KNOWLEDGE AND PERCEPTION OF HYPERTENSION AND ITS MANAGEMENT AMONG CLIENTS/PATIENTS

ABSTRACT

Hypertension is a critical public health challenge in Auchi, Nigeria, and across sub-Saharan Africa, where it remains the most rapidly rising non-communicable disease (Gyamfi et al., 2022; Adeke et al., 2022). The purpose of this qualitative phenomenological survey was to determine hypertensive patients' knowledge, perceptions, attitudes, and lifestyle practices in order to optimize their health and treatment needs. We examined a cohort of 108 randomly selected hypertensive patients by means of a self-structured questionnaire and a detailed interview. Analysis was performed using the Statistical Package for Social Sciences (SPSS) and chi-square was used for significance tests at the 0.05 level. More males 60 (55.6%) than females 48 (44.4%) were assessed. Their age range was 35–80 years (mean = 59.05 ± 9.06 years); the modal age group was 56–60 years (24.1%). Sixty-six respondents (61%) knew hypertension to be high blood pressure (BP), 22 (20%) thought it meant excessive thinking and worrying, while 57 (53%) claimed it was hereditary. Forty-three (40%) felt it was caused by malevolent spirits, and 32 (30%) believed it was caused by bad food or poisoning. A few (18%) knew some risk factors. Symptoms attributed to hypertension included headache, restlessness, palpitation, excessive pulsation of the superficial temporal artery, and "internal heat," but 80 (74%) attested to its correct diagnosis by BP measurement. Although 98 (90.7%) felt the disease indicated serious morbidity, only 36 (33.3%) were adherent to treatment, and fewer practiced lifestyle modification. Thirty-two (30%) knew at least one antihypertensive drug they use. Psychosocial factors like depression, anxiety, fear of addiction, and intolerable drug adverse effects impacted negatively on patients' attitudes to treatment (Ferreira et al., 2024; Zhou et al., 2024). We conclude that patients' knowledge of hypertension in Auchi is low and their attitudes to treatment are negative. Patient education, motivation, and public enlightenment are imperative.

CHAPTER ONE

INTRODUCTION

1.1 Background of Study

Hypertension remains a major global public health challenge and has been identified as the leading risk factor for cardiovascular morbidity and mortality worldwide (Campbell et al., 2024; World Health Organization [WHO], 2023). It accelerates the hardening of the arteries, thereby predisposing individuals to heart disease, peripheral vascular disease, stroke, heart failure, and kidney failure. According to the WHO (2023), approximately 1.3 billion adults between the ages of 30 and 79 worldwide now have high blood pressure, with the majority living in low- and middle-income nations. Hypertension is the commonest non-communicable disease in the world, and all races are affected with variable prevalence.

Rahut et al. (2023) noted that urbanization, ageing, dietary and lifestyle changes, high illiteracy rates, poor access to health facilities, poverty, and social stress have contributed to an increase in the prevalence of hypertension in developing countries. Prenissl et al. (as cited in Gyamfi et al., 2022) confirmed that hypertension produces significant disruptions in health, disability, and death in the adult population worldwide. Global Burden of Disease (GBD) data indicate that CVD deaths increased from 13.1 million in 1990 to 19.2 million in 2023, with hypertensive heart disease among the four leading cardiovascular causes of disability-adjusted life years (DALYs) globally (JACC GBD Collaborators, 2025).

In the United States of America, approximately 46.7% of adults have hypertension based on the American Heart Association/American College of Cardiology (AHA/ACC) definition of systolic BP ≥130 mmHg or diastolic BP ≥80 mmHg (Medscape, 2025). Of these, approximately 85–90% have primary hypertension (high blood pressure related to unidentified cause), while the remaining 10–15% have secondary hypertension (high blood pressure related to an identified cause). In Africa, hypertension affects about 46% of the adult population aged 25 years and above the highest regional prevalence globally while the lowest regional prevalence (35%) is found in the Americas (WHO, 2023). In sub-Saharan Africa, hypertension remains the most rapidly rising cardiovascular disease; a narrative review of evidence from 2017 to 2023 confirmed a high and increasing prevalence across the region, with poor detection, treatment, and control rates (Gyamfi et al., 2022). In Nigeria, a country-wide survey found that hypertension is strongly associated with age, obesity, marital status, and low physical activity, with hypertensive individuals having a mean age of 53.1 ± 13.6 years (Adeke et al., 2022).

