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Blood Pressure Control among Treated Hypertensives in a Tertiary Health Institution
Abstract
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
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.
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.
Control of BP in patients receiving antihypertensive drugs is still far from optimal in the study population in Nigeria just as in other countries. Many patients had multiple cardiovascular risk factors. Adherence to medication should be encouraged.
... (See Table 1). [43,44,[45][46][47][48][49][50][51][52][53][54][55][56][57]76] The commonest co -morbidities or "compelling indications" in HT receiving AHDs are:Type 2 DM (T2DM) [43,44], Left Ventricular Hypertrophy (LVH), hypertensive heart failure (HHF), valvular regurgitations [13], associated cardiac arrhythmias [13], and CKD [43]. See Table 2 [43,44,[45][46][47][48][49][50][51][52][53][54][55][56][57]. ...
... [43,44,[45][46][47][48][49][50][51][52][53][54][55][56][57]76] The commonest co -morbidities or "compelling indications" in HT receiving AHDs are:Type 2 DM (T2DM) [43,44], Left Ventricular Hypertrophy (LVH), hypertensive heart failure (HHF), valvular regurgitations [13], associated cardiac arrhythmias [13], and CKD [43]. See Table 2 [43,44,[45][46][47][48][49][50][51][52][53][54][55][56][57]. Low dose HCTZ alone, or combined with Lisinopril, in a single pill combination, did not impair Insulin sensitivity, beta cell function, or cause hyperglycemia, in HT patients whose blood potassium was unchanged [77]. ...
... The BP control rate, defined as Systolic BP < 140 mmHg/Diastolic BP < 90 mmHg in the clinic, ranged from 53.6% [49], 47% [71], 46% [53], 43.7% [52], to much lower values of 30.5% [54], 30% [57], or 29% [56]. These values represent poor control of BP, in treated hypertensives, seen in tertiary care centers in SSA. ...
Background
Hypertension (HT) prevalence, Uncontrolled Blood Pressure (UBP), morbidity and mortality are highest in Sub-Saharan Africa (SSA). Correlating pathophysiology of HT to pharmaco-therapy with antihypertensive drugs (AHD) may bring amelioration. Aims:To review peculiarities of HT in SSA, UBP causes, diagnostic modalities, AHD use, rationality and efficacy.
Methods and results
14 published therapeutic audits in 4 SSA nations on Google Scholar or PUBMED, (total n = 6496 patients) were evaluated. Calcium Channel blockers (CCB) amlodipine, and thiazide diuretics (TD), hydrochlorothiazide (HCTZ) were the commonest AHD. Thiazide Like Diuretics (TLD) were underutilized. The % of patients on AHD were: 1 drug 5.4–55%; 2 drugs 37–82%; >/ = 3 drugs 6–50.3%. 2-drug combinations were: ACEI/ARB + TD (42%); CCB + TD (36.8%); ACEI + CCB (15.8%) of studies. Triple/quadruple therapy included Methyldopa (MTD) with ACEI + CCB or TD. The (%) attaining BP < 140/< 90 mmHg, ranged from 29 to 53.6%, median, 44%. The co-morbidities, range and median were: Diabetes Mellitus (DM): 9.8–64%, 19.2%; Chronic Kidney Disease (CKD): 5.7–7.5%, 6.9%, and Coronary artery Disease (CAD): 0.9–2.6%, 2.3%. ACEI + CCB ± TD were the preferred AHD for comorbidities.
Conclusions
Therapeutic inertia; Non-compliance; co-morbidities; refractory HT; ignorance; substandard AHD; contribute to UBP. Studies relating 24 hour ABPM to complications and mortality in SSA hypertensives; and impact of different AHD classes on ABPM, are needed. Study of ACEI + alpha-1 blockers + TLD on 24 hour ABPM and personalized care, are required.
... [6,7] Furthermore, BP is not well controlled in the majority of patients with hypertension. [8,9] Consequently, chronic complications of hypertension are also on the rise in this region. CKD is one of the most frequent complications of poorly treated hypertension. ...
... However, it is known worldwide that many patients with hypertension are undiagnosed and of those diagnosed, only a small proportion are on treatment and well controlled. [1][2][3][6][7][8]16] The burden of kidney disease among this vulnerable group of the population is not known in the north central region of Nigeria. In the light of this, we conducted a cross-sectional study of hypertensive patients attending the medical outpatient departments of three major tertiary health institutions in three contiguous states of the six states in north central Nigeria, pooling data from over a thousand patients with hypertension, the largest so far in north central Nigeria. ...
... This study confirms the finding of earlier reports that a huge proportion of patients with hypertension are poorly controlled. [3,6,8,9] Despite this being long recognized, recent reports have shown that there has not been any improvement in the adequacy of BP control, especially in the developing world. A recent review of Cameroonian patients showed a similarly high proportion of poor BP control in hypertensive patients (69.5%). ...
Background:
Hypertension is one of the commonest cause of chronic kidney disease (CKD) in Nigerians. We describe blood pressure (BP) control and kidney disease markers in patients with hypertension as part of measures to curb the burden of this chronic debilitating disease.
Methods:
Patients with hypertension in the main tertiary hospitals in three states in north central Nigeria were evaluated for indicators of CKD, including proteinuria and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Patients had their early morning first void urine tested for proteinuria using Combi-10 test strips. eGFR was estimated using the MDRD equation.
Results:
A total of 1063 subjects (63.1% females and 36.8% males) with a mean age of 55 ± 11 years were studied. Diabetes mellitus (DM) was present in 214 (20.6%) and 422 (39.7%) had optimal BP control. The median duration of hypertension was 6 years (range 1-44 years). Proteinuria occurred in 130 (12.2%), while 212 (19.9%) had reduced eGFR and 46 (4.3%) had proteinuria and reduced eGFR. The use of calcium channel blockers [adjusted odds ratio (AOR): 0.70, 95% Confidence Interval (CI) 0.50-0.99] and the use of more than two antihypertensive medications (AOR: 0.62, 95% CI 0.40-0.96) were associated with reduced odds of optimal BP control. Male sex (AOR: 1.75, 95% CI 1.14-2.70) and the use of renin-angiotensin-aldosterone system blocking medications (AOR: 2.07, 95% CI 1.18-3.64) were independently associated with proteinuria while DM (AOR: 1.69, 95% CI 1.06-2.55) and treatment with more than two medications (AOR: 1.86, 95% CI 1.09-3.17) were more likely to have reduced eGFR.
Conclusion:
A large proportion of hypertensive patients in north-central Nigeria have poorly controlled BP. Kidney damage is common among these patients.
... Table 1. However, other studies reported higher BP control of 31.4% and 33% by Ayodele et al., (2004) and Sani et al., (2008) respectively. The findings of this study agree with previous reports that adequate BP control rates are low in Nigeria and occur only in less than half of treated hypertensives (Ayodele et al., 2004;Akpa et al. 2008;Sani et al., 2008). ...
... However, other studies reported higher BP control of 31.4% and 33% by Ayodele et al., (2004) and Sani et al., (2008) respectively. The findings of this study agree with previous reports that adequate BP control rates are low in Nigeria and occur only in less than half of treated hypertensives (Ayodele et al., 2004;Akpa et al. 2008;Sani et al., 2008). ...
... The high percentage of unrolled blood pressure is probably due to a number of factors such as poor patients' knowledge of hypertension and its treatment, inadequate healthcare facilities, misconceptions and health beliefs about hypertensive disorder (Oke and Bandele, 2004) Good adherence rate of 55.5% in this study is higher than that of 45.0% previously reported in some part of Kano, (Sani et al., 2008). The findings of this study have shown the importance of adherence in BP control amongst the study population. ...
Hypertension is a chronic medical condition characterized by an elevated arterial blood pressure with increasing prevalence in developing countries including Nigeria. One of the integral elements in the management of hypertension is adherence to medication and style modification. This study aimed to assess adherence level for anti medications among adult hypertensive patients attending public hospitals in Kano State, Nigeria. The study was a cross sectional prospective survey involving 600 pat six public healthcare facilities selected by multistage sampling technique. Adherence status was assessed using Morisky medication adherence scale. Sociodemographic data and other factors that may influence adherence to hypertension medications evaluated. Out of the 598 patients that participated in the study, only 178 (29.8%) have their BP controlled based on JNC8. Three hundred and thirty two (55.5%) out of 598 patients have good adherence, while 266 (45.5%) have poor adherence. Of the 178 patients who had good BP control, 120 (67.5%) have good adherence while 58 (32.5%) have poor adherence. BP control was significantly higher in those that adhered to antihypertensive medication compared with non p-value = < 0.001). Additionally, Chi number of antihypertensives and blood pressure control. (The study established that 55.5% of the respondents have good adherence to their antihypertensive medication while 29.8% had their BP controlled. Adherence and number of antihypertensive medication a patient is taking were found to have significant relationship with BP control.
