Mediterranean Journal of

Pharmacy & Pharmaceutical Sciences ISSN: 2789-1895 online

www.medjpps.com ISSN: 2958-3101 print

ORIGINAL RESEARCH article

Educational intervention on knowledge of hypertension and

lifestyle/dietary modification among hypertensive patients
attending a tertiary health facility in Nigeria
Muslim O. Jamiu 1 * , Bilkisu B. Maiha 2 , Nuhu M. Danjuma 2 and Abdulganiyu Giwa 1
1
Department of Clinical Pharmacy and Pharmacy Practice, University of Ilorin, Ilorin, Nigeria
2
Department of Pharmacology and Therapeutics, Ahmadu Bello University, Zaria, Nigeria
*
Author to whom correspondence should be addressed

Received: 13-12-2023, Revised: 04-01-2024, Accepted: 09-01-2024, Published: 31-03-2024

Copyright © 2024 Jamiu et al. This is an open-access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

HOW TO CITE THIS

Jamiu et al. (2024) Educational intervention on knowledge of hypertension and lifestyle/dietary modification among hypertensive
patients attending a tertiary health facility in Nigeria. Mediterr J Pharm Pharm Sci. 4 (1): 1-11. [Article number: 140].
https://doi.org/10.5281/zenodo.10535778

Keywords: Dietary, education, hypertension, knowledge, lifestyle, pharmacist

Abstract: Patients’ knowledge of hypertension and treatment has been found to affect health outcomes of
hypertension. This study aimed to assess the impact of therapeutic patients’ education on knowledge of
hypertension and lifestyle/dietary modification among hypertensive patients in Nigeria. The study was
conducted among 317 hypertensive patients randomized into controlled and intervention groups (158 vs 159,
respectively) between March 2021 and February 2022. Baseline knowledge of the patients was assessed and
intervention was provided for the intervention group with a structured educational program at a baseline and six
months. Descriptive data were presented with a frequency table in percentage while the chi-square test and
univariate logistic regression were used to determine the association between categorical variables. Out of the
total number of 318 patients, 275 completed the study (response rate: 86.8%) with 136 in the control group and
139 in the intervention group. The mean age of the patients was 59.5 (±12.5) and patients > 60 years (49.5%)
were the most frequent age category. The baseline knowledge score of hypertension was 9.8 (±2.6) and 9.3
(±2.6) on a scale of 16 points in the control group and intervention group, respectively (P = 0.060) while at six
months 11.9 (±2.3) vs 10.8 (±2.4) (P < 0.001) and 12 months 12.6 (±2.5) vs 9.5 (±2.0) (P < 0.001), respectively.
Knowledge of lifestyle/dietary modification in the control group and intervention group at baseline was 7.0
(±2.1) and 6.6 (±2.0), respectively, while at six months 7.5 (±1.5) vs 9.9 (±1.3) (P < 0.001) and at 12 months 7.2
(±1.5) vs 10.4 (±1.2), respectively. Marital status, body mass index, and family history of hypertension were
associated with knowledge of hypertension and lifestyle/dietary modification (P < 0.001). The educational
intervention provided was found to be associated with a significant improvement in knowledge of hypertension
and lifestyle/dietary modification. The marital status of the patients, body mass index and family history of
hypertension influenced patients’ level of knowledge.