Hypertension, also known as high blood pressure, is broadly defined as a persistent blood pressure in the arteries at or above 140/90 mmHg that is, systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg as recognized by the European Society of Hypertension (ESH) and most international guidelines outside the United States (Kario et al., 2026; Medscape, 2025). Normal blood pressure is below 120/80 mmHg; blood pressure between 120/80 and 139/89 mmHg is classified as elevated or "pre-hypertension," while 140/90 mmHg and above is considered high (abnormal) blood pressure in the majority of global guidelines (Kario et al., 2026). In the United States, the 2017 ACC/AHA guidelines redefined hypertension as SBP ≥130 mmHg or DBP ≥80 mmHg, eliminating the prehypertension category and expanding stage 1 hypertension to include readings of 130–139/80–89 mmHg (Messerli et al., 2022). Hypertension is sometimes called "the silent killer" because people who have it are often symptom-free. In this study, hypertension is defined as a systolic blood pressure greater than 140 mmHg and a diastolic blood pressure greater than 90 mmHg among adults, in keeping with WHO and ESH thresholds. The top number (systolic pressure) corresponds to the pressure in the arteries as the heart contracts and pumps blood forward, while the bottom number (diastolic pressure) reflects the lowest pressure to which the arteries are exposed. Blood pressure is normally measured at the brachial artery with a sphygmomanometer in millimetres of mercury (mmHg) and expressed as systolic over diastolic pressure. Hypertension is classified into two main types: primary (essential) and secondary.

Primary hypertension has an unknown cause and accounts for approximately 85–90% of all hypertension cases (Medscape, 2025). This type is strongly associated with lifestyle factors. Patients often do not manifest many signs and symptoms but may experience frequent headache, tiredness, dizziness, or nosebleeds. Although the underlying cause is not precisely known, obesity, smoking, alcohol use, diet, and heredity are known to play a role in essential or primary hypertension.

Secondary hypertension has a known cause and accounts for approximately 10–15% of all hypertension cases (Medscape, 2025). The most common cause of secondary hypertension is primary aldosteronism, occurring in 5–10% of patients with hypertension, as well as abnormalities in the arteries supplying blood to the kidneys. Other causes include airway obstruction during sleep, diseases and tumours of the adrenal glands, lifestyle factors, spinal cord injury, hormonal abnormalities (including oral contraceptives and estrogen replacement), thyroid disease, toxaemia of pregnancy, diabetic neuropathy, and anxiety-related hypoglycaemia. Several factors predispose adults to hypertension.

The risk factors of hypertension include genetic predisposition (inherited from parents), advancing age (as the body loses vascular elasticity), obesity (an increase in weight above normal body mass index due to generalized deposition of fat in the body), excessive salt intake (which raises blood pressure), psychological stress (producing chemical substances that cause generalized vasoconstriction), oral contraceptive use (which contains estrogen that causes salt retention and increases blood volume), sedentary lifestyle (which tends to increase body weight and directly raises blood pressure), elevated levels of plasma lipids particularly cholesterol excessive alcohol consumption, and tobacco use (cigarette smoking containing nicotine which causes constriction of blood vessels). Established risk factors also include unhealthy diet (high salt and low fruit and vegetable intake), physical inactivity, tobacco and alcohol use, and obesity, while emerging risk factors include pollution (air, water, noise, and light), urbanization, and loss of green space (Connell et al., 2021).

The signs and symptoms of hypertension commonly recognized in clinical literature include occipital headache, dizziness, restlessness, failing vision, shortness of breath, and rapid or increased heartbeat. Adults should possess knowledge of these risk factors in order to prevent hypertension, recognise its warning signs, and seek timely management.