... 13 Despite these facts, reports from both developed and developing countries have shown that BP control is still unsatisfactory Original Research Prescription pattern of antihypertensive medications and blood pressure control among hypertensive outpatients at the University of Benin Teaching Hospital in Benin City, Nigeria among patients with hypertension. [14][15][16][17][18] Effective treatment of hypertension has been reported to reduce the risk of stroke, coronary heart disease, congestive cardiac failure, and overall mortality. 19 Efforts should therefore be intensified towards achieving BP control using recommended guidelines in order to reduce hypertensionrelated morbidity, mortality, and healthcare expenditure. ...
... Previous studies in both developing and developed countries have shown good BP control rates between 33% and 70.7%. [14][15][16][17][18][28][29] Factors that account for this variation include differences in criteria used to define good BP control, medication adherence, accessibility to free antihypertensive medications, and differences in education provision and counselling by health workers. 14,15,16,28 Good BP control was higher in this study compared to previous reports from 2 different tertiary hospitals in northern Nigeria, most likely predominantly owing to the stricter BP cut-off of < 130/80 mmHg in defining good BP control among patients with both hypertension and diabetes in these studies. ...
... [14][15][16][17][18][28][29] Factors that account for this variation include differences in criteria used to define good BP control, medication adherence, accessibility to free antihypertensive medications, and differences in education provision and counselling by health workers. 14,15,16,28 Good BP control was higher in this study compared to previous reports from 2 different tertiary hospitals in northern Nigeria, most likely predominantly owing to the stricter BP cut-off of < 130/80 mmHg in defining good BP control among patients with both hypertension and diabetes in these studies. 14,15 Also, regular pre-clinic counselling, given by nurses, to attendees of the hypertension clinic at our hospital may have contributed to better BP control in our patients. ...
Background: The 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 hypertension-related 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. Results: The 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. Conclusions: The 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. © 2017 The College of Medicine and the Medical Association of Malawi.
... Prescription pattern of antihypertensive medications and blood pressure control among hypertensive outpatients at the University of Benin Teaching Hospital in Benin City, Nigeria these facts, reports from both developed and developing countries have shown that BP control is still unsatisfactory among patients with hypertension. [14][15][16][17][18] Effective treatment of hypertension has been reported to reduce the risk of stroke, coronary heart disease, congestive cardiac failure, and overall mortality. 19 Efforts should therefore be intensified towards achieving BP control using recommended guidelines in order to reduce hypertensionrelated morbidity, mortality, and healthcare expenditure. ...
... Previous studies in both developing and developed countries have shown good BP control rates between 33% and 70.7%. [14][15][16][17][18][28][29] Factors that account for this variation include differences in criteria used to define good BP control, medication adherence, accessibility to free antihypertensive medications, and differences in education provision and counselling by health workers. 14,15,16,28 Good BP control was higher in this study compared to previous reports from 2 different tertiary hospitals in northern Nigeria, most likely predominantly owing to the stricter BP cut-off of < 130/80 mmHg in defining good BP control among patients with both hypertension and diabetes in these studies. ...
... [14][15][16][17][18][28][29] Factors that account for this variation include differences in criteria used to define good BP control, medication adherence, accessibility to free antihypertensive medications, and differences in education provision and counselling by health workers. 14,15,16,28 Good BP control was higher in this study compared to previous reports from 2 different tertiary hospitals in northern Nigeria, most likely predominantly owing to the stricter BP cut-off of < 130/80 mmHg in defining good BP control among patients with both hypertension and diabetes in these studies. 14,15 Also, regular pre-clinic counselling, given by nurses, to attendees of the hypertension clinic at our hospital may have contributed to better BP control in our patients. ...
Background
The 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 hypertension-related 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.
Results
The 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.
Conclusions
The 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.
... 12 In Nigeria, BP control rates in adult patients range from 24.2% to 35.8% according to published studies. 9,10,11,13,14 These disparities are probably due to a milieu of limited healthcare facilities, widespread personal and family poverty, ignorance, poverty of knowledge and other diverse factors. 15,16 Blood pressure control is influenced by multiple factors, 2,3,13,15,16,17,18 some of which are related to the patients, the health professionals and government. ...
... and (5) how much of your previous BP medication is remaining after the previous one-month visit? Adherence was graded using an ordinal scoring system of 0-4 points developed by the authors from a review of the literature 9,10,11,12,13,14 as follows: all the time = 4 points, most times = 3 points, sometimes = 2 points, rarely = 1 point, never = 0. Four points indicated adherence, whilst 0-3 points meant non-adherence. Reasons for non-adherence were documented for those who scored 0-3 points. ...
... 25 The findings of this study corroborate previous reports that adequate BP control rates are low in Nigeria and occur only in a fraction of treated hypertensives. 9,10,11,12,23,14 These disparities are probably due to a milieu of limited healthcare facilities, misconceptions and health beliefs about hypertensive disorder. 26 Although adequate BP control does not completely obviate the risk of developing complications of hypertension, experience from developed countries has left no doubt that there is no magic bullet for adequate BP control amongst hypertensives. ...
Background: As the case detection rates of hypertension increase in adult Nigerians, achieving target blood pressure (BP) control has become an important management challenge. Objectives: To describe medication adherence and BP control amongst adult Nigerians with primary hypertension attending a primary care clinic of a tertiary hospital in a resource-poor environment in Eastern Nigeria. Methods: A cross-sectional study was carried out in 140 adult patients with primary hypertension who have been on treatment for at least 6 months at the primary care clinic of Federal Medical Centre, Umuahia. A patient was said to have achieved goal BP control if the BP was < 140 per 90 mmHg. Adherence was assessed in the previous 30 days using a pretested researcher-administered questionnaire on 30 days of self-reported therapy. Adherence was graded using an ordinal scoring system of 0-4; an adherent patient was one who scored 4 points in the previous 30 days. Reasons for non-adherence were documented. Results: Adherence to medication and BP control rates were 42.9% and 35.0% respectively. BP control was significantly associated with medication adherence (p = 0.03), antihypertensive medication duration =3 years (p = 0.042), and taking = one form of antihypertensive medication (p = 0.04). BP at the recruitment visit was significantly higher than at the end of the study (p = 0.036). The most common reason for non-adherence was forgetfulness (p = 0.046). Conclusion: The rate of BP control amongst the study population was low, which may be connected with low medication adherence. This study urges consideration of factors relating to adherence alongside other factors driving goal BP control.
... The BP control rate in this study was higher than that reported in Port Harcourt, Rivers State, and south-south Nigeria [12]. However, other studies reported higher BP control [13,14]. The findings of this study agree with previous reports that adequate BP control rates are low in Nigeria and occur only in less than half of treated hypertensives [12, 13, and 14]. ...
... Good adherence rate of 55.5% in this study was higher than of 45.0% previously reported in some parts of Kano, [14]. The findings of this study showed the importance of adherence in BP control amongst the study population. ...
The present study was aimed at identifying the degree of knowledge of people with hypertension about the disease, identifying the factors predicting adherence to therapy and administering intervention. It was a quasi-experimental study involving 600 patients selected by multistage sampling technique. Adherence status was assessed using Morisky medication adherence scale8. Knowledge was measured using an eight-item instrument. Educational intervention in form of group discussions was administered. Values of p ≤ 0.05 were considered statistically significant. BP control was significantly higher in those that adhered to antihypertensive medication compared with non-adhering patients (χ2 = 14.526; df = 1; p-value = < 0.001). Comorbidity and number of antihypertensive drugs the patients were taking were found to be the predictors of adherence. After intervention, the percentage of respondents with good adherence increased from 41.3% to 48.3% (p = 0.369) in the intervention group. Furthermore educational intervention had a positive effect on knowledge of the respondents [from 64% to 66.3% (p= 0.623)] in the intervention group. The results revealed that the educational intervention had positive impact of knowledge of hypertension and its treatment. Additionally, Comorbidity and number of antihypertensive prescribed were found to be the predictors of adherence to medications.
