypertens Manag. 2021 Mar 30;7(1):185–90.
View Article
Google Scholar

[47] View Article

[48] Google Scholar

[ref15] 15. Adeniyi OV, Yogeswaran P, Longo-Mbenza B, Goon DT. Uncontrolled hypertension and its determinants in patients with concomitant type 2 diabetes mellitus (T2DM) in rural South Africa. PloS one. 2016 Mar 1;11(3):e0150033. pmid:26930050
View Article
PubMed/NCBI
Google Scholar

[50] View Article

[51] PubMed/NCBI

[52] Google Scholar

[ref16] 16. Shukrala F, Gabriel T. Assessment of prescribing, dispensing, and patient use pattern of antihypertensive drugs for patients attending outpatient department of Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia. Drug design, development and therapy. 2015 Jan 17:519–23. pmid:25632220
View Article
PubMed/NCBI
Google Scholar

[54] View Article

[55] PubMed/NCBI

[56] Google Scholar

[ref17] 17. Ambaw AD, Alemie GA, W/Yohannes SM, Mengesha ZB. Adherence to antihypertensive treatment and associated factors among patients on follow up at University of Gondar Hospital, Northwest Ethiopia. BMC public health. 2012 Dec;12:1–6.
View Article
Google Scholar

[58] View Article

[59] Google Scholar

[ref18] 18. Fekadu G, Adamu A, Gebre M, Gamachu B, Bekele F, Abadiga M, Mosisa G, Oluma A. Magnitude and determinants of uncontrolled blood pressure among adult hypertensive patients on follow-up at Nekemte Referral Hospital, Western Ethiopia. Integrated blood pressure control. 2020 Apr 21:49–61. pmid:32368134
View Article
PubMed/NCBI
Google Scholar

[61] View Article

[62] PubMed/NCBI

[63] Google Scholar

[ref19] 19. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. The lancet. 2005 Jan 15;365(9455):217–23. pmid:15652604
View Article
PubMed/NCBI
Google Scholar

[65] View Article

[66] PubMed/NCBI

[67] Google Scholar

[ref20] 20. Kibret KT, Mesfin YM. Prevalence of hypertension in Ethiopia: a systematic meta-analysis. Public health reviews. 2015 Dec;36:1–2.
View Article
Google Scholar

[69] View Article

[70] Google Scholar

[ref21] 21. Lichisa G, Tegegne G, Gelaw B, Defersha A, Woldu M, Linjesa J. Blood pressure control and its contributing factor among ambulatory hypertensive patients in Adama Hospital medical college, East Shoa, Adama, Ethiopia. Int J Pharm Biol Sci Res Dev. 2014;2(7):1–5.
View Article
Google Scholar

[72] View Article

[73] Google Scholar

[ref22] 22. Gebremichael GB, Berhe KK, Zemichael TM. Uncontrolled hypertension and associated factors among adult hypertensive patients in Ayder comprehensive specialized hospital, Tigray, Ethiopia, 2018. BMC cardiovascular disorders. 2019 Dec;19:1–0.
View Article
Google Scholar

[75] View Article

[76] Google Scholar

[ref23] 23. Magara GM. Prevalence of Uncontrolled Hypertension and Associated Factors among Hypertensive Patients Attending Medical Outpatient Clinic, Thika Level 5 Hospital, Kiambu County, Kenya (Doctoral dissertation, JKUAT-COHES).
View Article
Google Scholar

[78] View Article

[79] Google Scholar

[ref24] 24. Negash AI, Siyoum D, Hailemariam T, Kidanu BH, Gebremdhin G. Uncontrolled hypertension and associated factors among adult hypertensive patients in public hospitals of central Zone, Tigray, Ethiopia, 2018: a cross-sectional study. International Journal of Endocrinology Research and Reviews. 2023;3(1):1–9.
View Article
Google Scholar

[81] View Article

[82] Google Scholar

[ref25] 25. Omar SM, Elnour O, Adam GK, Osman OE, Adam I. Assessment of blood pressure control in adult hypertensive patients in eastern Sudan. BMC cardiovascular disorders. 2018 Dec;18:1–6.
View Article
Google Scholar

