Blood Pressure Control among Treated Hypertensives in a Tertiary Health Institution

Abstract

Background: Goal blood pressure (BP) was defined by the JNC VI and the World Health Organization-International Society of Hypertension (WHO/ISH) as <140 mm Hg systolic and <90 mm Hg diastolic for the general and <130 mm Hg systolic and <85 mm Hg diastolic for special high-risk populations. It is well established that adequate BP control characterizes only a fraction of treated hypertensive patients. The importance of tight BP control has been established in preventing cardiovascular morbidity and mortality. Methods: We performed cross-sectional studies on the current status of BP control among treated hypertensive in our center. One hundred consecutive patients with essential hypertension who have been attending the out patient hypertension clinic and have been on treatment for at least 6 months were recruited. The pre treatment BP and BP records in the previous 2 visits were noted. Patients were said to have good BP control if their BPs are < 140/90 mmHg (<130/80 mmHg for high risk patients) at the time of the study and in the last visit. Results: There were 49 males and 51 female (M: F; 1:1), aged 26 to 85 (mean 52.33 +/-12.29) years. The duration of hypertension ranged 6 months to 30 (mean 7.37 +/-7.1) years. The duration of treatment in our centre was 6 months to 10 (mean 3.22 +/-2.23) years. Blood pressure was controlled in 33 (33%) of the patients. Pre-treatment mean blood pressure was significantly higher than the BP value at the time of the study (155.87 +/-26.02/97.81 +/-11.89 mmHg versus 143.40 +/-24.14/86.53 +/-12.71 mmHg) (p<0.05). Diuretics were the commonest antihypertensive prescribed either alone or in combination (69%), followed by a calcium antagonist (56%) and centrally acting drugs (38%). Twenty seven were on single antihypertensive, 43 (43%) on 2, 25 (25%) on 3 and 5 (5%) on 4 classes of antihypertensive. Blood pressure control was associated with taking more than one antihypertensive medication and compliance. Conclusion: Control of BP in patients receivingantihypertensive drugs is still far from optimal in the study population in Nigeria just as in other countries. Many patients had multiple cardiovascular risk factors.

Patient-related barriers to hypertension control in a Nigerian population

“…However, rates of adequate blood pressure control vary widely globally and in Nigeria. The low rate of blood pressure control (32.9%) obtained in this study is consistent with the 31% reported in Kano, Nigeria,38 the 31.4% reported in Abeokuta, Nigeria,48 and the 34% reported in the USA 19. Further, it is lower than the 36% reported from Ibadan,41 the 42.7% reported from Sokoto, Nigeria,37 the 53.3% reported from Ilorin, Nigeria,49 the 35% previously reported in Umuahia, Nigeria,42 and the 39% reported in Cuba 50.…”

“…However, these measures are susceptible to error with increased time between visits and their results are easily distorted by patients. The low level of adherence to antihypertensive medication by the majority of participants in this study corroborates previous reports that adherence is poor in some patients with hypertension 38,41,42,63. Factors identified in this study as being responsible for low adherence are shown in Table 3.…”

“…This is necessary to maximize the therapeutic effects of these drugs and to reduce the morbidity and mortality associated with hypertension. Most Nigerian studies on blood pressure control and related factors in hospital settings37,38 and rural/semiurban communities17,39 have not focused on patient-related barriers to hypertension control. A few have assessed the knowledge base of patients40 and their adherence to medication,40–42 but assessed the latter using nonvalidated tools developed by the researchers themselves for their own research purposes.…”

Prevalence, associated factors and relationship between prehypertension and hypertension: a study of two ethnic African populations in Northern Nigeria

“…39,40 Recent data from the National Health and Nutritional Examination Surveys in the Unites States, however, showed higher rates of hypertension awareness (78%), treatment (68%) and control (64%). 31 Blood pressure control rates are also obviously higher in a population than in hospital-based studies 41,42 as the latter tend to select more drug adherent hypertensives.…”

Drug prescription/blood pressure control in patients on monotherapy attending a tertiary hospital in Nigeria

“…[12][13][14] Inadequate BP control could be as a result of several factors, but rational drug prescription taking into account racial differences, financial implications, and adverse effect could improve BP control. BP control in this study was poor; this finding is similar to studies carried out in this region.…”