Knowledge, attitude, and practice regarding hypertension among patients at a tertiary care hospital in eastern Bhutan: A cross-sectional study

Abstract

Introduction: Hypertension is a major contributor to cardiovascular morbidity and mortality worldwide, yet knowledge, awareness, and lifestyle practices remain suboptimal in many low- and middle-income countries. Evidence on hypertension-related knowledge, attitudes, and practices in Bhutan is limited. This study assessed these factors and their association with blood pressure control among hypertensive patients attending the Eastern Regional Referral Hospital in Mongar, Bhutan.

Methods: A cross-sectional study was conducted among 546 adult hypertensive patients attending the outpatient department from June to August 2022. Data were collected using validated questionnaires assessing sociodemographic and clinical characteristics, hypertension knowledge (HK-LS), and self-care practices (HB-SCP). Blood pressure was measured, and hypertension-mediated organ damage was assessed when feasible. Descriptive statistics and logistic regression analyses were performed.

Results: A total of 546 hypertensive patients were included (mean age 58.6 ± 13 years; 66.5% female). Over 70% had no formal education, and 75% reported comorbidities, most commonly diabetes mellitus. Hypertension-mediated retinopathy was observed in 12.3%, nephropathy in 13.9%, and left ventricular hypertrophy in 5.9%. Monotherapy was used in 54.9% of patients, with angiotensin receptor blockers (77.7%) and calcium channel blockers (33.2%) being the most prescribed. Overall, 77% had uncontrolled blood pressure (>130/80 mmHg). Knowledge regarding hypertension was suboptimal: <20% correctly identified normal or diagnostic blood pressure, and misconceptions about medication use and reversibility of complications were common. Although most participants reported favorable dietary practices and regular clinic attendance, 91% never monitored blood pressure at home, and more than half did not check nutritional labels for sodium or saturated fat content.

Conclusions: Substantial gaps in knowledge, self-monitoring, and lifestyle practices exist among hypertensive patients in eastern Bhutan, contributing to poor blood pressure control. Strengthening patient education, promoting home blood pressure monitoring, improving nutrition literacy, and ensuring guideline-based pharmacotherapy are essential to reduce long-term cardiovascular complications.