International Journal of Public Health Science (IJPHS)

Vol. 12, No. 3, September 2023, pp. 981~988

ISSN: 2252-8806, DOI: 10.11591/ijphs.v12i3.22694  981

Quality of life among urban hypertensive patients

Tran Nguyen Ngoc1, Dang Thanh Tung2, Bui Van Dung3, Trinh Viet Anh4, Bui Van San1, Hoang Thi
Phuong Nam3, Nguyen Hoang Thanh1, Huy Dinh Quang5, Thien Van Tran6
1
Department of Psychiatry, Hanoi Medical University, Hanoi, Vietnam
2
National Institute of Mental Health, Bach Mai Hospital, Hanoi, Vietnam
3
Department of Cardiovascular and Respiratory, Geriatric Hospital, Hanoi, Vietnam
4
Department of Respiratory, E Hospital, Hanoi, Vietnam
5
School of Preventive and Public Health, Hanoi Medical University, Hanoi, Vietnam
6
Department of General Planning & Quality Management, Vietnam National University, Hanoi, Vietnam

Article Info ABSTRACT

Article history: Hypertension is a leading risk factor for major chronic illnesses. This study
investigated the quality of life (QOL) of hypertensive patients in an urban
Received Jan 14, 2023 setting and evaluate related factors. A cross-sectional study on 220
Revised May 20, 2023 hypertensive patients was performed in Hanoi, Vietnam. Short-form 12
Accepted Jun 8, 2023 version 2 (SF12-v2) was used to assess QOL. Sociodemographic and clinical
characteristics were also obtained. Multivariate regression was utilized to
explore the related factors with patients’ QOL. The mean physical health
Keywords: (PCS-12) and mental health (MCS-12) scores were 43.3 (SD=7.9) and 56.3
(SD=6.5), respectively, Higher age was related to a lower PCS-12. People
Developing country living in low-population-density settings have a higher MCS-12 score than
Hypertension those living in high-density settings. Increasing comorbidity and medication
Quality of life reduced both component scores. Patients participating in social activity had
Urban the MCS-12 score higher than those not participating. This study found a
moderate level of health-related quality of life (HRQOL) in hypertensive
patients regardless of treatment progress. Regular screening and controlling
comorbidities, as well as motivating active employment and social activities
involvement, are the potential to enhance the HRQOL of this population.
This is an open access article under the CC BY-SA license.

Corresponding Author:
Dang Thanh Tung
National Institute of Mental Health, Bach Mai Hospital
Hanoi, Vietnam
Email: tungdangthanh@bachmai.edu.vn

1. INTRODUCTION
Hypertension is well-recognized as a significant risk factor for several major non-communicable
diseases (e.g., cardiovascular diseases, diabetes, renal, or nerve diseases) as well as a predictor of early
premature mortality [1], [2]. In 2010, high blood pressure was attributable to approximately 7.5 million deaths,
which accounted for 12.8% of all-cause mortality worldwide [3]. There was estimated that close to 1.13 billion
people had been diagnosed with hypertension in 2015 [2], which is predicted to reach 1.56 billion in 2025 [4],
[5]. In Vietnam, hypertension is an emerging problem in the adult population as a consequence of the rapid
growth of the aging population, urbanization, and unhealthy lifestyles [6], [7]. The prevalence of hypertension
in Vietnamese adults ranges from 18.4 to 21.1% [6], which is responsible for 11.1% of the disease burden in
2017 [8]. However, only 9.3% of hypertensive patients are aware of their condition, 4.7% received appropriate
treatment [6], and 12.2% of patients have well-controlled hypertension [9].
As hypertension is a chronic condition that cannot be completely cured, quality of life (QOL) is an
important indicator to measure the effectiveness of hypertension treatment and management [10]. Several

