Hypertension in Hospitalized Patients: A Pilot Observational Study followed by a Comprehensive Narrative Review of Risk Factors and Management Strategies

Background: Hypertension is a leading cause of cardiovascular morbidity, yet control rates remain suboptimal due to poor adherence and multifactorial resistance. This article presents a two-part analysis: (1) a pilot observational study assessing disease awareness and compliance in a specific hospitalized cohort, and (2) a comprehensive narrative review of emerging risk factors, including infectious interactions and genetic susceptibility. Methods: We conducted a cross-sectional pilot study on 30 diagnosed hypertensive patients admitted to the cardiology department of a tertiary hospital. Participants were stratified by smoking status (smokers; non-smokers) to evaluate the impact of lifestyle risk factors on medication adherence. Awareness was operationalized as the patient's ability to identify their diagnosis and prescribed pharmacotherapy ("Capability"). Statistical differences in comorbidities and compliance were analyzed using Fisher’s Exact Test due to the small sample size. Results: The pilot cohort exhibited a high prevalence of comorbidities, with Diabetes Mellitus affecting 23% of the non-smoking group. Notably, the smoking subgroup demonstrated 100% compliance with antihypertensive therapy compared to variable compliance in non-smokers. This suggests that patients with visible risk factors may possess a higher "Intention" to adhere to treatment due to elevated risk perception. Conclusions: In this pilot study of hospitalized patients, established cardiovascular risk factors (smoking) appeared to reinforce treatment adherence, supporting the behavioral framework of "Intention" and "Capability". The subsequent narrative review contextualizes these findings, highlighting that while patient compliance is critical, clinical outcomes are further complicated by external "Constraints" such as infectious states (e.g., COVID-19) and resistant hypertension, necessitating the active intervention of clinical pharmacists.