Summary
Although physicians play a central role in the prevention and management of hypertension, limited data exist regarding their own awareness of the condition. In this cross-sectional study conducted among 178 doctors in Turkey, we found that 15.7% had hypertension, and 21.4% of these were newly diagnosed during the study. The findings highlight a significant gap in self-recognition and monitoring among physicians themselves. Addressing this issue may improve both personal health outcomes in doctors and the quality of hypertension care provided to patients.
Introduction
Hypertension is a prevalent non-communicable disease worldwide, significantly contributing to cardiovascular morbidity and mortality. The 2021 Global Burden of Disease Study estimates that approximately 1.28 billion adults between the ages of 30 and 79 suffer from hypertension, with nearly two-thirds of them living in low- and middle-income nations [1]. In Turkey, national studies report a hypertension prevalence of around 31.2% in adults aged 18 and above, with a significant increase observed in those over 50 [2]. Since hypertension often progresses without noticeable symptoms, diagnosis is frequently delayed, leading to a high number of undiagnosed cases and an elevated risk of severe complications [3].
Various modifiable factors contribute to hypertension, including stress, a sedentary lifestyle, and high salt consumption, all of which can be mitigated through lifestyle changes [4]. Medical doctors play a vital role in public health by engaging closely with patients and guiding preventive measures [5]. However, they may be susceptible to hypertension due to occupational stressors such as extended working hours, insufficient physical activity, and workplace violence – a growing concern in our country, as also highlighted in previous global studies [6].
Assessing doctors’ awareness of hypertension is essential to enhancing their role in promoting cardiovascular health both for themselves and their patients [7]. However, data on hypertension awareness among medical professionals in Turkey remain limited. This study examined the prevalence and awareness of hypertension among physicians in Turkey and assessed its influence on managing modifiable cardiovascular risk factors.
Aim
The primary objective of this study was to evaluate the prevalence and awareness of hypertension among practicing physicians in Turkey. Additionally, the study aimed to investigate the associations between hypertension and modifiable risk factors including age, body mass index (BMI), smoking status, physical activity, and the presence of comorbid conditions within this specific population.
Material and methods
This research was structured as a cross-sectional study and carried out in 35 medical centers, which were randomly chosen from 24 cities representing all regions of Turkey. The study participants comprised medical doctors aged 25–64 working at various healthcare facilities. Pregnant individuals and those who declined to provide written informed consent were excluded. Data collection involved a structured interview questionnaire, along with blood pressure and anthropometric measurements. Two nurses from the occupational health and safety unit carried out these interviews and measurements.
The structured questionnaire gathered information on sociodemographic characteristics, behavioral cardiovascular risk factors, and participants’ awareness of their hypertension status. Participants were classified as physically active if they engaged in moderate-to-vigorous activities such as walking, running, or cycling for at least 30 min per session, 5 days per week [8]. Hypertension awareness was evaluated by asking participants, “Has a doctor, nurse, or any other healthcare professional ever informed you that you have hypertension (high blood pressure)?” [9]. Unawareness of hypertension was defined as having hypertension without prior knowledge of the condition from a healthcare professional [10].
Blood pressure, weight, and height were systematically recorded. Blood pressure measurements were taken using a digital monitor (Omron M3 Comfort) with an appropriately sized cuff. The sphygmomanometer was calibrated at least every 6 months by comparison with mercury manometers. Before the measurements, participants were asked to rest for at least 5 min and refrain from consuming caffeinated beverages or using tobacco products for at least 30 min. Blood pressure was measured while seated, with both feet flat on the floor and the arm supported at elbow height. The initial measurement was taken from both arms, and subsequent readings were conducted on the arm that recorded the higher initial value, with a total of four measurements obtained. Hypertension was defined as a systolic blood pressure of ≥ 140 mm Hg and/or a diastolic pressure of ≥ 90 mm Hg, a self-reported diagnosis of hypertension, or the use of antihypertensive medication [3].