... However, despite the convenience of once daily dosing schedules of anti-hypertensive drugs, the relative lack of adverse effects and many interventions t h a t w e r e developed to improve medicine taking, adherence to anti-hypertensive d r u g s remain sub-optimal, t hu s resulting in persisting rates of uncontrolled blood pressure among hypertensive patients (Iloh et al., 2013;Cutrona et al., 2003). The blood pressure control rate is generally low across various settings in Nigeria including Kano ( 31%) (Sani et al., 2008), Umuahia (32.9%) (Iloh et al., 2013), and Abeokuta (31.4%) (Ayodele et al., 2004). One of the most important factors affecting the efficacy of blood pressure control in Nigeria is the lack of patient adherence to prescribed anti-hypertensive drugs and therapeutic lifestyle modification (Iloh et al., 2014); and generally low drug adherence levels were reported in studies conducted across Nigeria including Ado-Ekiti (44.7%) (Raimi, 2017), and Kano (54.2%) (Kabir et al., 2004). ...
... This study assessed the effect of home visits on lifestyle modification, drug adherence and blood pressure control among patients with uncontrolled hypertension in Sokoto, Nigeria. The predominance of females among both the intervention group and the control group participants in this study is similar to the findings in studies conducted in other cities in Nigeria including Kano (Sani et al., 2008) and Abia (Iloh et al., 2013) in which majority of participants were females. Also, the finding of majority of the participants in both the intervention and control groups in this study being married is in agreement with the higher proportion of females that was reported in the latter studies, and this could be due to the cultural similarities in the study areas concerned. ...
Background: Hypertension remains the leading risk factor for cardiovascular morbidity and mortality globally. Unhealthy lifestyle and non-adherence to medication are believed to constitute serious obstacles to achieving blood pressure control among hypertensive patients. Aim: This study aimed to determine the effect of home visits on lifestyle modification, drug adherence and blood pressure control among patients with uncontrolled hypertension in Sokoto, Nigeria. Materials and Methods: A randomized control trial was conducted among 139 patients with uncontrolled hypertension (selected by systematic sampling technique) attending the General Outpatient Clinics of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. A semi-structured questionnaire and data sheet were used to obtain information on the research variables. In addition to the routine hospital care for hypertension, the intervention group also had 3 home visits over a period of 3 months. Data were analyzed using the IBM SPSS version 22 statistical computer software package. Results: The participants in both groups were predominantly females and married. Although significant reductions in the proportion of participants that practiced unhealthy lifestyle, and significant increases in the proportion of participants that were adherent to medications, and those with controlled blood pressure, were recorded in both groups, the differences observed were by far higher in the intervention group as compared to the control group. Conclusion: This study showed that home visits are effective in facilitating healthy lifestyle modification, high medication adherence and blood pressure control among patients with uncontrolled hypertension in Sokoto, Nigeria. Management of healthcare institutions should make home visits a core component of the standard care of patients with hypertension.
... Nonetheless, data from this study shows that 73.3% of the older patients have blood pressure reading of <150/90mmHg, which is within the recommendation of the guidelines. Erstwhile, studies in both developing and developed countries have reported blood pressure control rate to be between 33% and 70.7% (Sani et al., 2008;Wang et al., 2005). Various factors such as medication adherence, affordability of antihypertensive medications, and differences in education delivery and counseling by health workers, account for this variation (Sani et al., 2008;Wang et al., 2005). ...
... Erstwhile, studies in both developing and developed countries have reported blood pressure control rate to be between 33% and 70.7% (Sani et al., 2008;Wang et al., 2005). Various factors such as medication adherence, affordability of antihypertensive medications, and differences in education delivery and counseling by health workers, account for this variation (Sani et al., 2008;Wang et al., 2005). The most common antihypertensive two drug class combinations used were CCB +TD and three drug class combinations CCB +ARB+LD. ...
Background: Hypertension is a prominent public health problem, with considerable health consequences. Recommended guidelines encourage use of antihypertensive medications with the best evidence of reducing cardiovascular risk. Data on antihypertensive medications use among older Nigerians is limited. Objective: This study evaluated the antihypertensive medication use among older persons with hypertension in compliance with the Eighth Joint National Committee guidelines (JNC 8). Method: A retrospective cross-sectional study, of older patients diagnosed with hypertension between the 1 st January 2017 and 31 st December 2017 at the geriatric center, University College Hospital, Ibadan. Results: The mean age was 70.2 ± 7.2 years and 62% were female. The mean number of medications used by the patient was 4.5 ± 1.4. Of the patients, 56% were receiving combination therapy, 42% two drugs and 14% three drugs. Most patients were receiving calcium channel blockers (33.8%), followed by diuretics (29.6%), angiotensin receptor blockers (23.4%) and angiotensin-converting enzyme inhibitors (10.8%). Commonest combination therapy was calcium channel blockers and thiazide diuretics (28.3%), while the commonest multi-morbidities were osteoarthritis (32.7%), diabetes (17.3%) and dyslipidemia (8.7%). Conclusion: This study showed that more than half of older persons with hypertension were on combination therapy, and the most frequently used class of antihypertensive drugs were calcium channel blockers, followed by diuretics. The guidelines and data for black ≥60 years indicate that lower doses of combination therapy are more effective in achieving blood pressure target. Despite the numerous advantages of ACEIs, they remain underutilized.
... Nonetheless, data from this study shows that 73.3% of the older patients have blood pressure reading of <150/90mmHg, which is within the recommendation of the guidelines. Erstwhile, studies in both developing and developed countries have reported blood pressure control rate to be between 33% and 70.7% (Sani et al., 2008;Wang et al., 2005). Various factors such as medication adherence, affordability of antihypertensive medications, and differences in education delivery and counseling by health workers, account for this variation (Sani et al., 2008;Wang et al., 2005). ...
... Erstwhile, studies in both developing and developed countries have reported blood pressure control rate to be between 33% and 70.7% (Sani et al., 2008;Wang et al., 2005). Various factors such as medication adherence, affordability of antihypertensive medications, and differences in education delivery and counseling by health workers, account for this variation (Sani et al., 2008;Wang et al., 2005). The most common antihypertensive two drug class combinations used were CCB +TD and three drug class combinations CCB +ARB+LD. ...
Background: Hypertension is a prominent public health problem, with considerable health consequences. Recommended guidelines encourage use of antihypertensive medications with the best evidence of reducing cardiovascular risk. Data on antihypertensive medications use among older Nigerians is limited. Objective: This study evaluated the antihypertensive medication use among older persons with hypertension in compliance with the Eighth Joint National Committee guidelines (JNC 8). Method: A retrospective cross-sectional study, of older patients diagnosed with hypertension between the 1 st January 2017 and 31 st December 2017 at the geriatric center, University College Hospital, Ibadan. Results: The mean age was 70.2 ± 7.2 years and 62% were female. The mean number of medications used by the patient was 4.5 ± 1.4. Of the patients, 56% were receiving combination therapy, 42% two drugs and 14% three drugs. Most patients were receiving calcium channel blockers (33.8%), followed by diuretics (29.6%), angiotensin receptor blockers (23.4%) and angiotensin-converting enzyme inhibitors (10.8%). Commonest combination therapy was calcium channel blockers and thiazide diuretics (28.3%), while the commonest multi-morbidities were osteoarthritis (32.7%), diabetes (17.3%) and dyslipidemia (8.7%). Conclusion: This study showed that more than half of older persons with hypertension were on combination therapy, and the most frequently used class of antihypertensive drugs were calcium channel blockers, followed by diuretics. The guidelines and data for black ≥60 years indicate that lower doses of combination therapy are more effective in achieving blood pressure target. Despite the numerous advantages of ACEIs, they remain underutilized.
... Nonetheless, data from this study shows that 73.3% of the older patients have blood pressure reading of <150/90mmHg, which is within the recommendation of the guidelines. Erstwhile, studies in both developing and developed countries have reported blood pressure control rate to be between 33% and 70.7% ( Sani et al., 2008;Wang et al., 2005). Various factors such as medication adherence, affordability of antihypertensive medications, and differences in education delivery and counseling by health workers, account for this variation ( Sani et al., 2008;Wang et al., 2005). ...
... Erstwhile, studies in both developing and developed countries have reported blood pressure control rate to be between 33% and 70.7% ( Sani et al., 2008;Wang et al., 2005). Various factors such as medication adherence, affordability of antihypertensive medications, and differences in education delivery and counseling by health workers, account for this variation ( Sani et al., 2008;Wang et al., 2005). The most common antihypertensive two drug class combinations used were CCB +TD and three drug class combinations CCB +ARB+LD. ...