[84] View Article

[85] Google Scholar

[ref26] 26. Sheleme T, Jilo O, Bekele F, Olika W, Safera B, Babu Y. Uncontrolled blood pressure and contributing factors among patients with hypertension at outpatient care of Bedele General Hospital, Southwest Ethiopia: A cross-sectional study. SAGE Open Medicine. 2022 Sep;10:20503121221126333. pmid:36187360
View Article
PubMed/NCBI
Google Scholar

[87] View Article

[88] PubMed/NCBI

[89] Google Scholar

[ref27] 27. Amare F. Blood Pressure control and Associated Factors among Hypertensive Patients Attending Health Centers of Addis Ababa (Doctoral dissertation, Addis Ababa University).
View Article
Google Scholar

[91] View Article

[92] Google Scholar

[ref28] 28. Abegaz TM, Abdela OA, Bhagavathula AS, Teni FS. Magnitude and determinants of uncontrolled blood pressure among hypertensive patients in Ethiopia: hospital-based observational study. Pharmacy Practice (Granada). 2018 Jun;16(2). pmid:30023028
View Article
PubMed/NCBI
Google Scholar

[94] View Article

[95] PubMed/NCBI

[96] Google Scholar

[ref29] 29. Antignac M, Diop IB, Macquart de Terline D, Kramoh KE, Balde DM, Dzudie A, Ferreira B, Houenassi MD, Hounsou D, Ikama MS, Kane A. Socioeconomic status and hypertension control in sub-Saharan Africa: the Multination EIGHT study (Evaluation of Hypertension in Sub-Saharan Africa). Hypertension. 2018 Apr;71(4):577–84. pmid:29378852
View Article
PubMed/NCBI
Google Scholar

[98] View Article

[99] PubMed/NCBI

[100] Google Scholar

[ref30] 30. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj. 2021 Mar 29;372.
View Article
Google Scholar

[102] View Article

[103] Google Scholar

[ref31] 31. Masilela C, Pearce B, Ongole JJ, Adeniyi OV, Benjeddou M. Cross-sectional study of prevalence and determinants of uncontrolled hypertension among South African adult residents of Mkhondo municipality. BMC Public Health. 2020 Dec;20:1–0.
View Article
Google Scholar

[105] View Article

[106] Google Scholar

[ref32] 32. DerSimonian R, Kacker R. Random-effects model for meta-analysis of clinical trials: an update. Contemporary clinical trials. 2007 Feb 1;28(2):105–14. pmid:16807131
View Article
PubMed/NCBI
Google Scholar

[108] View Article

[109] PubMed/NCBI

[110] Google Scholar

[ref33] 33. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Comparison of two methods to detect publication bias in meta-analysis. Jama. 2006 Feb 8;295(6):676–80. pmid:16467236
View Article
PubMed/NCBI
Google Scholar

[112] View Article

[113] PubMed/NCBI

[114] Google Scholar

[ref34] 34. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj. 2003 Sep 4;327(7414):557–60. pmid:12958120
View Article
PubMed/NCBI
Google Scholar

[116] View Article

[117] PubMed/NCBI

[118] Google Scholar

[ref35] 35. Borenstein M, Hedges LV, Higgins JP, Rothstein HR. A basic introduction to fixed‐effect and random‐effects models for meta‐analysis. Research synthesis methods. 2010 Apr;1(2):97–111. pmid:26061376
View Article
PubMed/NCBI
Google Scholar

[120] View Article

[121] PubMed/NCBI

[122] Google Scholar

[ref36] 36. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in medicine. 2002 Jun 15;21(11):1539–58. pmid:12111919
View Article
PubMed/NCBI
Google Scholar

[124] View Article

[125] PubMed/NCBI

[126] Google Scholar

[ref37] 37. Stovold E, Beecher D, Foxlee R, Noel-Storr A. Study flow diagrams in Cochrane systematic review updates: an adapted PRISMA flow diagram. Systematic reviews. 2014 Dec;3:1–5.
View Article
Google Scholar

[128] View Article

[129] Google Scholar

[ref38] 38. Abegaz TM, Tefera YG, Abebe TB. Antihypertensive drug prescription patterns and their impact on outcome of blood pressure in Ethiopia: a hospital-based cross-sectional study. Integrated Pharmacy Research and Practice. 2017 Jan 27:29–35. pmid:29354548
View Article
PubMed/NCBI
Google Scholar

