Graduation Year


Document Type




Degree Granting Department

Epidemiology and Biostatistics

Major Professor

Heather Stockwell

Co-Major Professor

Amy Alman


Antihypertensive protocols, Cardiovascular disease, High blood pressure, Primary hypertension, Risk factor


Background: According to the World Health Organization (WHO), hypertension is a major risk factor for cardiovascular disease (CVD), renal impairment, peripheral vascular disease, and blindness. In Panama, a recent study estimated the prevalence of hypertension at 38.5% in the two main provinces of the country, with a rate of uncontrolled hypertension of 47.2%.

Objectives: The aims of this study were to assess the feasibility of the study design and to describe the characteristics of the hypertensive population and the physician's adherence to Panamanian antihypertensive protocols and their relationship with uncontrolled hypertension.

Methods: This is a cross-sectional study of adult hypertensive patients attending a primary healthcare facility in Panama City. Clinical charts from eligible participants were examined to describe the demographic and clinical characteristics related to uncontrolled hypertension and the use of antihypertensive protocols by medical doctors. Descriptive and central tendency statistics were used to characterize the study population. Bivariate relationships between demographic and clinical characteristics, and uncontrolled hypertension were explored using specific test for no association. Logistic regression modeling was used to examine the association between physician's adherence to antihypertensive protocols and the presence of uncontrolled hypertension.

Results: In this study the mean age was 56.7 years (±13.6); 58.1% of participants were females; 71.3% of participants had body mass index >25.0kg/m2; and 53.0% of participants had stage 2 hypertension. Uncontrolled hypertension was present in 66.7% of the study sample. 82.9% of participants had one or more comorbidities. The medical doctors were compliant with antihypertensive protocols in 43.6% of participants, primarily due to lower compliance with lifestyle modification recommendations. In the multivariate analysis, a significant interaction was found with age, suggesting that age is a potential effect modifier.

Conclusions: The rate of uncontrolled hypertension was high among this study population. Nearly half of the attending physicians did not follow the recommendations given by current antihypertensive protocols. Further research is necessary to explore the relationships between subject characteristics, such as age, number of comorbidities, and the presence of diabetes mellitus with uncontrolled hypertension