Background: Hypertension is a prominent public health problem, with considerable health consequences. Recommended guidelines encourage use of antihypertensive medications with the best evidence of reducing cardiovascular risk. Data on antihypertensive medications use among older Nigerians is limited. Objective: This study evaluated the antihypertensive medication use among older persons with hypertension in compliance with the Eighth Joint National Committee guidelines (JNC 8). Method: A retrospective cross-sectional study, of older patients diagnosed with hypertension between the 1 st January 2017 and 31 st December 2017 at the geriatric center, University College Hospital, Ibadan. Results: The mean age was 70.2 ± 7.2 years and 62% were female. The mean number of medications used by the patient was 4.5 ± 1.4. Of the patients, 56% were receiving combination therapy, 42% two drugs and 14% three drugs. Most patients were receiving calcium channel blockers (33.8%), followed by diuretics (29.6%), angiotensin receptor blockers (23.4%) and angiotensin-converting enzyme inhibitors (10.8%). Commonest combination therapy was calcium channel blockers and thiazide diuretics (28.3%), while the commonest multi-morbidities were osteoarthritis (32.7%), diabetes (17.3%) and dyslipidemia (8.7%). Conclusion: This study showed that more than half of older persons with hypertension were on combination therapy, and the most frequently used class of antihypertensive drugs were calcium channel blockers, followed by diuretics. The guidelines and data for black ≥60 years indicate that lower doses of combination therapy are more effective in achieving blood pressure target. Despite the numerous advantages of ACEIs, they remain underutilized.
... [7,15,25,26,29] Of paramount concern is that research studies in Nigeria have reported high prevalence of hypertension with low level of medication adherence, low BP control with none reporting treatment satisfaction among Nigerians with essential hypertension. [10,[30][31][32] In Nigeria, hypertension treatment satisfaction remains a significant challenge particularly in primary care settings and is likely to affect adherence with medication and invariably BP control. This type of study has not been done in primary care settings in Nigeria; hence, there is a lack of knowledge of the role of treatment satisfaction in medication adherence and BP control. ...
... The inclusion criteria were adult hypertensive patients aged ≥18 years who gave informed consent, had been of your previous BP medication is remaining after the previous 1 month visit? Adherence was graded using an ordinal scoring system of 0-4 points developed by the authors from a review of the literature [10,12,[28][29][30][31][32][34][35][36] as follows: all the time = 4 points, most times = 3 points, sometimes = 2 points, rarely = 1 point, and never = 0. Four points indicated adherence while 0-3 points meant nonadherence. ...
BACKGROUND: Hypertension treatment satisfaction has been the subject of recent research particularly in developing countries and is widely recognized as patient-oriented outcome of quality of care. However, in Nigeria, little is known on the role of hypertensive treatment satisfaction on medication adherence and blood pressure (BP) control.
AIM: The study was aimed at determining the role of treatment satisfaction in medication adherence, and BP control among adult Nigerians with essential hypertension.
MATERIALS AND METHODS: A descriptive study was carried out on 140 adult hypertensive patients who have been on treatment for at least 6 months at a primary care clinic in Nigeria. Hypertension treatment satisfaction and medication adherence were assessed in the previous 30 days using pretested, interviewer-administered questionnaire on self-reported satisfaction and adherence to therapy, respectively. A goal BP control referred to BP of < 140/90 mmHg at the end of study visit.
RESULTS: The age of the study participants ranged from 32 to 83 years with mean age of 52 ± 7.4 years. There were 56 (40.0%) male and 84 (60.0%) female. Hypertension treatment satisfaction, medication adherence, and BP control rates were 78.6%, 42.9%, and 35.0%, respectively. Hypertension treatment satisfaction was significantly associated with medication adherence (P = 0.01) and BP control (P = 0.031).
CONCLUSION: This study has demonstrated variabilities in treatment satisfaction, medication adherence, and BP control among the study population. Medication adherence and BP control were significantly associated with treatment satisfaction. This study urges consideration of treatment satisfaction alongside with medication adherence and BP control.
... Moreover, this study recorded 86.1% use of combination therapy, 10.4% of monotherapy and 20.4% of BP control. For similar studies in Nigeria, the respective results (combination therapy, monotherapy and BP control) are as follows: 73%, 27% and 33% [14]; 64.4%, 34.7% and 25.4% [13]; a BP control as high as 70.7% was also documented whereas a study in Italy recorded a blood pressure control of 33.5% [1,15]. Review of other studies shows that increased usage of combination therapy is associated with higher proportions of rate of BP control. ...
... Finally, the strength of this study lies firstly in the unparalleled period of consideration (thirty-five [35] months). Earlier studies have been characterized by a relatively short period of consideration (usually not exceeding three [3] months) [3,21,22] with a tangible majority of them having comparatively smaller sample sizes [14,[21][22][23][24]. It is noteworthy also that there is no prior study of this kind in a secondary healthcare setting. ...
This research work aimed at investigating the management of hypertension from statistics documented in the hospital records. Data was sourced from patients’ case notes and from these records, information obtained include blood pressure readings, drugs used, comorbidities, length of treatment; these parameters were used in evaluating the prescription pattern in the management of hypertension and the recent rate of blood pressure control in the hypertensive patients as indices of the current management of hypertension. The underlying hypothesis for the work is that a longer period of evaluation should be a better metric in the evaluation of pattern of antihypertensive drug use and overall assessment of blood pressure control. The data obtained was analyzed statistically and the result revealed that the overall level of blood pressure control for the 279 patients’ records reviewed was 20.4%. The study revealed that the current rate of blood pressure control was low among this population.
... 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 settings 37,38 and rural/semiurban communities 17,39 have not focused on patient-related barriers to hypertension control. A few have assessed the knowledge base of patients 40 and their adherence to medication, [40][41][42] but assessed the latter using nonvalidated tools developed by the researchers themselves for their own research purposes. ...
... 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. Suffice it to say that forgetting to take antihypertensive medication is not a problem that adult patients overcome. This has been attributed to competing psychosocial demands in everyday life, 42,64 especially among traders. ...
Background
Hypertension 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.
Methods
This was a cross-sectional descriptive study of patients with a diagnosis of hypertension and on antihypertensive medication.
Results
A 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.
Conclusion
Poor 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.
... The BP control rate of 53% observed in this study is significantly higher than reports from similar tertiary health care centres in Nigeria which ranged between 25.4% and 42.6% [9,[14][15][16][17]. It is also remarkably higher than the aggregate figure for the sub-Saharan African region, where the overall control rate was put at <20% in a recent systematic review [18]. ...
... For the other similar studies in Nigeria, the respective figures (combination therapy, monotherapy, BP control) are as follows: Amira et al [15], 77.3%, 22.7 %, 39.6%; Sani et al [17], 73%, 27%, 33%; and Salako et al [9], 64.4%, 34.7%, 25.4%. This implies that BP control rate will improve with use of increased number of antihypertensives and decreased use of single agent. ...
Blood pressure (BP) is poorly controlled in sub-Saharan Africa and this is due to poor utilization of antihypertensive drugs among other factors. Evaluation BP control will provide basis for recommendation for appropriate therapeutic measures for achieving target BP.
To determine the pattern of BP control as a measure of impact of antihypertensive usage among treated hypertensive patients in University of Ilorin Teaching Hospital in Nigeria.
This is a descriptive-analytical study of 605 treated adult hypertensive patients who have been attending our specialist clinics for at least one year. Definition of blood pressure control was according to the World Health Organization criteria.
The results showed that the mean age was 58.48 +/- 11.65 with 211 (34.9%) males (M:F =1:1.87). Median duration of follow up was 4(1-27) years. 152 (25%) were diabetic, 381 (63%) were taking antiplatelet aspirin and 213 (35.2%) had cardiovascular events. There was a significant difference between the first visit BP (initial BP) and last BP observed during the study (SBP[initial])=154 +/- 28mmHg, SBP(last)=133 +/- 21 mmHg (p<0.01); DBP[initial]=95 +/- 17mmHg, DBP[last]=80 +/- 12mmHg (p<0.001)).The pattern of BP control was: SBP+DBP controlled 322(53.3%); SBP+DBP uncontrolled 149 (24.6%); SBP controlled/DBP uncontrolled 39 (6.4%); DBP controlled/SBP uncontrolled 95 (15.7%).The control rate among the diabetic subgroup was 23.7%.