Body weight and height were recorded to determine the body mass index (BMI), calculated as weight in kilograms divided by the square of height in meters (kg/m2). According to BMI classification, participants were grouped into three categories: normal weight (BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2) [11].
Statistical analysis
The collected data were analyzed using IBM SPSS Statistics, version 27 (IBM Corp., Armonk, NY, USA). χ2 tests were used to assess the relationship between hypertension prevalence and other variables. Quantitative variables were expressed as mean ± standard deviation, while qualitative variables were presented as median with interquartile range (IQR: 25%–75%) and as numbers with percentages. A p-value of less than 0.05 was regarded as statistically significant.
Results
A total of 178 participants were included in this study, with a median age of 39 years (range: 25–66). Among them, 64 (36%) were female, and 114 (64%) were male. The overall prevalence of hypertension was 15.7% (n = 28). Hypertension was significantly more common in males (20.2%) than in females (7.8%) (p = 0.03). However, no difference was found in the median age according to gender, with values of 47 years (min.–max.: 32–64) in male and 44 years (min.–max.: 36–66) in female participants (p = 0.95).
Age was strongly associated with hypertension prevalence, with individuals over 40 years exhibiting a significantly higher rate (27.9%) compared to those under 40 years (4.3%) (p < 0.001). A significant relationship was also found between hypertension and both smoking status and physical activity (p < 0.05).
As presented in Table I, BMI was significantly correlated with hypertension (p = 0.037), showing an increasing trend in prevalence as BMI increased. Moreover, hypertension was notably more prevalent among participants with cardiovascular disease (45.5%, p = 0.005), diabetes (50.0%, p = 0.006), and hyperlipidemia (35.0%, p = 0.012) compared to those without these conditions.
Table I
Demographic, behavioral, and biological risk factor profiles of the study population
To identify the key factors significantly affecting hypertension prevalence among medical doctors, logistic regression analysis was conducted, incorporating employment-related variables such as gender, age, smoking status, salt intake, BMI, and comorbidities (data not shown). Among these variables, being 40 years or older emerged as an independent risk factor for hypertension. Participants in this age group had a nearly sevenfold higher likelihood of hypertension (odds ratio [OR] = 6.883) compared to those under 40 (95% CI = 2.094–22.620). In contrast, other factors – including cardiovascular disease, BMI, gender, smoking status, diabetes, hyperlipidemia, salt intake, and physical activity – did not exhibit statistically significant associations with hypertension awareness in this model (all p-values > 0.05).
Of the 28 hypertensive participants, the prevalence of awareness of hypertension was 78.5% (n = 22), while 21.4% (n = 6) were newly diagnosed during the study and were previously unaware of their condition (shown in Table II). While some factors showed trends in hypertension awareness, they were not statistically significant, which is likely due to the small sample size. For instance, despite all women or participants with comorbid conditions being aware of their hypertension, gender differences (p = 0.55), cardiovascular disease (p = 0.55), diabetes (p = 0.54), and hyperlipidemia (p = 0.28) were not significantly associated with awareness. Similarly, awareness of hypertension was not significantly different based on physical activity, smoking, salt consumption, or BMI (p > 0.05).
Table II
Comparison of clinical and demographic characteristics of hypertensive participants according to their awareness status
Discussion
This study offers important insights into the prevalence and awareness of hypertension among medical doctors in Turkey, emphasizing its links to demographic, behavioral, and clinical factors. The findings reveal a hypertension prevalence of 15.7% within the study group, with notable variation by gender and a strong correlation with age, BMI, and comorbidities such as diabetes and cardiovascular disease. These results align with prior research highlighting the increasing impact of hypertension among healthcare professionals, especially those working in high-stress settings.