Journal homepage: http://ijphs.iaescore.com

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previous studies have affirmed that hypertension significantly reduced patients’ QOL compared to those
without hypertension [11], [12], especially in aspects of general health, physical functioning, vitality, and
mental health [13]. Predictors for the poor QOL in hypertensive patients included socioeconomic status (e.g.,
female, higher age, lower education, lower income, living in the rural area) [14], [15], and clinical
characteristics (e.g., polypharmacy, complications or co-morbidities, adverse effect form anti-hypertensive
medications) [15]–[17]. These factors vary depending on study settings, suggesting the need for contextualized
evidence for improving QOL in hypertensive patients.
Despite the importance of QOL assessment in hypertensive patients, studies on this issue in Vietnam
are insufficient. To date, only two studies were performed in the mountainous hospital setting using Short-form
36v2 [18] and in a rural community setting using The World Health Organization Quality of Life Brief Version
WHOQOL-BREF [19]. Both studies showed a moderate-low QOL of hypertensive patients in comparison with
the general population. This study investigated the QOL of hypertensive patients in an urban setting and
evaluate related factors.

2. METHOD
2.1. Study design
We obtained the cross-sectional data at an outpatient department of an urban hospital in Hanoi,
Vietnam in October 2019. More than 100 hypertensive patients visited this department per day for regular
examination. Patients who were aged 18 years or above, had high blood pressure which was diagnosed based
on the Ministry of Health’s criteria [20] at least one year and did not have any psychological or cognitive
disorders were included in the study. Patients who were inpatients or disagreed to become study participants
were excluded. We applied a convenient sampling method. During the data collection period, among 250
patients who were invited, 220 individuals agreed to participate in the study response rate 88%. The study and
data collection tool were approved by the institution review board of the hospital. All participants were
informed and signed the written informed consent form.

2.2. Data collection

The data collection process was performed by a team including undergraduate medical students. They
received appropriate training regarding the interview and data extraction skills before implementing the data
collection. First, after patients finished all examination procedures, physicians of the department checked the
eligible criteria and introduced the study and data collection team. Then, if patients accepted the invitation,
they were invited to a private counseling room for the interview. Each interview lasted 15-20 minutes. Data
collection was performed by using a structured questionnaire for a face-to-face interview, and a structured form
to extract data from medical records. The questionnaire had the following sections: demographic
characteristics, behaviors, QOL and social activities participation. Meanwhile, the extraction form had
information about age, gender, and clinical characteristics.
The office blood pressure of patients was measured twice during a medical examination by using the
Japanese Alpk2 sphygmomanometer. Patients having uncontrolled hypertension had a persistent blood
pressure of 140/90 mmHg, which was the average of the two measurements. Other patients were classified into
the “Controlled hypertension” group [20].
The Short-form Health Survey 12 version 2 (SF-12v2) was utilized to evaluate the QOL of patients
with hypertension. This is a general instrument comprising 12 items to evaluate eight domains of QOL:
physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social
functioning (SF), role emotional (RE), and mental health (MH). Each domain was scored from 0 “the worst
health state” to 100 “the best health state” [21]. The Physical Component Score-12 (PCS-12) was derived from
PF, RP, BP, and GH, while the Mental Component Score-12 (MCS-12) was computed from MH, VT, SF and
RE. These scores were standardized by using the norm of the US 1998 population according to guidelines [22].
Each component had a score range from 0 to 100 [22].
Demographic information included age, gender, education, occupation, marital status, living location
characteristics (low/high population density), smoking habits, and social activities participation. Clinical
characteristics consisted of comorbidities, hypertensive complications, and medication used. Weight and height
were measured after completing the survey to calculate body mass index.

2.3. Statistical analysis

Stata software version 14.0 was utilized for statistical analysis. Mann-Whitney test was utilized to
assess the difference in SF-12v2 domain score, PCS-12, and MCS-12 scores between controlled and
uncontrolled hypertensive patients. Multivariate linear regression was used to measure related factors with
quality-of-life scores. A p-value <0.05 was used for identifying statistical significance.

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2.4. Ethical considerations

We followed the WHO ethical and safety recommendations for medical research. The purpose of the
study was explained to the patients and participation was completely voluntary. Patients are also
consulted by doctors on how to control blood pressure and appropriate nutrition for patients with high blood
pressure. The study was approved by the Ethical Committee of the hospital (Decision 563/QĐ-KYD dated
September 25, 2019).