BP control rate among treated hypertensive patients in our institution is significantly higher than reports from similar patient populations in similar healthcare centres in Nigeria and sub-Saharan Africa which reflects an improved and appropriate usage of antihypertensive drugs recently observed in our institution. The rate of control among diabetics is still very poor.
... This guideline eminently identified and recommended a thiazide diuretic to be used as the cornerstone for hypertension pharmacotherapy for SSA people. However, shortly before the emergence of this and some other international guidelines [10,11] except the one produced by the World Health Organization/International Society of Hypertension (WHO/ISH) in 1999 [12], many studies on the utilization pattern of antihypertensive agent have been conducted in Nigeria including our center [13,14,15,16,17,18,19,21]. The study in our center showed that calcium channel blockers were the most commonly prescribed drug while diuretic were grossly underutilized (14%). ...
... The age distribution of the patients in this study conformed to the age distribution of hypertension in the general population. The higher proportion of females in this study is in contrast with the report of the national survey of hypertension in Nigerian general population which reported a higher prevalence among males [20], but in agreement with other studies in similar health institutions in the country [13,14,15,16,17,18,19,21]. For example a survey of hypertension control among 536 randomly selected hypertensive patients at the University College Hospital (UCH) in Ibadan revealed similar proportions of female patients (M : F; 1 : 63) [18]. ...
Despite availability and usage of wide array of antihypertensive drugs, blood pressure has remained poorly controlled in most health care settings particularly in Africa. The cost of these drugs among other factors strongly determines the prescription and usage pattern which ultimately affects control of blood pressure particularly in sub-Saharan Africa. The aim of this study was to describe the current utilization pattern of antihypertensive drugs in a tertiary hospital in Nigeria in line with the regional and international guidelines for hypertension management and to compare with similar studies in other parts of the country to generate the national outlook.
This is a cross sectional study of 805 adult hypertensive patients who were on treatment at the Medical Out-Patient Department of University of Ilorin Teaching Hospital in Nigeria, a country with the most populous black hypertensive patients. Data were collated from the patients' records and evaluated according to drug classifications.
787 patients out of the 805 evaluated were eventually included in the analysis. Mean age was 57.88 + or - 12.59 years with 490 (62.3%) females. Frequency of use of classes of antihypertensive was: diuretics (D, 84%), calcium channel blockers (CCB, 66%), angiotensin converting enzyme inhibitors (ACEI, 65%), a-methyldopa (ALD, 26%), beta-blockers (BB, 11.9%) and angiotensin receptor blockers (3.8%). Proportions of number of drugs usage per patient were: 0 (2.2%), 1 (9.1%), 2 (37.1%), 3 (35.8%), 4 (15.6%), and 5 (0.1%). The most commonly used combinations of drugs were ACEI + CCB + D (21.6%), followed by CCB + D (14.5%), ACE + D (11.4%) and ACEI + D + ALD (9.8%). Other recent studies in Nigeria revealed diuretics and multiple agents as the prevalent prescription pattern.
Antihypertensive utilization in Ilorin, Nigeria like some parts of the country conforms to the guidelines for the management of hypertension in blacks with majority of patients on diuretics particularly in combination with other agents. Angiotensin converting enzyme inhibitors are increasingly being used whereas beta-blockers and angiotensin receptor antagonists are still less utilized.
... 24 However, the blood pressure control rates in this study were higher than the 42.7% reported in Sokoto, 31% in Kano, 35% in Umuahia, 24.2% in Port Harcourt, 36% in Ibadan and 31.4% in Abeokuta, Nigeria. [25][26][27][28][29][30] In general, these rates of blood pressure control indicate that achieving optimal control is still a challenge in Nigeria. Better control of blood pressure is therefore needful among Nigerian hypertensive patients as evidence have shown that the black populations have worse hypertension-related outcomes including higher rates of fatal stroke, heart disease and end-stage renal disease when compared to their white counterparts. ...
There has been documented evidence of the fast growing rate of the knowledge and use of Complementary and Alternative medicine (CAM) Complementary and Alternative Medicine (CAM) in developed and developing countries and it’s increasingly popularity amongst patients as well as healthcare providers.1 The utilization of CAM products has been attributable to several factors which include fear or resentment of conventional medicine, the perceived negative side effects, over prescribing and failure of conventional medicine to meet the emotional needs of the patients all constituting the “push effects” on the one side. This study better blood pressure control among participants on conventional treatment only compared to those on conventional and CAM. In a resource poor nation as Nigeria where over 90% of health financing is out of pocket, additional financial cost with no additional benefit amounts to waste, not to mention the problem of adverse reactions that concomitant use may cause.
... Both studies concluded that hypertension was poorly controlled in their patient populations and discussed surveillance and treatment targets. 20,21 Pyle et al 22 The purpose of this study was to determine the prevalence of hypertension and describe related characteristics from the perspective of an outpatient podiatric medical clinic. It was hypothesized that podiatric medical clinic patients are frequently negligent in their management of hypertension and that certain risk factors would be found to be relevant. ...
Background: Hypertension is a highly prevalent condition in the general population, conferring a high risk of significant morbidity and mortality. Associated with the condition are many well-characterized controllable and noncontrollable risk factors. This study aimed to identify the prevalence of hypertension in the outpatient podiatric medical clinic setting and to determine the relevance of hypertension risk factors in this setting.
Methods: A survey tool was created to characterize relevant risk factors, and systolic and diastolic blood pressures were recorded. Descriptive statistics were generated after conclusion of enrollment. Analysis was also performed to determine the relationship between individual risk factors and systolic blood pressure.
Results: Of the 176 patients, 56 (31.8%) had an incidentally high blood pressure at intake, including 18.5% of patients without a known history of hypertension and 38.5% with a known history of hypertension. Three risk factors were found to be significantly associated with increasing systolic blood pressure: weight ( P = .022), stress level ( P = .017), and presence of renal artery stenosis ( P = .021). There was also a near–statistically significant inverse relationship between systolic blood pressure and amount of time spent exercising ( P = .068).
Conclusions: Overall, a relatively high prevalence of incidental hypertension was identified, including among patients not previously diagnosed as having hypertension. Consideration of risk factors and awareness of the prevalence of the condition can be useful for practitioners, even as they manage presenting podiatric medical concerns. Future investigations may consider interventional or preventive strategies in the outpatient clinic setting.
... In addition to the poor awareness of blood pressure status there is also poor blood [9] pressure control among hypertensive Nigerians . Hypertension is the most common cause of adult [6] emergences from cardiovascular disease in rural Nigeria and was responsible for 25.3% of medical ward admissions [10] in a teaching hospital in Kano, Northern Nigeria and 45% of hypertension related medical admissions in Enugu, [11] South-eastern Nigeria Hypertension has been reported to cause damage to target organs of the body like brain, heart and kidney of Nigerian patients and accounted for a large [11] 91] proportion of unnecessary deaths in Nigerian hospitals . One factor that leads to uncontrolled hypertension is poor adherence to antihypertensive medications. ...
Introduction: Poor adherence to medication is a major problem among patients with hypertension, and has been
identified as one of the main causes of failure to achieve adequate control of blood pressure (BP). Patients with
hypertension who have elevated BP as a result of their poor adherence to medication remain at risk for serious
morbidity and mortality.
Objectives: The objectives of this study were (1)- To investigate the level of adherence to antihypertensive
medications among the patients. (2)- To investigate the effect of Complementary and Alternative Medicine
(CAM) use on adherence to antihypertensive medications.
Methods: The study was conducted at the department of medicine of Murtala Muhammad General Hospital of
Kano State, Nigeria. A cross-sectional study was conducted on 208 patients, adopting the eight-item Morisky
Medication Adherence Scale (MMAS) for the assessment of medication adherence and using the
Complementary and Alternative Medicine Questionnaire for the assessment of the CAM use. Data analysis was
done using Microsoft Office Excel 2007 and SPSS V16.
Results: Adherence to antihypertensive medications as measured by MMAS-8 in this study was 30.0%. Poor
adherence to treatment in this study was found to be 46.0% and moderate adherence was found to be 24.0%.
Target BP (<140/90mmHg) values were achieved in the significantly higher percentage in adherent patients
(57.3%) compared to the moderately-adherent group (24%) and poorly adherent group (18.7%). The frequency
of CAM use in this study was (67.8%).
Conclusion: This study found no relationship between poor adherence to antihypertensive medication
adherence and the use of CAM, p ˃ 0.05.