The prevalence of hypertension observed among medical doctors in this study is lower than the reported 31.8% in the general adult population of Turkey, as indicated in national surveys [12]. This discrepancy may be due to the younger age profile of the study participants and their potentially greater health awareness as medical professionals. Nonetheless, the substantial rise in hypertension prevalence among those over 40 years (27.9%) highlights the importance of targeted interventions for this high-risk group. This finding aligns with international studies, including a cross-sectional analysis of healthcare workers in China, which also reported a similar age-related trend in hypertension prevalence [13].
BMI emerged as a key factor in our study, with hypertension prevalence rising from 9.2% in participants with normal weight to 25% in those classified as obese (BMI ≥ 30 kg/m2). This trend mirrors findings from a study in Nigeria, which identified obesity as a major determinant of hypertension among healthcare professionals [14]. The relationship between BMI and hypertension underscores the significance of workplace wellness initiatives that encourage weight control and regular physical activity.
The association between salt intake and hypertension is well documented [15]. However, our study, which included participants from various regions of Turkey, did not demonstrate a significant relationship. This outcome may be partly attributed to regional dietary differences, such as higher adherence to the Mediterranean diet in coastal areas or to the potential underreporting of actual sodium consumption.
Although smoking and physical inactivity were associated with hypertension in the univariate analysis, they did not emerge as independent predictors in the logistic regression model. This finding differs from studies conducted in other regions, such as Brazil, where smoking and sedentary behavior were significant risk factors for hypertension among healthcare professionals [16]. The absence of statistical significance in our study may be attributed to the relatively small sample size or cultural variations in smoking patterns and physical activity levels. Moreover, given the growing prevalence of electronic cigarette use, especially among young adults, and the lack of specific assessment in our study, future research should investigate its potential link with hypertension among medical professionals.
The overall awareness of hypertension among hypertensive participants in our study was 78.5%, higher than the estimated 54.7% awareness rate in the general population in Turkey [12] and exceeding the 64.7% reported among healthcare workers in Nigeria [17]. Notably, all hypertensive women in our study were aware of their condition, which may reflect gender differences in health-seeking behavior. Similar trends have been observed in European studies, where women are more likely than men to seek medical advice and adhere to hypertension treatment [18].
Despite the relatively high awareness rate, our study highlights gaps in hypertension management, particularly among participants with comorbid conditions. Although all individuals with diabetes or cardiovascular disease were aware of their hypertension, this awareness did not always lead to effective management, as evidenced by persistently high blood pressure levels in this subgroup, which is consistent with previous studies highlighting the importance of integrated care models for hypertension management in healthcare settings [19].
The findings of this study emphasize the need for targeted interventions to improve hypertension awareness and control among medical professionals. Workplace health promotion initiatives focusing on lifestyle modifications, routine blood pressure monitoring, and stress management could be instrumental in reducing hypertension within this group. Furthermore, educational campaigns directed at younger doctors may help address the age-related rise in hypertension prevalence observed in this study.
Nevertheless, this study has several limitations. First, this study relied on office-based blood pressure measurements and did not assess masked hypertension, which is known to be prevalent among healthcare workers and may have led to an underestimation of the true hypertension burden in this population. Moreover, its cross-sectional design limits the ability to draw causal inferences regarding the associations between hypertension and its risk factors. Finally, the relatively small sample size may limit the generalizability of our findings to the broader physician population in Turkey. Despite these limitations, the study provides valuable insights into the prevalence and awareness of hypertension among physicians – a population often overlooked in epidemiological research – and highlights the need for targeted workplace interventions to support cardiovascular health in this critical professional group.
Conclusions
This study highlights the substantial burden of hypertension among medical doctors in Turkey, particularly among older individuals and those with elevated BMI or comorbid conditions. Despite relatively high awareness rates, gaps in hypertension management persist, necessitating targeted interventions. Future studies should focus on longitudinal studies to highlight causal relationships and assess the effectiveness of workplace health initiatives in reducing hypertension among healthcare professionals.
