Barriers of Effective Hypertension Management Among Patients Attending Primary Health Care Centers in Mosul

Hypertension is a major global health problem and one of the leading risk factors for cardiovascular disease; uncontrolled blood pressure remains common in primary care settings despite available treatment. This comparative cross-sectional study aimed to assess the common barriers to effective hypertension management among 300 hypertensive patients aged 18 years and older attending four primary health care centers in Mosul City, Iraq, between February and July 2025. Barriers were classified into three domains — healthcare system, patient-related, and cultural/social — and were compared between patients with controlled (n=218) and uncontrolled (n=82) hypertension using the chi-square test, with odds ratios (OR) and 95% confidence intervals (CI) calculated for each barrier. Cultural and social barriers were the strongest correlate of uncontrolled hypertension (OR=3.87, 95% CI 2.11–7.10, P<0.001), driven mainly by preference for traditional or alternative remedies (OR=5.91, P<0.001) and the belief that hypertension resolves without treatment (OR=3.58, P<0.001). Patient-related barriers, chiefly non-adherence to the treatment plan due to poor motivation, were also significantly associated with poor control (OR=1.72, P=0.043), while healthcare system barriers showed the weakest, non-significant association (OR=1.55, P=0.128). All three barrier domains were more frequent among uncontrolled patients, and the difference was statistically significant overall (OR=2.10, P=0.008). Cultural beliefs and inadequate patient adherence, rather than health system deficiencies, were the principal drivers of poor hypertension control in this population, highlighting the need for culturally sensitive counseling and adherence-focused interventions.