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Introduction
Hypertension (HTN) is a leading cause of disability and death in developing and developed countries as a result
of its leading role in the development and progression of cardiovascular diseases [1]. It contributes to more than
7.5 million deaths per year of the total 17 million deaths resulting from cardiovascular diseases [2]. It has been
found to a pose high economic burden in a developing economy like Nigeria [3]. In a systematic review across
Sub-Saharan African countries, the cost of medication accounted for the most of the expenditures ranging from
1.70$ to 97.06$ from a patient perspective and 0.09$ to 193.55$ from a provider perspective per patient per
month [4]. Major cost drivers were multi-drug treatment, inpatient or hospital care and having a comorbidity
like diabetes mellitus. Despite the availability of multiple effective antihypertensive drugs, control of HPT
remains poor [5]. Complications resulting from uncontrolled HTN such as stroke, heart failure and renal failure
are associated with high morbidity/mortality and economic loss [6, 7]. HTN is a resource-intensive disease
condition and families are often driven into poverty due to lifelong care associated with its management [6].
Patients whose health has deteriorated due to complications from the disease often live with reduced
productivity in their routine activities and possible loss of jobs due to illness.
Patient’s knowledge of disease conditions like HTN has been known to improve health outcomes. However,
this knowledge must be evidence-based and relevant to the patient’s needs. Knowledge is one of the
components of complex intervention especially in chronic disease states like HTN and diabetes mellitus [8, 9].
While some studies have reported patients’ poor knowledge of HTN as consequent to poor blood control [10,
11], some have shown patients good knowledge which has translated to good control of blood pressure [12]. A
quite number of patients with non-communicable diseases have very poor knowledge of different components
of non-pharmacological therapy. Sabouhi and others [12] have demonstrated that with patients’ good level of
knowledge about HTN, there was no correlation between the knowledge and good patient’ practice that would
enhance blood pressure control. With the relatively high level of awareness, knowledge, attitude and practice of
HTN, blood pressure control was still poor [12]. A study carried out in Kano, North-Western Nigeria on
Knowledge, attitude, and adherence to non-pharmacological therapy among patients with HTN and diabetes
mellitus reported that patient self-management education, lifestyle modification which include healthy diet,
regular physical exercise, management of stress and avoidance of tobacco have been shown to improve outcome
of therapy [13]. It has also been demonstrated by Silveira de Castro and others [14] that pharmaceutical care
intervention in identifying and resolving drug-related problems improved blood pressure control in patients with
uncontrolled HTN. Erah and Chuks-Eboka [15] identified most common components of pharmacists’ activities
offered were the supply of medication and provision of information on the cost of medication. They found that
patients perceived a significantly lower chance of developing medication-related problems when they met with
the pharmacists as compared to when they did not. Effective control of blood pressure through health education
intervention programs has been shown to decrease the risk of cardiovascular complications especially systolic
blood pressure which is more prevalent among the elderly population [16]. The World Health
Organization/Europe proposed the concept of Therapeutic Patient Education (TPE) in the prevention of chronic
diseases [17]. It is almost impossible to reproduce the education intervention (EI) without a detailed description
of the teaching program (number of meetings, duration of the intervention, place, and profession of the teacher
and teaching models [18]. Giving appropriate educational intervention to patients is, therefore, a necessary
component of care given to patients to improve their knowledge level of their disease condition and also
empower them in self-care practices.

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www.medjpps.com ISSN: 2958-3101 print

Materials and methods

The study was conducted at the cardiology clinic of the main outpatient department of the hospital among
hypertensive patients who were registered with, and attended the Cardiology Clinic of the University of Ilorin
Teaching Hospital, Ilorin, Nigeria. Eligible patients were hypertensive patients who had been on
antihypertensive medication for not less than four weeks and were adults of 18 years and above. Ethical
approval for the study was obtained from the University of Ilorin Teaching Hospital Ethical Committee (UITH-
ERC) with reference number ERC/PAN/2020/02/0002. The study design was a prospective longitudinal
randomized interventional study that was carried out between March 2021 and February 2022. The design was
in line with the CONSORT (Consolidated Standards of Reporting Trials) 2010 statement [19]. This study
design was chosen because it is less prone to bias and can more easily demonstrate the relationship between
causes and effects [20]. Sample size was determined according to recommended standards for sample size
calculation in a randomized control study [21]. The design was to assess the effect of the intervention in the
treatment group (intervention group) compared to the control group. Online sample size calculator as contained
in [21]. The parameter definitions were n=size per group; significance level (α) was set at 5.0% (0.05); expected
SD=10.17 mmHg; power (β)=0.9; Ratio of control to intervention=1; Z=1.96; margin=4 and an estimated drop
rate 30.0%. The allowable difference in the mean BP was assumed to be zero and a difference in 5.0% (δ)
change in systolic blood pressure was assumed to be clinically meaningful [22]. The sample size obtained for
each group was 159 making a total of 318 (159x2) participants. There was a drop-out of one participant from
the controlled group after recruitment which makes the controlled group become 158.
Eligible patients were identified and recruited for the study continuously on every clinic day. A simple
randomization method was used to allocate patients into either a control or intervention group. This method was
considered the easiest method of simple randomization but capable of producing reliable results that eliminate
bias [23, 24]. Baseline data were collected from each arm of the randomized group where a questionnaire on
knowledge of HPT which was developed through a literature review on knowledge of HPT, treatment,
complication and self-care practices, and knowledge of life and dietary modification and lifestyle/dietary
modification were administered to the patients in an interviewer-administered manner. After baseline data were
collected in the intervention group, it was followed by educational intervention which was self-delivered to the
intervention group after baseline assessment and repeated at six months.