... In Nigeria, BP control rates in adult patients range from 24.2% to 35.8% according to research studies [7][8][9]. These disparities are probably due to a milieu of limited healthcare facilities, widespread Blood pressure control is influenced by multiple factors [10][11][12][13], some of which are related to patient factors. ...
Background: Hypertension is a global health issue among the adult population with high morbidity and mortality rates. As the case
... Calcium channel blockers are the most commonly used antihypertensive drugs and their availability is widespread in Lagos State. [15], [16], [17], [18], [19] Samples of nifedipine tablets were collected between May and July 2017 from registered pharmacies using a stratified sampling approach. First, we obtained a comprehensive list of registered pharmacies in Lagos State and their location from the Pharmacists Council of Nigeria. ...
Background
As the burden of noncommunicable diseases grows, access to safe medical therapy is increasing in importance. The aim of this study was to develop a method for evaluating the quality of antihypertensive drugs and to examine whether this prevalence varies by socioeconomic variables.
Methods
We conducted a cross-sectional survey of registered pharmacies in 6 local government areas (LGAs) in Lagos State, Nigeria. In each LGA, we sampled 17 pharmacies from a list of all registered pharmacies derived from the Pharmacists Council of Nigeria. We assessed drug quality based on (1) the level of active pharmaceutical ingredients (APIs), which identified falsely labeled drug samples; and (2) the amount of impurities, which revealed substandard drug samples in accordance with the international pharmacopoeia guidelines. Good-quality drugs met specifications for both API and impurity.
Results
Of the 102 drug samples collected, 30 (29.3%) were falsely labeled, 76 (74.5%) were substandard,78 (76.5%) were of poor quality and 24 (23.5%) were of good quality.Among the falsely labeled drugs, 2 samples met standards set for purity while 28 did not. Among the 76 substandard drug samples, 28 were also falsely labeled. Of the falsely labeled drugs, 17 (56.7%) came from LGAs with low socioeconomic status, and 40 (52.6%) of the substandard drug samples came from LGAs with high socioeconomic status. Most of the good-quality drug samples, 14 (58.3%), were from LGAs with low socioeconomic status. Eighteen (60%) of the falsely labeled samples, 37 (48.7%) of the substandard samples, and 15 (62.5%) of the good-quality drug samples were from manufacturers based in Asia. The average price was 375.67 Nigerian naira (NGN) for falsely labeled drugs, 383.33 NGN for substandard drugs, and 375.67 NGN for good-quality drugs. The prevalence of falsely labeled and substandard drug samples did not differ by LGA-level socioeconomic status (P = .39) or region of manufacturer (P = .24); however, there was a trend for a difference by price (P = .06).
Conclusion
The prevalence of falsely labeled and substandard drug samples was high in Lagos. Treatment of noncommunicable diseases in this setting will require efforts to monitor and assure drug quality.
... This observation agrees with previous reports highlighting the fact that in most countries, less than 30% of patients achieve BP goals, 20 and therapy with a single antihypertensive agent fails to achieve BP goals in up to 75% of patients. 21 The frequency of uncontrolled hypertension observed in the present study was somewhat higher than that reported in primary care settings by Rayner et al. (60.2%) 22 28 in Nigeria. ...
Background:
Uncontrolled hypertension remains an important issue in daily clinical practice worldwide. Although the majority of patients are treated in primary care, most of the data on blood pressure control originate from population-based studies or secondary healthcare.
Objective:
The aim of this study was to evaluate the frequency of uncontrolled hypertension and associated risk factors among hypertensive patients followed at primary care facilities in Kinshasa, the capital city of Democratic Republic of the Congo.
Methods:
A sample of 298 hypertensive patients seen at primary healthcare facilities, 90 men and 208 women, aged ≥ 18 years, were consecutively included in this cross-sectional study. The majority (66%) was receiving monotherapy, and diuretics (43%) were the most used drugs. According to 2007 European Society of Hypertension/European Society of Cardiology hypertension guidelines, uncontrolled hypertension was defined as blood pressure ≥ 140/90 or ≥ 130/80 mmHg (diabetes or chronic kidney disease). Logistic regression analysis was used to identify the determinants of uncontrolled hypertension.
Results:
Uncontrolled hypertension was observed in 231 patients (77.5%), 72 men and 159 women. Uncontrolled systolic blood pressure (SBP) was more frequent than uncontrolled diastolic blood pressure (DBP) and increased significantly with advancing age (p = 0.002). The proportion of uncontrolled SBP and DBP was significantly higher in patients with renal failure (p = 0.01) and those with high (p = 0.03) to very high (p = 0.02) absolute cardiovascular risk. The metabolic syndrome (OR 2.40; 95% CI 1.01-5.74; p = 0.04) emerged as the main risk factor associated with uncontrolled hypertension.
Conclusion:
Uncontrolled hypertension was common in this case series and was associated with factors related to lifestyle and diet, which interact with blood pressure control.
... BP control remains a serious concern especially in sub-Saharan Africa, reports from Nigeria indicate poor BP controls albeit the use of antihypertensive drugs. [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. ...
... Two tools were used for data collection namely the socio demographic characteristics sheet and physical assessment sheets. The first sheet developed by researchers was used to obtain information from subjects by self-reporting on age, gender, smoking habits, history of chronic diseases, and family history of chronic disease [16]. ...
Background:
With 29% of the world’s adult population projected to have hypertension by the year 2025, prevention and management of hypertension have become a public health priority. Hypertension also referred to as high blood pressure, in which the arteries have persistent high blood pressure. This results in a condition where the heart has to work harder than normal to flow blood through the vessels. A few years ago, there was no sufficient information about the epidemiology of hypertension, treatment protocols and its consequences in Egypt. Lately, there has been a major change in health system in Egypt, including research development.
Objectives:
To evaluate the existing data on prevalence, levels of awareness, treatment and control of hypertension in Egypt with a view of suggestive actions that could enhance control of hypertension and improve quality of life of the patients.
Methods:
Six databases (Pub Med, Cochrane, MEDLINE, Sciencedirect, MedEase, Embase) were searched in November 2013, applying the following criteria: published from January 1995 to November 2013 written in English and carried out on human subjects.
Results:
21 studies were included in the systematic review of the prevalence, awareness, and control of hypertension in Egypt. The sample size ranged from 27 subjects to 12008 subjects, and the age range from 6-95 years. Every study had both male and female representatives. In most of the studies, the women were more than the men.
Conclusion:
There are declines in the levels of awareness of hypertension and even lower levels of control. Research is required to reveal reasons behind these near to the ground levels of control and treatment, and especially awareness, in order to put in the picture policy for the improvement of quality of life of hypertensive patients in Egypt.
... 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. ...
To determine the prevalence and relationship between prehypertension and hypertension, we studied 782 ethnic Hausa and Fulanis (men, 409; women, 373) aged 38.9±13.9 years recruited by multistage cluster sampling. Demographic, anthropometry, metabolic and JNC VII-based blood pressure categories were obtained and analysed using univariate and multivariate models. The prevalence rates of prehypertension and hypertension were 58.7% (men 59.2%, women 58.2%) and 24.8% (men 25.9%, women 23.6%), respectively. Only 16.5% of the population had JNC VII defined optimum blood pressure. Compared to hypertension, prehypertension had earlier onset (second versus third decade) and peak (fourth versus fifth decade) of life. The peak and trough prevalence of hypertension and prehypertension, respectively were observed in the 5th decade of life. Obesity, abnormalities of glucose metabolism and insulin resistance were the major factors associated with prehypertension and hypertension. Multivariate analysis identified obesity and impaired glucose tolerance as independent predictors of hypertension. Of those with hypertension, 13.9% were aware of their high blood pressure status of which 85.7% were commenced on treatment and 12.5% achieved blood pressure control. Overall, 1.5% of the study population had blood pressure <140/90 mm Hg. It is concluded that less than 20% of people of Hausa and Fulani ethnicities had optimum blood pressure. These are predominantly in their second decade of life suggesting that rise in blood pressure begins early in this population. The fifth decade of life may represent a period of transition from prehypertension to hypertension.
