BackgroundHypertension control is a challenge globally. Barriers to optimal control exist at the patient, physician, and health system levels. Patient-related barriers in our environment are not clear. The aim of this study was to identify patient-related barriers to control of hypertension among adults with hypertension in a semiurban community in South-East Nigeria.MethodsThis was a cross-sectional descriptive study of patients with a diagnosis of hypertension and on antihypertensive medication.ResultsA total of 252 participants were included in the survey, and comprised 143 males (56.7%) and 109 females (43.3%). The mean age of the participants was 56.6±12.7 years, with a diagnosis of hypertension for a mean duration of 6.1±3.3 years. Among these patients, 32.9% had controlled blood pressure, while 39.3% and 27.8%, respectively, had stage 1 and stage 2 hypertension according to the Seventh Report of the Joint National Committee on Prevention, Detection and Evaluation of High Blood Pressure. Only 23.4% knew the consequences of poor blood pressure control and 64% were expecting a cure from treatment even when the cause of hypertension was not known. Furthermore, 68.7% showed low adherence to medication, the reported reasons for which included forgetfulness (61.2%), financial constraints (56.6%), high pill burden (22.5%), side effects of medication (17.3%), and low measured blood pressure (12.1%). Finally, knowledge and practice of the lifestyle modifications necessary for blood pressure control was inadequate among the participants.ConclusionPoor knowledge regarding hypertension, unrealistic expectations of treatment, poor adherence with medication, unawareness of lifestyle modification, and failure to apply these were identified as patient-related barriers to blood pressure control in this study.

BackgroundThe prevalence of hypertension and attendant cardiovascular disease burden is increasing globally. Auditing antihypertensive prescriptions and assessing patients with hypertension for blood pressure (BP) control are important steps on the path to reducing hypertensionrelated morbidity, mortality, and health expenditure. This study assessed the prescription pattern of antihypertensive medications and BP control among hypertensive outpatients at the University of Benin Teaching Hospital in Benin City, Nigeria. Methods This was a cross-sectional descriptive study that involved 224 hypertensive patients. Information obtained from participants included sociodemographic data, duration of hypertension, history of diabetes mellitus, and number and classes of antihypertensive medications used. Good BP control was defined as a mean BP less than 140/90mmHg. ResultsThe mean age of hypertensive subjects was 59.6 ± 12.2 years, with a male:female ratio of 1:1.9 and a median duration of hypertension of 5 years. Twenty-four participants (10.7%) had both hypertension and diabetes. The common classes of antihypertensive medications used were diuretics, calcium channel blockers (CCB), and angiotensin converting enzyme inhibitors (ACEIs). Forty participants (17.8%) were on monotherapy, while the rest were on multidrug therapy. The most commonly prescribed antihypertensive combination was diuretic + ACEI/angiotensin receptor blocker (ARB), followed by diuretic + CCB + ACEI/ARB. Good BP control was observed in 120 participants (53.6%). The proportion of patients with good BP control was largest among patients on monotherapy and those with tertiary education, though these observations were not statistically significant. ConclusionsThe pattern of prescribed antihypertensive medications complied with recommended guidelines. Blood pressure control amongst hypertensive patients was unsatisfactory. More efforts should be geared towards better BP control.