Statistical analysis: After collecting data at baseline, six months and 12 months, data was entered and analyzed
using SPSS version 25. Data were presented in frequency tables and numerical data were analyzed using a
Student t-test and one-way ANOVA while categorical data were analyzed by using a chi-square test and
univariate logistic regression analysis. P less than 0.05 was considered significant.

Results
In this study, a total of 318 patients were recruited for the study which were randomized into controlled and
intervention groups. The patients were analyzed following the completion of the baseline study with 158 in the
controlled group and 159 in the intervention group. The number of patients that returned for follow-up at six
months was 301 (94.7%, response rate) out of the initial 318 patients at baseline. Seventeen hypertensive
patients were lost to follow up with 10 patients in the control group and seven in the intervention group. At 12
months, 275 patients (86.8%, response rate) completed the study with 136 in the control and 139 in the
intervention groups. In Table 1, the demographic distribution of the patients between the control and the

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intervention groups showed that there is no significant difference in most of the patients’ baseline
characteristics groups except in the marital status (P = 0.033) and family history of HPT (P = 0.027).

Table 1: Baseline characteristics of the study population at baseline

Variable Group n (%) total = 317 χ²/t P value

Control: 158 Intervention: 159 MS (±SD)

Age (years) 58.7 (±13.1) 59.7 (±11.9) 59.5±12.5 -0.72 0.472

Age group
< 30 years 01(00.6) 03 (01.9) 04 (01.3) 2.114 0.549
30-45 years 28 (17.6) 22 (13.9) 50 (15.8)
46-60 years 50 (31.4) 56 (35.4) 106 (33.4)
> 60 years 80 (50.3) 77 (48.7) 157 (49.5)

Gender
Male 72 (45.3) 69 (43.7) 141 (44.5) 0.083 0.773
Female 87 (54.7) 89 (56.3) 176 (55.5)

Educational Qualification
Non-formal 20 (12.6) 31 (19.6) 51 (16.1) 4.116 0.249
Primary 18 (11.3) 22 (13.9) 40 (12.6)
Secondary 38 (23.9) 30 (19.0) 68 (21.5)
Tertiary 83 (52.2) 75 (47.5) 158 (49.8)

Occupational status
Unemployed 26 (16.4) 20 (12.7) 46 (14.5) 2.577 0.462
Self-employed 56 (35.2) 68 (43.0) 124 (39.1)
Civil servant 42 (26.4) 35 (22.2) 77 (24.3)
Retiree 35 (22.0) 35 (32.0) 70 (22.1)

Marital status
Single 01 (00.6) 04 (02.5) 05 (01.6) 8.72 0.033*
Married 146 (91.8) 130 (82.3) 276 (87.1)
Divorced/separated 00 (00.0) 04 (02.5) 04 (01.3)
Widowed 12 (07.5) 20 (12.7) 32 (10.1)

Family history of hypertension

Yes 69 (43.4) 73 (46.2) 142 (44.8) 7.241 0.027*
No 54 (34.0) 34 (21.5) 88 (27.8)
Not sure 36 (22.6) 51 (32.3) 87 (27.4)

Presence of adverse drug reaction

Present 33 (20.7) 52 (32.9) 85 (26.5) 7.483 0.024*
Absent 126 (79.2) 106 (67.1) 232 (73.2)

Body weight mass category

(Kg/m2)
Underweight: < 18.4 05 (03.1) 05 (03.2) 10 (03.2) 1.126 0.890
Normal weight: 18.5-24.9 53 (33.3) 49 (31.0) 102 (32.2)
Overweight: 25.0-29.9 50 (31.4) 49 (31.0) 99 (31.2)
Obesity I: 30.0-34.9 30 (18.9) 37 (23.4) 67 (21.1)
Obesity II: ≥ 35 21 (13.2) 18 (11.4) 39 (12.3)

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Knowledge of hypertension among hypertensive patients: In Table 2, at baseline (pre-intervention), the scores
of knowledges of HPT between the control group and intervention group were found not statistically significant
(P > 0.05). However, a significantly higher mean score of knowledge of HPT in the intervention group
compared with the control group was observed at six months and 12 months as shown in Table 2 (P < 0.001).