Knowledge is used to cover such related terms as facts, information, understanding, awareness, insight, wisdom, reasons, comprehension, meaning, concept, and experience. It is an organized body of information shared by people. Health knowledge could be said to mean putting into reality the art of mobilization of resources by an individual intellectually, physically, and emotionally. Hamburg and Russell (as cited in Myo et al., 2012) opined that health knowledge and understanding of related factors have a favourable effect on the quality of overall well-being. They further stated that one's exposure to proper health knowledge will positively influence the person's health attitude and practice, and thus knowledge is the key to optimum well-being. Research has consistently shown that 40% of hypertensive patients demonstrate inadequate knowledge of hypertension (Kumar et al., 2025), underscoring the urgent need for targeted health education. In this study, knowledge is referred to as all understanding and familiarity gained by learning and experience that will enable adults to recognize risk factors as well as recognizing and using preventive measures for hypertension.

Risk factors are defined as individual characteristics that affect a person's chances of developing a particular disease or group of diseases within a defined future time period. According to Campbell et al. (2024), a risk factor is anything identified as increasing an individual's chances of getting a disease or developing a condition. Risk factors of hypertension are of two types: modifiable and non-modifiable. Modifiable risk factors include obesity, excess salt intake, smoking, environmental stress, oral contraceptive use, sedentary lifestyle, elevated levels of plasma lipids, and unregulated secretion of aldosterone. Non-modifiable risk factors include genetic predisposition, age, and gender. Adults should have adequate knowledge of these risk factors to be able to prevent hypertension.

Preventive measures are interventions directed at averting the emergence of specific diseases, reducing their incidence and prevalence in populations. In this study, preventive measures refers to all activities whose primary purpose is to promote, restore, and maintain health, and those practices directed towards preventing hypertension among adults. There are two types of preventive measures: primary and secondary. Primary prevention involves actions taken prior to the onset of disease that remove the possibility that a disease will occur. Secondary prevention involves action that slows the progression of a disease at its incipient stage and prevents complication, including early detection through screening tests.

Adulthood is the longest period of a person's life. An adult is a person who has grown to full physical size and intellectual and emotional maturity, and is legally old enough to vote or marry (Hornby, 2001). Adults in the younger age group (21–40 years) are generally at peak physical fitness but also undergo critical life transitions, including occupational stress. Middle-aged adults (41–65 years) are susceptible to hypertension due to factors such as reduced physical activity, weight gain, and psychological stress, which may lead to smoking, alcohol use, and other unhealthy behaviours (Ejifugha, as cited in Adeke et al., 2022). Older adults (65 years and above) are additionally subject to progressive vascular ageing that can further elevate the risk of cardiovascular diseases, including hypertension. In this study, an adult is referred to as an individual who has reached the age of maturity and falls within the age bracket of thirty-five years and above.

There are many variables that may influence knowledge of hypertension. Studies on knowledge of hypertension have examined socio-demographic factors including age, race, level of education, parity, gender, income, location, occupation, and marital status (Adeke et al., 2022; Jalo et al., 2025). The present study is concerned with the demographic factors of age, gender, location, and level of education.

Age has been identified as a strong factor that can limit the ability of adults to acquire adequate knowledge of hypertension. Age determines growth, development, maturity, and vulnerability to disease. Global studies confirm that hypertension prevalence increases with advancing age, with older adults bearing a disproportionate disease burden (WHO, 2023; JACC GBD Collaborators, 2025). Because of their exposure and life experience, older adults may have come to understand certain aspects of hypertension, including signs, symptoms, risk factors, and prevention; however, age-related cognitive changes and entrenched habits can also act as barriers.

Gender has influence on knowledge and risk of hypertension. A nationwide Nigerian study found that gender disparities exist in hypertension prevalence, awareness, and healthcare-seeking behaviour, with males in the 20–39 age group showing a significantly higher prevalence of hypertension, while females above 54 years tend to have higher incidence due to the disappearance of oestrogen's protective effects after menopause (Jalo et al., 2025). A review of 37 African countries found that among hypertensive individuals, awareness was 62.4% for females compared to 50.5% for males, but treatment and control rates remained low in both sexes (JACC, 2025).