3. RESULTS AND DISCUSSION

Our study filled the evidence gap about the QOL of hypertensive patients in the hospital setting in
Vietnam. The findings revealed a moderate level of QOL in both controlled and uncontrolled hypertensive
patients regarding different aspects. Moreover, some factors associated with the impairment of QOL in this
population were also explored, such as age, living location, comorbidities, medications used, body mass index,
and social activity participation, suggesting further implications to improve the QOL of people living with
hypertension.
The characteristics of the participants are presented in Table 1 of 220 patients, 50.9% were females.
Most patients aged more than 60 years old 70%. The proportion of samples having a high school education or
above was 55.4%. The majority were self-employed 44.5% and living with a spouse 81.8%.

Table 1. Sociodemographic characteristics of hypertensive patients

Characteristics n %
Age group
<49 years 12 5.5
50-59 years 54 24.5
60–69 years 93 42.3
≥70 61 27.7
Gender
Female 112 50.9
Male 108 49.1
Education
Under secondary school 24 10.9
Secondary school 74 33.6
High school 50 22.7
Colleges 30 13.6
≥University 42 19.1
Occupation
Self-employed 98 44.5
Retired 89 40.5
Others 33 15.0
Marital status
Single/Divorce/Widow 40 18.2
Having a spouse/partner 180 81.8
Living area
Low population density 188 85.5
High population density 32 14.5
Participating in social activities
Yes 120 54.6
No 100 45.5
Ever smoking
Yes 86 39.1
No 134 60.9
Mean SD
Age (years) 64.0 8.9

Clinical characteristics and health status are shown in Table 2. The majority of participants were
controlled hypertensive patients 59.6%. The proportion of patients experiencing lipid disorders as a
comorbidity was the highest at 40.9%, followed by bone-joint diseases 40.5%, heart diseases 27.7%, and
diabetes 22.3%. The mean number of medications per person was 1.6 (SD=1.1), and the mean body mass index
was 23.7 (SD=2.7kg/m2).
In controlled hypertensive patients, the mean PCS-12 score, and MCS-12 score were 43.3 (SD=7.9)
and 56.3 (SD=6.5), respectively. In uncontrolled hypertensive patients, the corresponding values were 43.3
(SD=9.2) and 56.1 (SD=9.1), respectively. Results of Table 3 show that no difference was found in SF-12
domain scores and component summary scores between controlled and uncontrolled hypertensive patients
(p>0.05).

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The findings of this study indicated that the QOL of adults with hypertension had moderate scores in
all SF-12 aspects, particularly general health. The physical and mental component summary scores in our
sample can be comparable to the sample of Vietnamese older women in the previous study, who are among
the most vulnerable population to chronic diseases [23]. Unfortunately, we could not find any literature about
HRQOL measured by SF-12 or Short-form 36 in the general Vietnamese population for comparison. However,
compared to studies in other countries such as South Korea [24] and China [25], which had a similar culture to
Vietnam, we found that the HRQOL in our patients equaled half of the QOL of general people living in these
countries. Our finding in the MCS-12 score was higher, but our PCS-12 score was lower than MCS-12 and
PCS-12 in Brazilian hypertensive patients, respectively [26]. The difference could be explained by several
reasons such as different socio-economic and clinical characteristics or differences of QOL perceptions across
nations. However, these findings suggested the significant HRQOL impairment of hypertensive patients in
comparison with the general population.
After adjusting to other covariates, we found that higher age was associated with a lower PCS-12
score (Coef. = -0.17, 95% C=-0.31; -0.02). People living in low-population density areas have a higher MCS-
12 score (Coef. =3.22, 95% Ci=0.15; 6.30) than those living in high-population density areas. Increasing one
comorbidity and one medication reduced 1.09 points of PCS score (Coef. =-1.09, 95%CI=-1.87; -0.31) and
1.47 points of PCS score (Coef. = -1.47, 95%Ci=-2.52; -0.43), respectively. Meanwhile, a one kg/m2 increase
was related to a 0.51-point increase in the MCS score (Coef. =0.51, 95%CI=0.11; 0.91). Finally, patients
participating in social activity had a 3.02 MCS-12 score higher than those not participating (Coef. =3.02;
95%CI=0.78; 5.27) as shown in Table 4.