Knowledge scores of lifestyles and dietary modification among the hypertensive patients before and after the
intervention: The mean knowledge scores of lifestyles and dietary modification at baseline, six months and 12
months in the control group were 7.0, 7.5 and 7.2, respectively. A highly significant relationship between
knowledge of HTN and blood pressure control at six months and 12 months following intervention was
observed (P < 0.001) (Table 3).

Table 2: Knowledge scores of hypertensions among the patients at baseline, 6 and 12 months

Groups n MS (±SD) t P n MS (±SD) t P value

Baseline (n=317)
Controlled 126 09.8 (±2.6) 1.887 0.060 132 09.6 (±2.6) 0.764 0.445
Uncontrolled 191 09.3 (±2.6) 185 09.4 (±2.5)

6 months (n=301)
Controlled 170 11.9 (±2.3) 4.153 <0.001* 12.1 (±2.2) 5.278 <0.001*
Uncontrolled 131 10.8 (±2.4) 10.7 10.2 (±2.1)

12 months (n=275)
Controlled 157 12.6 (±2.5) 10.70 <0.001* 171 12.7 (±2.5) 11.18 <0.001*
Uncontrolled 118 09.5 (±2.0) 104 09.5 (±2.0)
*
Significant difference in the level of knowledge between the control and intervention group by χ² is the Chi-square test.

Table 3: Knowledge scores of lifestyles and dietary modification among the patients at baseline, 6 and 12 months
Parameters n (%) MS (±SD) t-test P
Baseline (N=317)
Control 159 (50.2) 7.0 (±2.1) 1.823 0.069
Intervention 158(49.8) 6.6 (±2.0)

6 months (N=301)
Control 149 (49.5) 7.5 (±1.5) -15.29 <0.001*
Intervention 152 (50.5) 9.9 (±1.3)

12 months (N=275)
Control 136 (49.5) 7.2 (±1.5) -18.3 <0.001*
Intervention 139 (50.5) 10.4 (±1.2)

*
Significant difference in knowledge scores between control and intervention groups.

Relationship between patients’ socio-demographic characteristics and knowledge of hypertension, and lifestyle/
dietary modifications: In Table 4, when the relationship between socio-demographic characteristics of the
patients and knowledge of HPT was assessed, patients' marital status was observed to be the only demographic
variable significantly associated with the knowledge of HPT (P = 0.017). The highest mean score of knowledge
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in marital status was found among the divorced/separated individuals. Almost all the patients’ health-related
characteristics were not significantly associated with knowledge of HPT except the body mass index of the
patients (P < 0.001). When the relationship between socio-demographic characteristics of the patients and
knowledge of lifestyle/dietary modifications was assessed, only family history and body mass index showed a
highly significant relationship with a P = 0.01 and P < 0.001, respectively (Table 4).

Relationships between patient's characteristics and knowledge of lifestyle and dietary modifications: As shown
in Table 5, there was no significant difference (P > 0.05) in patients’ knowledge scores of lifestyles and dietary
modifications in most of the assessed patients’ socio-demographic characteristics with a P > 0.05).

Table 4: Relationship between socio-demographic characteristics and knowledge of hypertension

among the study population

Variables n (%) MS (±SD) F/t P

Age group
< 30.0 02 (7.0) 14.5 (±0.7) 2.351 0.073
31.0-45.0 89 (17.1) 11.2 (±2.8)
46.0-60.0 47 (32.4) 11.9 (±2.7)
> 60.0 137 (49.8) 11.2 (±2.7)

Gender
Male 122 (44.4) 11.3 (±2.6) -0.593 0.554
Female 153 (55.6) 11.5 (±2.7)

Educational Qualification
Non-formal 44 (16.0) 11.4 (±3.0) 0.096 0.962
Primary 35 (12.7) 11.7 (±2.5)
Secondary 61 (22.2) 11.3 (±2.7)
Tertiary 135 (49.1) 11.5 (±2.8)

Occupational status
Unemployed 45 (16.4) 11.0 (±3.1) 0.574 0.633
Self-employed 118 (42.9) 11.5 (±2.7)
Civil servant 69 (25.1) 11.7 (±2.8)
Retiree 43 (15.6) 11.3 (±2.6)

Marital status
Single 03 (1.1) 12.3 (±3.8) 4.112 0.017*
Married 243(88.4) 11.4 (±2.8)
Divorced/separated 15 (5.5) 12.5 (±2.0)
Widowed 14 (5.1) 11.5 (±2.7)

