EDUCATIONAL LEVEL DIFFERENCES IN ADHERENCE TO LIFESTYLE MODIFICATION AMONG UNCONTROLLED HYPERTENSIVE PATIENTS: EHUH 2 STUDY

Objective: Education level impacts adherence to lifestyle modifications presenting a barrier to blood pressure control. Our aim was to explore educational level differences in adherence to lifestyle among uncontrolled hypertensive patients. Design and method: This cross-sectional study was part of the EH–UH 2 survey. Out of total of 2021 participants included by random selection from the general adult population, this study involved 271 participants with treated uncontrolled hypertension Subjects were divided into three education groups: <8 years (LE) (N=77), 8-12 years (ME) (N=146), and >12 years (HE) (N=47. Participants completed a survey on adherence to lifestyle changes, including weight reduction (WR), salt intake restriction (SR), increased physical activity (PA) alcohol moderation (AM), smoking cessation (SC), and dietary changes (reducing dried meat and increasing fish intake). Results: Compared to the HL group, the LE group smoked significantly less and ate fish significantly rarely (10.3% vs. 21.2%, p=0.009; 32% vs. 59%, p=0.004, respectively). There were no differences in cured meat intake, alcohol consumption, or physical activity among groups. SC adherence decreased with increase of education level (55.5% vs.22.5% vs.18.1%; p=0.004), while WR adherence and AM showed positive trends (66.6% vs.70.2% vs.78.9%; 33.3% vs.88.8% vs.100%, respectively, p> 0.05 for all). There were no differences in adherence to SR and PA among groups. Group LE mostly followed SR and WR recommendations, and most rarely AM (80.4%, 66.6%, 33.3%, respectively; p=0.036). Group ME adhered most to SR and AM, and most rarely to SC (89.2%, 88.8%,22.5, respectively; p<0.001). Group HE complied most with AM and WR recommendations, and the least with SC (100%, 83.3%, 22.2%, respectively: p<0.001). Conclusions: Educational level has an important impact on lifestyle. Prevalence of smokers was the lowest and compliance with SC was highest in the LE group; prevalence of obesity was the lowest and adherence to WR recommendation was the highest in the HE group. Across all groups, compliance to SR was the most frequent, while SC and increased PA were the least complied lifestyle modification recommendations.