Table 2. Clinical characteristics of hypertensive patients

Clinical characteristics n %
Hypertension
Controlled 131 59.6
Uncontrolled 89 40.4
Comorbidity
Lipid disorders 90 40.9
Bone-joint diseases 89 40.5
Heart diseases 61 27.7
Diabetes 49 22.3
Gastrointestinal diseases 36 16.4
Metabolic disorders 31 14.1
Coronary diseases 25 11.4
Liver diseases 22 10.0
Kidney diseases 17 7.7
Prostate diseases 14 6.4
Stroke 10 4.6
Others 15 6.8
Mean SD
Number of comorbidities 2.3 1.5
Number of medications 1.6 1.1
Body mass index (kg/m2) 23.7 2.7

Table 3. HRQOL of controlled and uncontrolled hypertensive patients

HRQOL Controlled hypertensive Uncontrolled hypertensive Overall p-value
patients patients
Mean±SD Mean±SD Mean±SD
Physical functioning 47.4±10.4 45.7±11.3 46.7±10.8 0.27
Role physical 53.7±4.1 54.3±3.8 54.0±4.0 0.40
Bodily pain 46.3±13.3 47.5±13.8 46.8±13.5 0.33
General health 33.3±9.4 32.7±9.7 33.1±9.5 0.61
Vitality 56.8±15.4 54.9±14.6 56.0±15.1 0.20
Social functioning 49.0±12.0 50.5±11.6 49.6±11.9 0.25
Role emotional 53.2±4.5 53.1±4.5 53.2±4.5 0.71
Mental health 55.8±11 55.1±12.7 55.5±11.7 0.97
Physical component summary score (PCS-12) 43.3±7.9 43.3±9.2 43.3±8.4 0.98
Mental component summary score (MCS-12) 56.3±6.5 56.1±9.1 56.2±7.6 0.71

Advancing age, the higher number of comorbidities, and medications used were associated with the
decrease in QOL regarding physical perspective. These results were similar to prior works in Vietnam and

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other countries [18], [27], [28]. Notably, hypertensive patients participating in social activities had a higher
MCS score than those who did not. Indeed, most of our sample were aged 60 or above and were legally retired.
Literature underlined the fact that increasing the independence or autonomy of older people via facilitating
social participation or providing job opportunities would also improve their quality of life [27], [29].
Furthermore, patients who lived in the low population-density area (such as suburban or rural places) had
higher MCS scores than individuals living in the high-density area (such as the urban part of Hanoi), which
aligned with previous findings in the general population that urban people were more likely to experience
mental problems compared to rural ones, leading to the reduction of MCS score [27].
Finally, we did not find any association between hypertension condition and HRQOL. This finding
was in line with the previous study in Vietnam [18], but different from a study in Nigeria [30] and China [14].
We supposed that these phenomena might be due to methodological and cultural differences. Studies in Nigeria
used blood pressure as a continuous variable while our study used a binary variable. Moreover, we did not
measure patients’ medication adherence, which might be a potential confounder for this association.
Several major limitations should be acknowledged. First, the validity and reliability of SF-12v2 in the
Vietnamese population in general and hypertensive patients, in particular, are unknown. Despite its
pervasiveness in other Asian countries such as Korea and China [24], [25], further studies should be required
to elucidate this issue. Second, data were acquired via face-to-face interviews, which might be at risk of recall
bias. Third, we used the cross-sectional design which was not appropriate for drawing causal associations
between QOL and its related factors. Finally, the finding should be cautious when applied to other settings
because of the sampling process.

