Knowledge on hypertension among hypertensive stroke survivors in Ghana: A cross-sectional, multicenter study

Hypertension is a premier risk factor for index and recurrent strokes globally. However, knowledge of hypertension as a risk factor for stroke occurrence and subsequent adverse vascular events among recent stroke survivors in the sub-Saharan Africa is limited.

To assess the level and determinants of knowledge on hypertension and risk of stroke among recent stroke survivors in Ghana.

This is a cross-sectional survey conducted at enrollment of participants involved in the multi-center, phase III randomized trial titled Phone-based Intervention under Nurse Guidance after stroke II (PINGS-2) study. Recent stroke survivors within 1-2 months of stroke onset were recruited from 10 Ghanaian hospitals comprising of (five primary-level, two secondary-level, and three tertiary-level facilities) between 2020 and 2022. We assessed knowledge of hypertension and stroke using a validated 14-item questionnaire on hypertension and stroke. We analyzed data using univariate and multivariate analysis to determine the associations between sociodemographic variables and the knowledge on hypertension among recent stroke survivors.

We enrolled 500 participants, mean (SD) age of 58 (12) years, 56.2% being males and 73.3% had ischemic stroke. Out of 14 questions, the mean (SD) score was 8 (3) with a range of 0 to 13. Four factors significantly associated with knowledge of hypertension with adjusted β (95%CI) were Islam religion -1.40 (-2.40 - -0.49), NIHSS score -0.15 (- 0.22 - -0.07) for each unit increase and body mass index 0.08 (0.03 - 0.13) for each kg/m² increase and educational attainment with primary level, secondary, and tertiary educational level 1.10 (0.02 - 2.10), 1.60 (0.52 - 2.70), 2.40 (1.20 - 3.60) compared with no education.

We found substantial deficiencies in the knowledge on hypertension among recent hypertensive stroke survivors in the Ghanaian population in this multicenter study. Educational interventions are urgently needed to address these knowledge gaps to minimize risk of adverse outcomes among stroke survivors in resource-limited settings.