Location is an environmental factor that may limit the ability of adults to seek adequate knowledge of hypertension. Adeke et al. (2022) indicated that hypertension was significantly associated with age, gender, and geographical location in Nigeria. A systematic review and meta-analysis of urban-rural differences in LMICs (1990–2020) confirmed that urban-rural disparities in hypertension prevalence have been narrowing as rural areas experience rapid urbanization, lifestyle transition, and mounting risk factor exposure (Geldsetzer et al., 2022). Adults in urban areas generally have greater opportunities to access health information through seminars, health talks, workshops, and medical check-ups, though the urban poor in particular face unique health disparities.

Studies have consistently indicated that level of education is associated with knowledge of hypertension, including awareness of risk factors and preventive measures. A country-wide Nigerian study found that adults with higher educational attainment were more knowledgeable about hypertension and more likely to adopt positive lifestyle behaviours, while those with lower education tended to adopt unhealthy lifestyles (Adeke et al., 2022). Similarly, awareness rates in Africa showed associations with higher education level (JACC, 2025). Among hypertensive patients studied in Asian settings, 40.1% demonstrated inadequate knowledge about hypertension, particularly those with limited formal education (Kumar et al., 2025). The variables of age, gender, location, and level of education were all examined in this study.

This study was anchored on three theoretical frameworks: the Critical Knowledge Theory, the Health Belief Model, and the Theory of Reasoned Action. The Critical Knowledge Theory holds that when an individual is ignorant of or holds an incorrect belief about a health matter, the health educator attempts to change or ascertain the individual's level of knowledge through purposive questioning and education. The Health Belief Model (HBM) focuses on explaining and predicting preventive health behaviour by examining the attitudes and beliefs of individuals (Islam et al., 2025). A systematic review of the HBM in hypertension management across low- and middle-income countries found that HBM constructs perceived susceptibility, severity, benefits, barriers, and cues to action were significantly associated with blood pressure control, medication adherence, and self-management behaviours (Islam et al., 2025). A randomized controlled trial further confirmed that HBM-based health education significantly reduced systolic blood pressure and improved medication adherence among hypertensive patients compared to routine care (Li et al., 2024). Adults who believe that certain lifestyles such as excess salt intake and physical inactivity can predispose them to hypertension are more likely to modify those behaviours. The Theory of Reasoned Action posits that a person's attitude towards a particular behaviour is influenced by the perceived outcome of that behaviour. Adults who develop positive attitudes towards high salt intake, excess alcohol, and physical inactivity are more likely to develop hypertension; conversely, those who hold negative attitudes towards these risk behaviours are less likely to develop hypertension.

The study was carried out in Auchi, in Edo State, located in the South South geopolitical zone of Nigeria. The inhabitants of Auchi and its environs are engaged in agriculture, businesses, and civil service. These activities occupy much of their time, leaving little or no time for rest and healthcare, thereby exposing them to the stress associated with hypertension. Furthermore, the area contains places that serve as social and commercial attractions, exposing adults to excessive alcohol consumption. Auchi, as a commercial hub, is cosmopolitan in nature, making it an appropriate setting for examining the knowledge and perception of hypertension across diverse adult populations.

1.2 Statement of Problem

Hypertension has been shown to have serious consequences, and adequate knowledge of risk factors can help in its prevention. Therefore, adults in Auchi, Edo State, need to have adequate knowledge of hypertension to reduce its prevalence, improve their health, and achieve optimum well-being. However, it is likely that many adults in the area may not possess adequate knowledge of hypertension, and published evidence regarding the level of hypertension knowledge in this specific population does not appear to exist. This study on knowledge and perception of hypertension and its management therefore becomes necessary.

Regrettably, most adults, due to ignorance of risk factors and preventive measures of hypertension, engage in unhealthy lifestyles such as excessive consumption of alcohol, sedentary living, excess consumption of sodium, tobacco and cigarette smoking, obesity, reduced intake of fruits and vegetables, stress, and consumption of foods rich in cholesterol. These unhealthy lifestyle practices have increased the prevalence of hypertension globally and in Nigeria. According to the WHO Global Report on Hypertension (2023), only 54% of adults with hypertension worldwide are diagnosed, 42% receive treatment, and a mere 21% have their hypertension controlled underscoring the enormous gap in awareness, treatment, and control. In Nigeria, a country-wide survey revealed that only 32.5% of hypertensive individuals on medication had controlled blood pressure (Obinna et al., 2024), and the country contributes immensely to the total burden of hypertension on the continent (Gyamfi et al., 2022).