Table 4. Associated factors with HRQOL among hypertensive patients

Characteristics PCS MCS
Coef. 95%CI Coef. 95%CI
Hypertension
Controlled 1 1
Uncontrolled 0.48 -1.88 2.85 -0.75 -2.98 1.48
Age (year) -0.17* -0.31 -0.02 0.07 -0.07 0.21
Gender
Male 1 1
Female -2.33 -6.05 1.39 -2.03 -5.53 1.48
Occupation
Self-employed 1 1
Retired 0.30 -2.23 2.82 -1.20 -3.58 1.17
Others -0.42 -4.11 3.26 0.96 -2.51 4.43
Marital status
Single/Divorce/Widow 1 1
Having spouse/partner -0.18 -3.38 3.03 0.00 -3.02 3.03
Living location
High population density 1 REF
Low population density 0.59 -2.68 3.85 3.22* 0.15 6.30
Ever smoking
No 1 1
Yes -1.07 -4.77 2.62 -0.81 -4.30 2.68
Number of comorbidities -1.09* -1.87 -0.31 0.19 -0.55 0.92
Number of medications -1.47* -2.52 -0.43 0.33 -0.65 1.32
Body mass index (kg/m2) -0.40 -0.82 0.03 0.51* 0.11 0.91
Participating in social activities
No 1 1
Yes -1.57 -3.95 0.81 3.02* 0.78 5.27
MCS= mental component summary score, PCS= physical component summary score, *p<0.05

4. CONCLUSION
This study found a moderate level of QOL in hypertensive patients regardless of treatment progress.
Age, living area, comorbidities, medications used, and social participation are critical factors associated with
the QOL of hypertensive patients. Regular screening and controlling comorbidities, as well as motivating active
employment and social activities involvement, are the potential to enhance the QOL of this population.

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BIOGRAPHIES OF AUTHORS

Tran Nguyen Ngoc is a lecturer and researcher at Hanoi Medical University,

Hanoi, Vietnam. His expertise focused on mental disorders in different populations. He has
published many articles in the areas of quality of life and mental health. He can be contacted
at email: trannguyenngoc@hmu.edu.vn.

Dang Thanh Tung Tung is a psychologist and researcher in National Institute

of Mental Health, Bach Mai Hospital, Hanoi, Vietnam. His expertise focused on mental
disorders. He has published many articles in the areas of quality of life. He can be contacted
at email: tungdangthanh@bachmai.edu.vn.

Bui Van Dung is a medical doctor and researcher in National Geriatric Hospital,
Hanoi, Vietnam. His expertise focused on the health of older people. He has published many
articles in quality of life at older people. He can be contacted at email:
dungtmvlk@gmail.com.

Trinh Viet Anh is a medical doctor and researcher at E Hospital, Hanoi. His
expertise is respiratory disease. He has published many articles in the areas of quality of life
and mental health. He can be contacted at email: vaphuong34@gmail.com.

Bui Van San is a lecturer and researcher at Hanoi Medical University, Hanoi,
Vietnam. His expertise focused on mental health. He has published many articles in the areas
of quality of life and mental health. He can be contacted at email: buivansan@hmu.edu.vn.

Quality of life in urban hypertensive patients (Tran Nguyen Ngoc)

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Hoang Thi Phuong Nam is a medical doctor and researcher in National Geriatric
Hospital, Hanoi, Vietnam. Her expertise focused on the health of older people. She has
published many articles in quality of life at older people. She can be contacted at email:
hoangthiphuongnam@hmu.edu.vn.

Nguyen Hoang Thanh is a researcher and lecturer in Hanoi Medical University,

Hanoi, Vietnam. His expertise focused on public health. He has published many articles in
the areas of quality of life, public health and mental health. He can be contacted at email:
nguyenhoangthanh@hmu.edu.vn.

Huy Dinh Quang is a radiologist and has extensive experience in the field of
medical management. He is currently working at the Department of General Planning and
Quality Management, Vietnam National University Hospital. He is interested in measures
and processes to support expertise and maximize work efficiency. He can be contacted at
email: dinhquanghuy@vnu.edu.vn.

Thien Tran Van is an expert in the field of Public Health, and a person with
extensive experience in the field of health management. Currently, he is the Deputy Director
of Vietnam National University Hospital. He is interested in measures and processes to
support expertise and maximize work efficiency. He can be contacted at email:
thientv.vnuh@gmail.com.

Int J Public Health Sci, Vol. 12, No. 3, September 2023: 981-988