Level of income**
Low (<30,00 Naira/month) 166 (60.4) 11.5 (±2.7) 0.065 0.948
High (≥30, 000 Naira /month) 109 (39.6) 11.5 (±2.8)

Body weight category (Kg/m2)

Normal weight, 18.5-24.9 112 (40.7) 12.6 (±2.6) 16.4 <0.001*
Overweight, 25.0-29.9 117 (42.5) 11.1 (±2.7)
Obesity I, 30.0-34.9 36 (13.1) 9.6 (±2.0)
Obesity II, ≥ 35.0 10 (3.6) 9.5 (±2.1)

*
Significant difference in knowledge scores of hypertension, F = ANOVA; ** Based on national minimum wage, n = 275.

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Table 5: Socio-demographic characteristics and knowledge scores of lifestyles and dietary modifications
Variables n (%) MS (±SD) F/t P
Age group
<30.0 02 (07.0) 11.0 (±0.0) 1.915 0.127
31.0-45.0 47 (17.1) 8.9 (±2.1)
46.0-60.0 89 (32.4) 9.1 (±2.1)
>60.0 137 (49.8) 8.6 (±2.1)

Gender
Male 122 (44.4) 8.7 (±2.2) -0.638 0.524
Female 153 (55.6) 8.9 (±2.1)

Educational Qualification
Non-formal 44 (16.0) 8.8 (±2.2) 0.217 0.885
Primary 35 (12.7) 8.7 (±1.9)
Secondary 61 (22.2) 8.7 (±2.0)
Tertiary 135 (49.1) 8.9 (±2.1)

Occupational status
Unemployed 45 (16.4) 8.2 (±2.3) 1.700 0.167
Self-employed 118 (42.9) 8.9 (±2.1)
Civil servant 69 (25.1) 9.2 (±2.0)
Retiree 43 (15.6) 8.8 (±2.1)

Marital status
Single 03 (1.1) 9.3 (±2.9) 1.135 0.335
Married 243(88.4) 8.7 (±2.1)
Divorced/separated 15 (5.5) 9.7 (±1.6)
Widowed 14 (5.1) 9.1 (±1.4)

Level of income**
Low (Less than 30,00 Naira/Month) 166 (60.4) 8.8 (±2.2) -0.327 0.744
High (≥30, 000 Naira / Month) 109 (39.6) 8.9 (±2.1)

F = ANOVA, * Significant difference in the mean scores of knowledges of lifestyle and dietary modifications.
**
Based on national minimum wage.

Discussion
This study was conducted to explore the effect of pharmacist intervention on patients’ knowledge of HPT and
knowledge of lifestyle/dietary modification. The socio-demographic characteristics of the patients at baseline
showed a homogenous distribution of most of the patients’ characteristics in control group and intervention
group were not different. The mean age of the participants was 59.4 (±13.1). In similar studies carried out in
Baltimore, Maryland, USA on knowledge of HPT and lifestyle practices among hypertensive patients by Abu et
al. [25], the mean age of the participants was 59.5 (±12.4) years while Adedapo et al. [26] in a study carried out
among hypertensive patients at University College Hospital, Ibadan, Nigeria, it was found 57.1 (±11.0) year.
The reason for a similar age bracket with studies could be the fact that HPT is more common in adults and its
trend increases with increase in age [27]. Higher mean age has also been found in other studies as seen in a
study carried out at Sri Lankan hospital by Ralapanawa et al. [11] where the mean age of 64.5 years was
obtained. Studies by Demisse et al. [28] from Ethiopia and Odili et al. [29] from Delta State, Nigeria have
identified increasing age as an associated factor with increased incidence of HPT. The most occurring age group