[131] View Article

[132] PubMed/NCBI

[133] Google Scholar

[ref39] 39. Asgedom SW, Gudina EK, Desse TA. Assessment of blood pressure control among hypertensive patients in Southwest Ethiopia. PloS one. 2016 Nov 23;11(11):e0166432. pmid:27880781
View Article
PubMed/NCBI
Google Scholar

[135] View Article

[136] PubMed/NCBI

[137] Google Scholar

[ref40] 40. Muleta S, Melaku T, Chelkeba L, Assefa D. Blood pressure control and its determinants among diabetes mellitus co-morbid hypertensive patients at Jimma University medical center, South West Ethiopia. Clinical hypertension. 2017 Dec;23:1–9.
View Article
Google Scholar

[139] View Article

[140] Google Scholar

[ref41] 41. Solomon M, Negussie YM, Bekele NT, Getahun MS, Gurara AM. Uncontrolled blood pressure and associated factors in adult hypertensive patients undergoing follow-up at public health facility ambulatory clinics in Bishoftu town, Ethiopia: a multi-center study. BMC Cardiovascular Disorders. 2023 May 17;23(1):258. pmid:37198582
View Article
PubMed/NCBI
Google Scholar

[142] View Article

[143] PubMed/NCBI

[144] Google Scholar

[ref42] 42. Tesfaye B, Haile D, Lake B, Belachew T, Tesfaye T, Abera H. Uncontrolled hypertension and associated factors among adult hypertensive patients on follow-up at Jimma University Teaching and Specialized Hospital: cross-sectional study. Research Reports in Clinical Cardiology. 2017 Mar 30:21–9.
View Article
Google Scholar

[146] View Article

[147] Google Scholar

[ref43] 43. Teshome DF, Demssie AF, Zeleke BM. Determinants of blood pressure control amongst hypertensive patients in Northwest Ethiopia. PloS one. 2018 May 2;13(5):e0196535. pmid:29718964
View Article
PubMed/NCBI
Google Scholar

[149] View Article

[150] PubMed/NCBI

[151] Google Scholar

[ref44] 44. Berhe DF, Taxis K, Haaijer-Ruskamp FM, Mulugeta A, Mengistu YT, Mol PG. Hypertension treatment practices and its determinants among ambulatory patients: retrospective cohort study in Ethiopia. BMJ open. 2017 Aug 1;7(8):e015743. pmid:28775184
View Article
PubMed/NCBI
Google Scholar

[153] View Article

[154] PubMed/NCBI

[155] Google Scholar

[ref45] 45. Burusie A, Deyessa N. Determinants of mother to child HIV transmission (HIV MTCT); a case control study in Assela, Adama and Bishoftu Hospitals, Oromia Regional State, Ethiopia. Cell Dev Biol. 2015;4(2):1000152.
View Article
Google Scholar

[157] View Article

[158] Google Scholar

[ref46] 46. Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, Baker P, Smith E, Buchbinder R. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. Journal of clinical epidemiology. 2012 Sep 1;65(9):934–9. pmid:22742910
View Article
PubMed/NCBI
Google Scholar

[160] View Article

[161] PubMed/NCBI

[162] Google Scholar

[ref47] 47. Jafar TH, Gandhi M, Jehan I, Naheed A, de Silva HA, Shahab H, Alam D, Luke N, Wee Lim C, COBRA-BPS Study Group. Determinants of uncontrolled hypertension in rural communities in South Asia—Bangladesh, Pakistan, and Sri Lanka. American journal of hypertension. 2018 Oct 15;31(11):1205–14. pmid:29701801
View Article
PubMed/NCBI
Google Scholar

[164] View Article

[165] PubMed/NCBI

[166] Google Scholar

Figures

Abstract

Introduction

Methods

Results

Conclusions

Introduction

Methods

Reporting and registration protocol

Databases and search strategy

Eligibility criteria

Study selection

Data extraction

Primary outcome measure of interest

Operational definition of variables

Data analysis

Results

Search results

Characteristics of the included studies

Quality assessment of the included studies

Risk of bias assessment

Meta-analysis

Pooled prevalence of uncontrolled hypertension

Publication bias

Investigation of heterogeneity

Sensitivity analysis

Subgroup analysis using the study area

Factors associated with uncontrolled hypertension

Discussion

Strengths and limitations of the study

Conclusions

Supporting information

S1 File. S1 Table PRISMA checklist.

S2 File. S2 and S3 Tables quality and risk of bias assessment of the included studies.

References