The Nigerian rural people demonstrate undesirable health-seeking behavior because of their cosmological and nosological notions which ascribe etiology of diseases and ill-health to entities far beyond the realm of the stethoscope. The present review is therefore solicited to enhance the health status of rural dwellers by providing potentially useful guidance that will enhance the knowledge of healthcare professionals with respect to the peculiar health-seeking behavior of rural dwellers so as to promote good patient-physician interaction and to provide empirical basis for rational health policy formulation. A manual literature and internet (Google, Medline, Embase, HINARI and Cochrane data bases) search showed that in a pluralistic medical milieu in which the rural dwellers find themselves, the decision to seek healthcare, where to do this and the form of care perceived as appropriate are all influenced by a multiplicity of factors relating to the person, the facility and the socio-cultural environment. Primarily, religious beliefs, use of Traditional African Medicine (TAM) and patients' perception of reality influence health-seeking behavior. In order to adequately and successfully manage the Nigerian rural patients, the healthcare provider must pay attention to patients' impression of illness and underpinning health beliefs during consultation, in therapeutics and in handling evolving complications of TAM and ethical dilemmas. Improvement of rural infrastructure and behavioral health promotion campaigns among the rural people together with rational health policy formulation and regulation of TAM practice, are imperative.

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In order to evaluate whether amlodipine or hydrochlorothiazide would be preferable to initiate therapy, 90 untreated hypertensive Nigerians of both genders aged 31-86 years with blood pressure >160/90 and ≤180/120 mm Hg were recruited into a randomized 48-week study. Patients, 30 each in amlodipine, hydrochlorothiazide, and amlodipine-hydrochlorothiazide groups, were treated, respectively, with amlodipine 5 mg for 6 weeks and the dose increased to 10 mg till week 12, after which hydrochlorothiazide 25 mg was added; hydrochlorothiazide 25 mg till week 6, after which amlodipine 5-10 mg was added; and amlodipine 5-10 mg + hydrochlorothiazide 25 mg. Body mass index, blood pressure, heart rate, and 24-hour urine volume were evaluated at baseline and at the end of weeks 1, 3, 6, 12, 24, 36, and 48. The primary efficacy variables were decreased in mean trough sitting diastolic and systolic blood pressure such that blood pressure < 140/90 mm Hg was regarded as normalized. At week 48 in the amlodipine group, 27 patients versus 25 patients in the hydrochlorothiazide group had diastolic blood pressure <90 mm Hg (90% vs. 83.3%; P <.03). In the amlodipine group, 23 patients versus 20 patients in the hydrochlorothiazide group had blood pressure < 140/90 mm Hg (76.7% vs. 66.7%; P <.01). In the amlodipine-hydrochlorothiazide group, 27 patients (90%) and 15 patients (50%) had diastolic blood pressure <90 mm Hg and blood pressure < 140/90 mm Hg, respectively. This study has demonstrated that a regimen of amlodipine to which hydrochlorothiazide is subsequently added provides superior efficacy on blood pressure control when compared with a regimen of hydrochlorothiazide to which amlodipine is subsequently added or with ab initio amlodipine-hydrochlorothiazide combination therapy.

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Information is scarce regarding the effects of amlodipine or hydrochlorothiazide therapy on serum and urine electrolyte profiles in hypertensive Nigerians with type 2 diabetes mellitus. Therefore, to evaluate whether amlodipine or hydrochlorothiazide would be preferable to initiate treatment, we randomized 40 newly diagnosed hypertensive subjects with controlled type 2 diabetes mellitus aged 43-68years to amlodipine and hydrochlorothiazide treatment groups of 20 patients each (10 males, 10 females), and they were treated respectively, with amlodipine 10mg and hydrochlorothiazide 25mg, both drugs being given once daily for 48 weeks. Body mass index, blood pressure, 24h urine volume, serum and urine electrolytes were assessed at baseline and at the end of weeks 1, 3, 6, 12, 24, 36 and 48. The two drugs significantly reduced blood pressure, though the effect of amlodipine was significantly greater compared with that of hydrochlorothiazide (P < 0.01). Diuresis was significant in hydrochlorothiazide group (P < 0.01). Observed male/female serum Na + loss was 9.18±2.32/10.90±2.50 and 13.30±1.34/15.10±1.77mmol/L for amlodipine and hydrochlorothiazide subgroups, respectively. There was a parallel significant (P < 0.05) natriuresis. Significant (P < 0.05) hypokalemia occurred in hydrochlorothiazide subgroups and overall male/female serum K + loss was 0.10/0.08 and 0.16/0.24mmol/L for amlodipine and hydrochlorothiazide, respectively. However, there was no significant parallel kaliuresis. Significant (P < 0.05) disproportionate hypochloremia occurred in all subgroups, so also was the parallel chloriuria. By providing effective blood pressure control and beneficial biochemical effects, amlodipine therapy appears suitable for treatment of hypertension in these diabetic patients. Similarly, low dose hydrochlorothiazide therapy, which seems to have more marked effects in females, appears to have moderate biochemical complications in these patients and is, therefore, a logical alternative to substitute for or add to amlodipine therapy.

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There is paucity of information regarding the effects of combination therapy with amlodipine and hydrochlorothiazide on lipid profiles in hypertensive Nigerians. Therefore, to evaluate whether this combination therapy would ameliorate or aggravate the known metabolic adversity of hydrochlorothiazide on lipid parameters, 90 male and female Nigerians aged 31-86 years with newly diagnosed uncomplicated essential hypertension (blood pressure > 160/90 ≤ 180/120mmHg) were enrolled into a randomised 48-week study. Treatment was initiated in the patients, who were 30 each in amlodipine, hydrochlorothiazide and amlodipine-hydrochlorothiazide groups, with amlodipine 5mg, hydrochlorothiazide 25mg and amlodipine 5mg + hydrochlorothiazide 25mg, respectively. Body mass index, blood pressure and lipid profiles were evaluated at baseline as well as at the end of weeks 1, 3, 6, 12, 24, 36 and 48. The 3 regimens significantly (p<0.05) reduced blood pressure. At the end of week 48, mean male/female % significant decrease or increase in lipid parameters in amlodipine, hydrochlorothiazide and amlodipine-hydrochlorothiazide groups were, respectively:-4.3/-1.5, 2.8/3.7 and 2.6/2.5, p<0.0001 for total cholesterol;-7.2/-2.6, 5.3/5.6 and 6.6/6.2, p<0.0001 for triglyceride; 16.5/19.6,-12.0/-8.6 and-7.8/-8.4, p<0.0001 for high density lipoprotein cholesterol;-4.6/-3.0, 5.6/11.7 and 4.5/8.0, p<0.0001 for low density lipoprotein cholesterol. This study demonstrates that beyond reducing blood pressure, amlodipine and hydrochlorothiazide combination therapy has varied effects on lipid panel and it also suggests that, with regard to cardiovascular risk profile, it may be preferable to initiate treatment with a regimen of amlodipine to which hydrochlorothiazide is subsequently added, instead of a regimen of hydrochlorothiazide to which amlodipine is later added or a regimen of ab initio amlodipinehydrochlorothiazide combination therapy.

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