• Omed Hama Karem Department of Medicine, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Zana Ismael Abdulrahman Kurdistan board candidate (Internal Medicine ), Sulaimani, Kurdistan Region, Iraq.
  • Farman Jaafar Ahmad Kurdistan board candidate (Cardiovascular Medicine), Sulaimani, Kurdistan Region, Iraq.




Uncontrolled hypertension, Risk factors, Non-adherence



Hypertension is the major risk factor for cardiovascular disease (CVD) morbidity and mortality globally, which accounts for nearly half of the CVD events. A striking change has happened in the diagnosis of hypertension and its management after the introduction of the 2017 hypertension guideline by the American College of Cardiology and American Heart Association (ACC/AHA).


To detect risk factors of uncontrolled hypertension according to ACC/AHA 2017 Guideline.

Patients and Methods

A cross-sectional study conducted at Ali Kamal outpatient clinic, a total of 282 uncontrolled hypertensive patients were collected and evaluated for risk factors of uncontrolled hypertension, including gender, age, body mass index & other variables.


A total of 282 patients were included in this study.The mean ± SD age was  55.4 ± 12.5 (ranged from 30 to 84) years and around 68.4 % (n= 193) were females. A high percentage of 77.3% were living in rented houses. Their mean BMI was 28.4 ± 4 kg/m2 (ranged from 19.5 to 51.9). Minority of participants.13.5% (n=38), had normal body mass index, 49.6% (n=140) were on triple antihypertensive therapy. The duration of hypertension was less than 10 years in 45 % (n=127).48% (n=136) of the patients were taking the medications from mixed sources (governmental and private sector). The mean DBP of the patients was 87.7±8.4 mm Hg, while the mean SBP was 147±15.4 mmHg and 96.5% (n=272) of the patients were adherent to the medications. 


Hypertension is a major risk factor for CAD; every patient with uncontrolled hypertension must be evaluated for any associated comorbidity, and strongly advised against smoking and obesity especially with advanced age.


Writing Group, M. Heart Disease, and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 133, e38–360 (2016)

Whelton PK, Carey RM, Aronow WS, ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. J Am Coll Cardiol. 2017 .jacc.2017.11.006 DOI: https://doi.org/10.1161/HYP.0000000000000065

Khera R, Lu Y, Lu J. Impact of 2017 ACC/AHA guidelines on prevalence of hypertension and eligibility for antihypertensive treatment in the United States and China: a nationally representative cross-sectional study. BMJ. 2018; 362:k2357. DOI: https://doi.org/10.1136/bmj.k2357

Mancia G, Corrao G. Global Impact of the 2017 American College of Cardiology/American Heart Association Hypertension Guidelines: a perspective from Italy. Circulation. 2018;137(9):889-890. DOI: https://doi.org/10.1161/CIRCULATIONAHA.117.032850

Iyer AS, Ahmed MI, Filippatos GS, Ekundayo OJ, Aban IB, Love TE, et al. Uncontrolled hypertension and increased risk for incident heart failure in older adults with hypertension: findings from a propensity-matched prospective population study. J Am Soc Hypertens. 2010;4(1):22–31. DOI: https://doi.org/10.1016/j.jash.2010.02.002

Acelajado MC, Calhoun DA. Resistant hypertension, secondary hypertension, and hypertensive crises: diagnostic evaluation and treatment. Cardiol Clin. 2010;28(4):639–654. DOI: https://doi.org/10.1016/j.ccl.2010.07.002

Verdecchia P, Staessen JA, Angeli F, De SG, Achilli A, Ganau A, et al. Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): an open-label randomized trial. Lancet. 2009;374:525-33. DOI: https://doi.org/10.1016/S0140-6736(09)61340-4

Khatib R, Schwalm JD, Yusuf S. Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies. PloS one. 2014;9(1):e84238. DOI: https://doi.org/10.1371/journal.pone.0084238

Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL (July 1972). "Indices of relative weight and obesity". Journal of Chronic Diseases. 25 (6): 329–43 DOI: https://doi.org/10.1016/0021-9681(72)90027-6

Yoon SS, Ostchega Y, Louis T. Recent Trends in the Prevalence of High Blood Pressure and its Treatment and Control, 1999–2008.NCHS Data Brief. 2010; 48:1–8. DOI: https://doi.org/10.1037/e665602010-001

Franklin SS, Jacobs MJ, Wong ND, L'Italien GJ, Lapuerta P. Predominance of Isolated systolic hypertension among middle-aged and elderly US hypertensives: an analysis based on National Health and Nutrition Examination Survey (NHANES) III. Hypertension. 2001;37:869–874. DOI: https://doi.org/10.1161/01.HYP.37.3.869

Lloyd-Jones DM, Evans JC, Larson MG, O’Donnell CJ, Roccella EJ, Levy D. Differential control of systolic and diastolic blood pressure: factors associated with lack of blood pressure control in the community. Hypertension. 2000; 36: 594–599. DOI: https://doi.org/10.1161/01.HYP.36.4.594

