Association of disease awareness, medication adherence, and home blood pressure monitoring with blood pressure control in hypertensive patients: a cross-sectional study

Aims: Hypertension (HT) remains a major global health problem, and achieving optimal blood pressure (BP) control continues to be challenging in clinical practice. Patient-related factors such as disease awareness, medication adherence, and home blood pressure monitoring (HBPM) behaviors play a crucial role in HT management. This study aimed to evaluate the relationship between these factors and BP control. Methods: This prospective, single-center, cross-sectional study included 280 adult patients with HT. Disease awareness was assessed using the Hypertension Knowledge-Level Scale (HK-LS), and medication adherence was evaluated using the Adherence to Refills and Medications Scale (ARMS). HBPM habits were assessed using a structured questionnaire. Multivariable logistic regression analysis was performed to identify independent predictors of uncontrolled HT. Model performance was evaluated using receiver operating characteristic analysis, calibration plots, and decision curve analysis. Results: A total of 280 patients were analyzed, of whom 132 (47.1%) had uncontrolled HT. Patients with uncontrolled HT had significantly lower HK-LS scores and higher ARMS scores (p<0.001 for both). HBPM practices, including frequency and measurement accuracy, were significantly better in the controlled group (p<0.001). A strong negative correlation was observed between HK-LS and ARMS scores (r=-0.71, p<0.001). In multivariable analysis, higher HK-LS scores [odds ratio (OR): 0.82], higher ARMS scores (OR: 1.11), and absence of HBPM (OR: 0.48) were independent predictors of uncontrolled HT (all p<0.01). The combined model demonstrated excellent discrimination [area under the curve (AUC): 0.86], good calibration, and clinical utility. Conclusion: Disease awareness, medication adherence, and HBPM habits are key determinants of BP control. Their combined assessment provides a robust framework for predicting uncontrolled HT and may guide personalized, patient-centered management strategies.