Uncontrolled hypertension remains a significant problem in daily clinical practice worldwide. Few data are available on blood pressure control in hospitals. The aim of this study was the frequency of uncontrolled hypertension and associated risk factors in hypertensive patients followed at the general referral hospital of Boma in the province of Kongo Central in the Democratic Republic of Congo From January 1 to May 31, 2019; we conducted a cross-sectional and descriptive study at the Boma reference hospital located in the southeast and 440 Km from Kinshasa, the capital of DR Congo. Included was any hypertensive patient aver 18 years and informed consent. Information on demographic parameters, behavioral lifestyles, anthropometric and biological (blood sugar, creatinine, urine strip and lipid profile ) and blood pressure (BP) measurements was obtained. Hypertension was defined as an average of two BP ≥ 140/90 mmHg. Independent factors associated with control hypertension were identified using logistic regression analysis. P<0.05 defined the level of statistical significance. The prevalence of uncontrolled hypertension was 62 % BP control was observed in 150 (38.0%) of 395 treated hypertensive participants mainly in men than women (68.3 vs 53.3 %; p=0.001). Age <60 years (p=0.005), no smoking ( p=0.047), no Central obesity (p=0.008), CKD ( stade 1 vs 2 ) (p=0.065) , and no hypercholesterolemia ( p= 0.014) emerged as associated with control hypertension. Uncontrolled hypertension was common in our hospitals.Therapeutic lifestyle changes and pharmacological treatment are necessary for hypertensive participants.
To assess further the relation in Intersalt of 24 hour urinary sodium to blood pressure of individuals and populations, and the difference in blood pressure from young adulthood into middle age.
Standardised cross sectional study within and across populations.
52 population samples in 32 countries.
10,074 men and women aged 20-59.
Association of sodium and blood pressure from within population and cross population multiple linear regression analyses with multivariate correction for regression dilution bias. Relation of sample median daily urinary sodium excretion to difference in blood pressure with age.
In within population analyses (n = 10,074), individual 24 hour urinary sodium excretion higher by 100 mmol (for example, 170 v 70 mmol) was associated with systolic/diastolic blood pressure higher on average by 3/0 to 6/3 mm Hg (with and without body mass in analyses). Associations were larger at ages 40-59. In cross population analyses (n = 52), sample median 24 hour sodium excretion higher by 100 mmol was associated with median systolic/diastolic pressure higher on average by 5-7/2-4 mm Hg, and estimated mean difference in systolic/diastolic pressure at age 55 compared with age 25 greater by 10-11/6 mm Hg.
The strong, positive association of urinary sodium with systolic pressure of individuals concurs with Intersalt cross population findings and results of other studies. Higher urinary sodium is also associated with substantially greater differences in blood pressure in middle age compared with young adulthood. These results support recommendations for reduction of high salt intake in populations for prevention and control of adverse blood pressure levels.
This study was undertaken to describe the distribution of blood pressures, hypertension prevalence, and associated risk factors among seven populations of West African origin.
The rates of hypertension in West Africa (Nigeria and Cameroon), the Caribbean (Jamaica, St. Lucia, Barbados), and the United States (metropolitan Chicago, Illinois) were compared on the basis of a highly standardized collaborative protocol. After researchers were given central training in survey methods, population-based samples of 800 to 2500 adults over the age of 25 were examined in seven sites, yielding a total sample of 10014.
A consistent gradient of hypertension prevalence was observed, rising from 16% in West Africa to 26% in the Caribbean and 33% in the United States. Mean blood pressures were similar among persons aged 25 to 34, while the increase in hypertension prevalence with age was twice as steep in the United States as in Africa. Environmental factors, most notably obesity and the intake of sodium and potassium, varied consistently with disease prevalence across regions.
The findings demonstrate the determining role of social conditions in the evolution of hypertension risk in these populations.
To provide an update on blood pressure (BP) levels and hypertension correlates in urban workers in Ibadan, Nigeria, we administered a questionnaire to, and measured the BP in, 608 men and 309 women, age range 18-64 years. Systolic BP (SBP) rose in men and women after the age of 25, but the rise in diastolic BP (DBP) started earlier dropping in women only after the age of 44. SBP and DBP were higher in men than women (P < 0.001). The prevalence of hypertension was 9.3% in the population, being 10.4% in men and 7.1% in women; age-adjusted rates were 9.8% and 8.0% respectively. The prevalence of hypertension increased with age in both genders. Body mass index was correlated to SBP (r = 0.142, P = 0.022) and DBP (r = 0.149, P = 0.032) in men, and with SBP (r = 0.1501, P = 0.013) and DBP (r = 0.1569, P = 0.0085) in women. BP was correlated to years of education (P < 0.001) and income (P < 0.001) in men, but not in women. Regular and moderate alcohol consumption was associated with hypertension (chi2 = 4.8, P < 0.05). Awareness of BP status was generally low, 7.7% in men and 8.7% in women, but was significantly higher in the hypertensives than the normotensives (chi2 = 241, P < 0.0001). The hypertension prevalence rates are not too different from figures obtained in the last four decades, which generally have not exceeded 15%, inspite of the apparent influence of the modernisation indices of education and income.
Addressing the epidemic of poor compliance with antihypertensive medications will require identifying factors associated with poor adherence, including modifiable psychosocial and behavioral characteristics of patients.
Cross-sectional study, comparing measured utilization of antihypertensive prescriptions with patients' responses to a structured interview.
Four hundred ninety-six treated hypertensive patients drawn from a large HMO and a VA medical center.
We developed a survey instrument to assess patients' psychosocial and behavioral characteristics, including health beliefs, knowledge, and social support regarding blood pressure medications, satisfaction with health care, depression symptom severity, alcohol consumption, tobacco use, and internal versus external locus of control. Other information collected included demographic and clinical characteristics and features of antihypertensive medication regimens. All prescriptions filled for antihypertensive medications were used to calculate actual adherence to prescribed regimens in a 365-day study period. MAIN OUTCOME OF INTEREST: Adjusted odds ratios (ORs) of antihypertensive compliance, based on ordinal logistic regression models.
After adjusting for the potential confounding effects of demographic, clinical, and other psychosocial variables, we found that depression was significantly associated with noncompliance (adjusted OR per each point increase on a 14-point scale, 0.93; 95% confidence interval [95% CI], 0.87 to 0.99); in unadjusted analyses, the relationship did not reach statistical significance. There was also a trend toward improved compliance for patients perceiving that their health is controlled by external factors (adjusted OR per point increase, 1.14; 95% CI, 0.99 to 1.33). There was no association between compliance and knowledge of hypertension, health beliefs and behaviors, social supports, or satisfaction with care.
Depressive symptoms may be an underrecognized but modifiable risk factor for poor compliance with antihypertensive medications. Surprisingly, patient knowledge of hypertension, health beliefs, satisfaction with care, and other psychosocial variables did not appear to consistently affect adherence to prescribed regimens.
The current prescription patterns for essential hypertension and the efficacy, safety, tolerability and cost-effectiveness of the newer antihypertensive drugs were evaluated in Nigerian patients. The findings were compared with that of a previous study conducted in the same tertiary hospital 10 years earlier. A cross-sectional evaluation of blood pressure (BP) control in a hypertension clinic was undertaken among 150 Nigerian patients aged 61 +/- 12 years (55% females), with a duration of treatment on a particular drug class or combination of 9 +/- 3 months. The initial blood pressure was 176 +/- 20/108 +/- 11 mmHg and 22% of the patient had concurrent diabetes mellitus. Thiazide diuretics (D) alone or in combination remained the most commonly prescribed drugs in 56% of all patients. There were significant increases in the prescriptions of calcium channel blockers (CCBs) (51%), P < 0.0001, and ACE-inhibitors (ACEIs) (24%), P < 0.0001, but a slight reduction in the use of methyldopa, and fixed drug combinations (P < 0.01) compared to the previous study. The fall in systolic blood pressure on D (r = 0.65, P < 0.001) or CCB (r = 0.48, P < 0.02) was significantly correlated with the initial systolic blood pressure, but not age. More patients achieved normotension BP < 140/90 mmHg on CCB monotherapy (71%), than D monotherapy (56%). Combination therapy with ACEIs + D or methyldopa+thiazides normalized BP in 63 and 68%, respectively. Pulse pressure, a surrogate marker for cardiovascular complications and mortality in essential hypertension, was significantly reduced (P < 0.01) equally by all treatments, with 95% confidence intervals ranging from -28 to -1 mmHg. However, hypertensive-diabetic (HT-DM) patients (n = 33) exhibited no significant change in pulse pressure in response to treatment. Adverse drug reactions that occurred in 11% were impotence or postural dizziness with D, headache and pitting oedema with CCB, and dry cough with ACEI. Pharmaco-economic comparison of the drug classes revealed that for every US dollar (dollar) spent per month, the percentage of treated patients attaining normotension was 18.6 for D, 4.73 for CCB, 3.5 for ACEI + D and 13.6 for methyldopa + thiazides. A combination of ACEI + CCB or D was the preferred treatment for hypertensive-diabetic Nigerians, but only 24% attained a BP < 130/85 mmHg. These results demonstrate a shift in trend to a more rational and efficacious treatment of hypertension over a 10 year period. This may be associated, at least in part, with the intensive and continuous education of the prescribers in rational drug use and the introduction of a hospital formulary. Methyldopa is still a highly efficacious and cost-effective drug in this population. Black HT-DM Africans still constitute a subgroup who not only require more and costlier antihypertensive drugs, but whose BP control is suboptimal, and exhibit a poor therapeutic response to other risk factors (pulse pressure) that constitute a continuing risk for cardiovascular mortality.