Hyman DJ, Pavlik VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med. 2001; 345: 479–486 DOI: https://doi.org/10.1056/NEJMoa010273

Stockwell DH, Madhavan S, Cohen H, Gibson G, Alderman MH. The determinants of hypertension awareness, treatment, and control in an insured population. Am J Public Health. 1994; 84: 1768–1774 DOI: https://doi.org/10.2105/AJPH.84.11.1768

Alexander M, Tekawa I, Hunkeler E, Fireman B, Rowell R, Selby JV, Massie BM, Cooper W. Evaluating hypertension control in a managed care setting. Arch Intern Med. 1999; 159: 2673–2677 DOI: https://doi.org/10.1001/archinte.159.22.2673

Hicks LS, Fairchild DG, Horng MS, Orav EJ, Bates DW, Ayanian JZ. Determinants of JNC VI guideline adherence, the intensity of drug therapy, and blood pressure control by race and ethnicity. Hypertension. 2004; 44: 429–434 DOI: https://doi.org/10.1161/01.HYP.0000141439.34834.84

Majernick TG, Zacker C, Madden NA, Belletti DA, Arcona S. Correlates of hypertension control in a primary care setting. Am J Hypertens. 2004; 17: 915–920. DOI: https://doi.org/10.1016/j.amjhyper.2004.05.016

Knight EL, Bohn RL, Wang PS, Glynn RJ, Mogun H, Avorn J. Predictors of uncontrolled hypertension in ambulatory patients. Hypertension. 2001; 38: 809–814. DOI: https://doi.org/10.1161/hy0901.091681

Dennison CR, Peer N, Steyn K, Levitt NS, Hill M. Determinants of hypertension care and control among peri-urban black South Africans: the HiHi Study. Ethn Dis. 2007;71:484–502.

King DE, Garr DR, Pearson WS. Race, rural residence, and control of diabetes and hypertension. Ann Fam Med. 2004;2(6):563–568. DOI: 10.1370/afm.119. DOI: https://doi.org/10.1370/afm.119

Mulrow CD, Chiquette E, Angel L, Dieting to reduce body weight for controlling hypertension in adults. Cochrane Database Syst Rev 2000;(2):CD000484.

The fifth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure (JNC V). Arch Intern Med. 1993; 153: 154–183. DOI: https://doi.org/10.1001/archinte.153.2.154

Edo TA, De Villiers L. Factors affecting compliance with anti-hypertensive drug treatment and required lifestyle modifications among hypertensive patients in Praslin Island. S Afr Med J. 2008;14:2765–2786

Wang TJ, Vasan RS. Epidemiology of uncontrolled hypertension in the United States. Circulation. 2005;112:16511662.doi:10.1161/CIRCULATIONAHA.104.490599 DOI: https://doi.org/10.1161/CIRCULATIONAHA.104.490599

Zhang M, Meng Y, Yang Y, Liu Y, Dong C, Li F. et al, Major inducing factors of hypertensive complications and the interventions required to reduce their prevalence: an epidemiological study of hypertension in a rural population in China. BMC Public Health. 2011;11:301. DOI: https://doi.org/10.1186/1471-2458-11-301

Sica DA. Fixed-dose combination antihypertensive drugs. Do they have a role in rational therapy? Drugs. 1994;48(1):16–24. DOI: https://doi.org/10.2165/00003495-199448010-00003

Spranger CB, Ries AJ, Berge CA, Radford NB, Victor RG. Identifying gaps between guidelines and clinical practice in the evaluation and treatment of patients with hypertension. Am J Med. 2004; 117: 14–18. DOI: https://doi.org/10.1016/j.amjmed.2004.01.024

Hyman DJ, Pavlik VN. Self-reported hypertension treatment practices among primary care physicians: blood pressure thresholds, drug choices, and the role of guidelines and evidence-based medicine. Arch Intern Med. 2000; 160: 2281–2286. DOI: https://doi.org/10.1001/archinte.160.15.2281

Chaudhry SI, Krumholz HM, Foody JM. Systolic hypertension in older persons. JAMA. 2004; 292: 1074–1080 DOI: https://doi.org/10.1001/jama.292.9.1074

Phillips LS, Branch WT, Cook CB, Doyle JP, El Kebbi IM, Gallina DL, et al. Clinical inertia. Ann Intern Med. 2001; 135: 825–834. DOI: https://doi.org/10.7326/0003-4819-135-9-200111060-00012



How to Cite

Karem O, Abdulrahman Z, Ahmad F. RISK FACTORS OF UNCONTROLLED HYPERTENSION AMONG PEOPLE IN SULAIMANI CITY ACCORDING TO THE HYPERTENSION GUIDELINE OF AHA/ACC 2017. JSMC [Internet]. 2020 Sep. 21 [cited 2024 Jun. 21];10(2):173-80. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10254

Similar Articles

1-10 of 136

You may also start an advanced similarity search for this article.