Self-care behaviors and lifestyle habits among hypertensive outpatients: bridging the gap between awareness and practice

Abstract Introduction Arterial hypertension (AH) is the most important modifiable risk factor for cardiovascular disease and premature mortality worldwide. Awareness of AH is essential for effective management, as it represents the first step in the care cascade: diagnosing the condition and informing the patient, initiating treatment, and achieving blood pressure control. Objective The primary aim of this study is to assess the level of self-care behaviors and lifestyle habits among ambulatory patients with AH seen in the outpatient service of our tertiary center, and to examine correlations between them and several basic clinical parameters. Methodology A prospective observational study was conducted from August to October 2025, including all hypertensive patients attending our outpatient clinic. Self-care and lifestyle habits were assessed using a 15-item questionnaire. Each item was rated on a 5-point Likert scale (0–4). Thirteen items scored positively when patients answered "Always," while two items on harmful behaviors (smoking and stress-inducing situations) scored positively when answered "Never." Total scores (0–60) were converted to percentages and categorized using Bloom’s taxonomy: ≥80% good self-care, 60–79% moderate, and 60% poor. Results Among 150 patients with AH (52.7% men, mean age 64.5 ± 10.6 years), mean blood pressure was 140.7/85.7 mmHg, peak historical pressures averaged 182.5/104.9 mmHg, and mean disease duration was 10.6 ± 9.2 years. The mean total score of patients’ knowledge was 82.3% ± 13.9%, consistent with a good level of knowledge about AH. However, analysis of self-care behaviors revealed that many patients do not read food labels, consume enough fruits and vegetables, or meet recommended physical activity levels (Table 1). The average self-care score was 60.5% ± 11.9, barely reaching a moderate level. Table 2 shows correlations between self-care scores and clinical parameters. Higher education and higher doses of ARBs and spironolactone were positively associated with better self-care. In contrast, higher doses of loop diuretics showed an inverse correlation, likely because these patients were decompensated due to poor self-care and therefore required intensified diuretic therapy. Conclusion Although patients demonstrated good knowledge about AH, likely reflecting regular engagement in outpatient care, there was a clear gap between what they knew and how they applied it, as evidenced by only moderate self-care levels. Better self-care was associated with higher education and the use of medications often required in more advanced disease, suggesting greater awareness among these patients. Conversely, poorer self-care was linked to the need for higher doses of loop diuretics, likely reflecting clinical decompensation. These findings highlight the need for targeted interventions to strengthen practical self-care behaviors in hypertensive patients.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.