Antihypertensive Drug Prescription Patterns and their Impact on Outcome of Blood Pressure in Ethiopia:A Hospital-Based Observational Study

Abstract

Objectives: PARADIGM-HF, a phase III trial conducted in patients with heart failure and reduced ejection fraction (HFrEF), showed that sacubitril/valsartan, a first-inclass angiotensin receptor-neprilysin inhibitor, provided incremental cardiovascular and overall survival benefit compared to enalapril. This analysis aimed to quantify the number of potential all-cause deaths that could be avoided with optimal usage of sacubitril/valsartan for the treatment of HFrEF in Costa Rica. MethOds: Data from Instituto Nacional de Estadística y Censos was used to identify patients with HFrEF for whom sacubitril/valsartan could be indicated. A literature review was conducted to determine the prevalence of HF, and the proportion of HFrEF patients classified as NYHA Class II-IV, in Latin America. The number needed to treat (NNT) to avoid one all-cause death, standardized to 12 months, was derived from the PARADIGM-HF trial. The potential number of all-cause deaths prevented or postponed with sacubitril/valsartan treatment was estimated using multi-way sensitivity analysis. The main outcome measure was all-cause mortality. Results: The entire 2017 population (≥ 20 years) was estimated at 3,435,930 and the estimated prevalence of HF was 1.0%. Physician interviews indicated that 60% of patients with chronic HF are diagnosed, yielding approximately 20,616 patients. Half of diagnosed patients had HFrEF, 80% of whom were classified as NYHA Class II-IV, equating to 8,246 patients with HFrEF NYHA II-IV. The absolute reduction in all-cause mortality in PARADIGM-HF was 2.8% over an average follow-up of 27 months with a NNT of 80.3, standardized to 12 months. Thus, optimal usage of sacubitril/valsartan therapy was estimated to prevent 103 deaths each year. cOnclusiOns: This analysis suggests that a significant number of all-cause deaths could potentially be prevented with optimal implementation of sacubitril/valsartan therapy into routine clinical practice in Costa Rica. However, one limitation of this analysis is the lack of current epidemiology data available specific to HF prevalence in Costa Rica.

Rate of blood pressure control and its determinants among adult hypertensive patients at Jimma University Medical Center, Ethiopia: Prospective cohort study

“…The finding was similar to the studies conducted at Gondar University Hospital and Zewditu Memorial Hospital, Addis Ababa, Ethiopia, and it might be due to comparable health care professionals, health care service, and medication availability. 22,25 The prevalence of appropriate use of antihypertensive medications was 44.2% in this study. It was lower than studies conducted in South Indian (65%) and South Africa (51.9%).…”

“… 24 In contrast, according to a study conducted in Gondar, Ethiopia, loose combination pills therapy produced better BP control than monotherapy. 25 Another study conducted in Jimma, Ethiopia, showed that the number of antihypertensive medications prescribed was not associated with BP control. 26 Furthermore, studies on guidelines adherence and rate of BP control have been limited by cross-sectional study design; therefore, this prospective cohort study was conducted to assess clinicians’ adherence to hypertension treatment guidelines and BP control among ambulatory adult hypertensive patients at Jimma University Medical Center (JUMC).…”

Prevalence of uncontrolled hypertension and contributing factors in Ethiopia: a systematic review and meta-analysis

“…We performed a sensitivity analysis of the prevalence of uncontrolled HTN by applying a random-effects model. Each excluded study showed a slight difference in pooled estimate of prevalence of uncontrolled HTN, the highest and lowest estimates being 53.1% (95% CI, 45.3%–60.8%) ( 35 ) and 49.99% (95% CI, 41.9%–57.9%) ( 34 ) when the respective studies were omitted.…”

“…The AHA/ACC guidelines ( 33 , 34 ), JNC-8 ( 22 , 24 , 25 , 28 , 30 – 32 , 35 – 45 ), and JNC-7 ( 23 , 27 , 29 , 46 , 47 ) were used as assessment tools for 2, 19, and 5 studies, respectively. Eight studies were conducted in the Amhara region ( 22 , 26 , 32 , 33 , 35 , 36 , 45 , 46 ), nine in Oromia ( 24 , 25 , 28 – 31 , 37 , 43 , 47 ), one in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) ( 34 ), four in Addis Ababa ( 39 , 40 , 42 , 44 ), and four in Tigray ( 23 , 27 , 38 , 41 ). In this meta-analysis 9,046 study participants were involved and 4,415 of them were found to have uncontrolled HTN.…”