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in this study was > 60 years. The high occurrence of HPT among female patients in this study compared to their
male counterparts could be attributed to possible family and job pressure since the majority of the participants
were married and also self-employed. Meeting ends need may be a difficult task which might expose them to
stressful environmental risk factors for HPT [30, 31].
Patients’ knowledge of HPT between the control group and intervention group was not different at the
beginning of the study. Higher scores of knowledges which were significantly different in the intervention
group at six months and 12 months might be a result of the educational received by the intervention group.
However, the magnitude of the difference from the level of knowledge of knowledge of HPT also showed that
the level of knowledge in the control group and the intervention group at baseline was found to be comparable
because there was no significant difference in the knowledge level of the patients. A significantly higher level
of knowledge level of HPT in the intervention group compared with the control group at six months and 12
months following the intervention could be attributed to intervention provided. It was also observed that the
patients in the control group showed improvement in their level of knowledge from baseline to six months.
However, the observed improvement could be attributed to general counseling and education usually provided
by other healthcare providers although the intervention group showed a significantly higher knowledge level
than the control. Nevertheless, there was a slight reduction in knowledge level from 79.2% to 64.0% from six
months to 12 months. This could be due to a lack of consistency in the routine counselling and/or difficulty in
attending the counseling session regularly among the patients in the control group. In a similar interventional
study carried out in Spain by Ho and his colleagues [32] a lower level of knowledge was achieved following
intervention (50.0%). This value was far below the baseline knowledge level in this study. The high baseline
level of knowledge of HPT could be attributed to effectiveness in the general counseling and educational
programs the health care providers administer to hypertensive patients. The patients’ knowledge increase found
in the current study demonstrated the possible positive impact of the educational intervention which increased
by about two times the baseline value within six months of the study. A significant relationship found between
knowledge of HPT and blood pressure control demonstrated the significance of knowledge in disease
management. Knowledge imparted to patients was capable of empowering patients to make meaningful
contributions to their disease state management [33]. In a similar study in Ekiti South-Western Nigeria,
patients’ knowledge improvement was found to be associated with good blood pressure control [34]. There was
also a significant increase in patients’ level of knowledge of lifestyle and dietary modification following
intervention from baseline to six months (48.0% to 94.6%). The observed difference was higher than what was
obtained by Bogale et al. [35] in Harar, Eastern Ethiopia, with an average knowledge of 83.9%. Significant
differences in the relationship between patients’ family history of HPT and knowledge of lifestyle and dietary
modification could be a result of interaction between the patients and family members in sharing knowledge and
experience. Body mass index which was found to be associated with knowledge of lifestyle and dietary
modification might be related to the fact that it has been reported in a study carried out in the USA that 63.0%
of individuals who are overweight or obese would be willing to participate in weight loss programs [36]. This
implied that there could be raised consciousness among the patients in this recent study with about two-thirds of
overweight and obese patients showing interest in what would help them in losing weight.
Most patients’ socio-demographic characteristics did not show their influence on patients’ knowledge of HPT.
The positive relationship between the patient’s marital status and body mass index was, however, evident. A
similar study in Babylon Province also identified marital status’s influence on knowledge of HPT [37] while the
study of Chen et al. [38] has only identified body mass index as a strong risk factor for HPT but no association

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has been found with patients' knowledge of HPT or lifestyle modification [38]. Reasons for divorce/separation
having a significantly higher knowledge score than others could be as a result of their possibility of having
available time to attend their clinic appointments more regularly than others. The relationship of body mass
index with knowledge could be attributed to patients’ attitudes in seeking ways to control their weight which
could expose them to some areas of knowledge about their health. As observed in this study, patients with
overweight and obese at baseline were 64.0%, hence differences in their characteristics could impact the result.

Conclusion: The patient's knowledge of hypertension and lifestyle/dietary modification improved tremendously
following pharmaceutical care intervention in terms of patient education. Marital status, body mass index and
family history of hypertension were significantly associated with improved knowledge of hypertension and,
lifestyle/dietary modification.

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Acknowledgments: The cooperation of the entire physicians, nurses and other members of staff of the Cardiology unit of the
University of Ilorin. Teaching Hospitals are highly appreciated for their cooperation in providing. The research assistants who
worked with me throughout the field-work are highly acknowledged for their efforts.
Author contribution: All authors contributed significantly to the proposal, data collection data analysis and script development
and review.
Conflict of interest: The authors declare the absence of any commercial or financial relationships that could be construed as a
potential conflict of interest.
Ethical issues: Including plagiarism, informed consent, data fabrication or falsification, and double publication or submission have
completely been observed by authors.
Data availability statement: The raw data that support the findings of this article are available from the corresponding author
upon reasonable request.
Author declarations: The authors confirm that all relevant ethical guidelines have been followed and any necessary IRB and/or
ethics committee approvals have been obtained.

Jamiu et al. (2024) Mediterr J Pharm Pharm Sci. 4 (1): 1-11. Volume 4: Issue 1: Page 11