Some studies have been conducted on the knowledge of hypertension in various parts of the world, including Nigeria, among populations such as pregnant women, workers in the banking industry, hypertensive patients, primary care patients, and rural communities. However, to the best of the researcher's knowledge, no study has been specifically conducted in Auchi, Edo State, to determine the level of knowledge of hypertension among adults accessing care in that community. In view of the above, the need arose to determine whether adults in Auchi, Edo State, possess adequate knowledge of hypertension and its management. Despite effective therapies and lifestyle interventions, optimal prevention and control of hypertension remains a major challenge for health professionals, especially in most developing countries like Nigeria (Connell et al., 2021; Ferreira et al., 2024). If health promotion programmes are to be appropriate and effective, adults' knowledge of hypertension must be identified, and gaps must be addressed. Identification of such gaps is capable of aiding the development of adequate information and strategies to enhance the knowledge and perception of hypertension and its management among clients and patients in Auchi, Edo State. Therefore, as part of a quality assessment aimed at improving the management outcomes of hypertensive patients, we evaluated by means of a descriptive, cross-sectional qualitative phenomenological survey hypertensive patients' knowledge, perceptions, attitudes, and lifestyle practices in Auchi, Nigeria.

1.3 Purpose of Study

The general purpose of this research work is to assess the knowledge and perception of hypertension and its management among patients in Auchi, Edo State. The specific objectives include:

1. To evaluate knowledge, perception, attitudes, and lifestyle practices of hypertensive patients in Auchi.

2. To describe the barriers to effective management of hypertension.

3. To determine the level of knowledge and perception of hypertension and its management possessed by hypertensive patients.

1.4 Research Questions

1. What is the knowledge, perception, attitudes, and lifestyle practices of hypertensive patients in Auchi?

2. What are the barriers to effective management of hypertension?

3. What is the level of knowledge and perception of hypertension and its management possessed by hypertensive patients?

1.5 Significance of Study

The results of this study will be useful to health educators, medical and paramedical officers, public health officers, counsellors, media educators, researchers, curriculum planners, government, and adults in many ways. The study may help to develop a positive regard towards hypertension. The Ministry of Health may benefit from the study by discovering gaps in the knowledge of the adult population and emphasizing strategies to teach that population how to prevent hypertension risk factors. It may also be useful to other researchers to carry out studies in areas where disease prevention measures and health promotion are needed with regards to hypertension.

Answering the research questions associated with this project offers insight into managing hypertension by revealing an understanding of individuals' health-related knowledge, perceptions, and behaviours three domains consistently shown to influence hypertension outcomes in Nigeria and across sub-Saharan Africa (Adeke et al., 2022; Gyamfi et al., 2022).

1.6 Scope of the Study

The study covered adults in Auchi, Edo State. The study was restricted to adults between the ages of fifty years and above who were found within the urban and rural areas. The study was concerned with determining the level of knowledge and perception of hypertension and its management among patients, encompassing the concept of hypertension, its signs and symptoms, risk factors, and preventive measures. The demographic factors of age, gender, location, and level of education as they relate to knowledge of hypertension were all examined.

1.7 Limitation of Study

The researcher faced a number of restraints in the course of carrying out this research project, including time constraints, financial constraints, and the uncooperative attitudes of some respondents. These constituted limitations of this research project, as some respondents did not return their questionnaires. The researcher only made use of responses from respondents whose questionnaires were correctly completed and returned.

1.8 Operational Definition of Terms

Hypertension: A chronic medical condition of abnormally elevated blood pressure, defined in this study as a systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg; also a state of great psychological stress.

Hypertension Management: A combination of lifestyle modification and antihypertensive medications used to lower and control blood pressure. The treatment target is generally to achieve a blood pressure below 140/90 mmHg, as recommended by most global guidelines (Kario et al., 2026).

Knowledge: Facts, information, and skills acquired through experience or education; the theoretical or practical understanding of a subject relevant to hypertension and its prevention.

Perception: The organization, identification, and interpretation of sensory and experiential information in order to represent and understand a given phenomenon or the surrounding environment, particularly as it relates to patients' understanding of their health condition.

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