Background:Cardiovascular risk factors are responsible for cardiovascular disease and rapid progression of chronic kidney disease (CKD) to end-stage renal disease. Prompt evaluation, modification, and treatment of these factors in predialysis patients will reduce morbidity and mortality. This study assessed some cardiovascular risk factors in predialysis CKD patients in a tertiary hospital in Southern Nigeria.Patients and Methods:This was a case–control study that involved 76 consecutive predialysis CKD patients and 38 age-and sex-matched controls without CKD over 1 year period. Both groups were assessed for cardiovascular risk factors, and comparisons were made. A P value of <0.05 was taken as significant.Results:The mean ages of the CKD versus control group were 48.00 ± 15.28 versus 45.34 ± 15.35 years. The male:female ratio was 1.7:1 for both groups. The common etiologies of CKD in this study were hypertension 30 (39.5%), diabetes mellitus 23 (30.3%), and chronic glomerulonephritis 19 (25%). There were 38 (50%) in CKD stage 3, 31 (40.8%) in CKD stage 4, and 7 (9.2%) in CKD stage 5. The common cardiovascular risk factors found in the CKD versus control were hypertension (96.1% vs. 42.1%), anemia (96.1% vs. 23.7%), left ventricular hypertrophy (77.6% vs. 23.7%), dyslipidemia (67.1% vs. 39.5%), hypocalcemia (60.1% vs. 18.5%), hyperphosphatemia (63.2% vs. 0%), and hyperuricemia (57.9% vs. 15.8%). These risk factors were significantly higher in CKD group. Hyperphosphatemia and hypoalbuminemia significantly increased across CKD stages 3–5. Anemia was significantly more common in males whereas dyslipidemia was more common in female CKD patients.Conclusion:Cardiovascular risk factors were highly prevalent in predialysis CKD subjects even in early stages. Hypoalbuminemia and hyperphosphatemia significantly increased across the CKD stages 3–5 whereas anemia and dyslipidemia showed significant gender differences. Cardiovascular risk factors should be treated early in predialysis CKD patients.

SUMMARYBackground: Cardiovascular disease is the major cause of hospitalization and mortality in chronic kidney disease (CKD). C-reactive protein (CRP) is a marker of cardiovascular disease and predictor of mortality in CKD patients. CKD patients with elevated CRP should be identified early with institution of measures to treat cardiovascular risk factors in order to reduce attendant mortality. Aims: Determination of serum CRP levels in CKD patients and associated factors. Methods: This was a case-control study involving 80 consecutive CKD patients and 40 control subjects without CKD. Data obtained from participants included demographics, body mass index (BMI), and aetiology of CKD. Serum CRP levels, albumin, creatinine and lipid profile were determined. Cases and controls were compared. P values <0.05 were taken as significant Results: The mean age of the CKD subjects was 49.09±16.85 years. The median CRP value was significantly higher in the CKD group compared to controls (p=<0.001). Low, average and high cardiovascular event risk according to CRP values were present in 51(63.8%), 13(16.2%) and 16(20%) of the CKD patients respectively. Cardiovascular event risk was significantly higher in CKD subjects (p=<0.001). Serum creatinine, BMI, triglyceride and atherogenic index of plasma correlated positively with CRP. Estimated glomerular filtration rate (eGFR), high density lipoprotein-cholesterol and albumin correlated negatively with CRP. Elevated serum CRP was significantly predicted by low eGFR and high BMI on multivariate analysis. Conclusion: Chronic kidney disease patients have increased cardiovascular event risk. Interventions aimed at reducing weight and treating dyslipidaemia should be instituted early in order to reduce this risk.

Background:Blood pressure (BP) variation is commonly encountered during hemodialysis (HD) procedure. Both intradialysis hypotension and hypertension have implications for outcome of treatment and overall morbidity and mortality of the patients.Methodology:A retrospective study was carried out in the dialysis unit of a tertiary health institution in Benin City among patients who had HD for acute kidney injury (AKI) or chronic kidney disease (CKD) over a 3-year period. Data retrieved included age, gender, type of kidney disease, cause of kidney disease, systolic BP at onset of dialysis and at end of dialysis, and diastolic BP (DBP) at onset of and at end of dialysis.Results:Complete data were available for 217 patients. One hundred and seven patients (49.3%) had no significant change in BP; 30.9% had intradialytic hypertension (IDHT) while 19.8% had intradialytic hypotension (IDH). IDH was more prevalent among patients with diabetic kidney disease while IDHT was more common among patients with hypertensive nephropathy (P = 0.002). Female patients had higher mean BP parameters compared to male patients pre- and post-dialysis, but only changes in DBP were statistically significant (P = 0.029). Patients with CKD had higher mean BP parameters pre- and post-dialysis compared to patients with acute AKI and the differences were statistically significant.Conclusion:Females had higher mean BP parameters than males. Patients with CKD had higher mean BP parameters compared with AKI patients. IDHT is a significant problem among patients on HD in our center. Measures to curtail this trend should be instituted with the goal of reducing morbidity and mortality.