The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.
Despite many years of study, questions remain about why patients do or do not take medicines and what can be done to change their behaviour. Hypertension is poorly controlled in the UK and poor compliance is one possible reason for this. Recent questionnaires based on the self-regulatory model have been successfully used to assess illness perceptions and beliefs about medicines. This study was designed to describe hypertensive patients' beliefs about their illness and medication using the self-regulatory model and investigate whether these beliefs influence compliance with antihypertensive medication. We recruited 514 patients from our secondary care population. These patients were asked to complete a questionnaire that included the Beliefs about Medicines and Illness Perception Questionnaires. A case note review was also undertaken. Analysis shows that patients who believe in the necessity of medication are more likely to be compliant (odds ratio (OR)) 3.06 (95% CI 1.74-5.38), P<0.001). Other important predictive factors in this population are age (OR 4.82 (2.85-8.15), P<0.001), emotional response to illness (OR 0.65 (0.47-0.90), P=0.01) and belief in personal ability to control illness (OR 0.59 (0.40-0.89), P=0.01). Beliefs about illness and about medicines are interconnected; aspects that are not directly related to compliance influence it indirectly. The self-regulatory model is useful in assessing patients health beliefs. Beliefs about specific medications and about hypertension are predictive of compliance. Information about health beliefs is important in achieving concordance and may be a target for intervention to improve compliance.
The risk of cardiovascular and renal diseases has been shown to be higher for systolic blood pressure than diastolic blood pressure. The aim of this study was to assess the differential control of systolic and diastolic blood pressure in Nigerians with primary hypertension.
This was a prospective observational study carried out at the Medical Outpatient Department of the State Hospital, Abeokuta, Nigeria. Ethical approval for the study was obtained from the ethical committee of the hospital.
The study population consisted of 185 consecutive patients (65 males, 120 females), aged 35-85 years with primary hypertension who had been on drugs one- to 25 years prior to the onset of the study. Clinic blood pressure control was assessed during a year period. Six consecutive clinic blood pressure readings were recorded for each patient and the average calculated (systolic blood pressure and diastolic blood pressure separately). Patients were classified into subgroups based on the pattern of blood pressure control.
Clinic systolic blood pressure and diastolic blood pressure was controlled in 58 patients (31.4%). Systolic blood pressure control was less frequent than diastolic blood pressure control (35.7% versus 51.4%, p<0.05). Patients with uncontrolled systolic blood pressure were significantly older than patients with only uncontrolled diastolic blood pressure (66.7+/-7.4 versus 52.9+/-8.7 years, p<0.001).
Systolic blood pressure is less frequently controlled than diastolic blood pressure in Nigerians treated for primary hypertension. This may increase the patient's risk of developing stroke, and cardiovascular and renal complications.
The aim of this study was to determine whether the provision of further practice-based support by pharmacists will bring about improved outcomes for blood pressure (BP) control in middle-aged and elderly Nigerian hypertensive patients managed with combination diuretics (amiloride hydrochloride 5 mg+hydrochlorothiazide 50 mg) and/or methyl dopa at the primary care level.
This was a 1-year prospective, randomized cohort study of the outpatients of a state comprehensive health centre in South-western Nigeria. Free primary health services including free drugs were provided for all patients.
The study population comprised 51 Nigerian patients with uncomplicated hypertension aged 45 years or more, with a 0.2-3.0-year history of hypertension, registered at the Comprehensive Health Centre, Ife between October 2002 and March 2003. They were invited into the pharmacist-managed hypertension clinic and followed for the study period. Participating pharmacists counselled for current medication, personalized goals of lifestyle modification stressing weight loss and/or increased activity, increased patient awareness by providing relevant education about hypertension and associated/related diseases, adjusted drug therapy to optimize effectiveness and minimize adverse events, utilized treatment schedules that enhanced patients' adherence to therapy, and monitored treatment outcomes between enrollment and return visits. Patient satisfaction and the number of treatment failures within 6 months post enrollment were compared with retrospective data from our earlier study involving physician-managed patients under a similar setting.
Uncontrolled BP reduced from 92 to 36.2% by 10.15+/-5.02 days after enrollment. Treatment failures were observed at 5.9% of the total return visits (n=184) within 6 months.
Pharmacist-managed hypertension clinics can improve BP control, reduce treatment failure and increase patient satisfaction.
This study was conducted to evaluate the relationship between medication compliance and blood pressure (BP) control among members of 13 managed care organizations with essential hypertension (HTN) who received antihypertensive monotherapy for at least 3 pharmacy claims prior to the blood pressure measurement.
This was a retrospective review of medical and pharmacy claims over a 4-year period (1999-2002) from 13 U.S. health plans. Data were collected by trained health professionals from randomly selected patient medical records per Health Plan Employer Data and Information Set (HEDIS) technical specifications. Patients were selected if they (1) had received monotherapy or fixed-dose combination therapy (administered in one tablet or capsule) during the time BP was measured (thus those with no BP drug therapy were excluded); (2) had received 3 or more antihypertensive pharmacy claims for the antihypertensive drug therapy prior to BP measurement; and (3) had one or more antihypertensive pharmacy claims after BP was measured. Control of BP was defined according to guidelines of the Sixth Report of the Joint National Committee (JNC 6) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (<140/90 mm Hg, or <130/85 mm Hg for patients with diabetes). Medication adherence was measured using the medication possession ratio (MPR), and MPR was used to classify patients into 3 adherence levels: high (80%-100%), medium (50%-79%), and low (<50%). The relationship between medication adherence and BP control was assessed using a logistic regression model.
There were 1,017,181 patients with a diagnosis of HTN in medical claims data from which 10,734 (10.6%) were randomly selected for chart review. There were 1,032 patients (9.6%) in the sample who had a diagnosis of HTN but who were excluded because they had no HTN drug therapy. Of the total 9,894 patients (92.2%) who were excluded from the sample, 3,029 patients (28.2%) met all other inclusion criteria but were receiving more than one HTN drug. Of the 840 patients on HTN monotherapy, the mean age was 59 12.2 years; 422 (50%) were women, 16% had diabetes, and 43% had dyslipidemia. The monotherapy HTN drug was an angiotensin-converting enzyme inhibitor (27% of patients), calcium channel blocker (22%), beta-blocker (20%), or diuretic (11%). Of the 840 patients, 629 (74.8%) were determined to have high medication adherence, 165 (19.6%) had medium adherence, and 46 (5.5%) had low adherence. Approximately 270 (43%) of high adherence patients achieved BP control compared with 56 (34%) and 15 (33%) patients with medium and low adherence, respectively. High-adherence patients were 45% more likely to achieve BP control than those with medium or low compliance after controlling for age, gender, and comorbidities (odds ratio=1.45; P =0.026).
These results demonstrate that 75% of these health plan members with a diagnosis of essential HTN who were selected for receipt of at least 4 pharmacy claims for HTN monotherapy exhibited high medication adherence. However, only 43% of high-adherence patients attained their target (JNC 6) blood pressure goal compared with 33% to 34% of patients with medium or low adherence to antihypertensive monotherapy.
The importance of tight blood pressure (BP) control has been established. We performed cross-sectional studies on the current status of BP control and the prescription and efficacy of antihypertensive drugs in hypertensive patients in Japan. The data were also evaluated in subgroups with or without diabetes mellitus (DM) and in winter and summer. Analyses were performed on the collected data of 12,437 treated hypertensive patients in winter and 5,972 in summer 2002. In winter, 50.3% of patients received calcium channel blockers (CCBs), 15.3% received angiotensin converting enzyme inhibitors (ACEIs) and 11.0% received angiotensin receptor blockers (ARBs). In the patients receiving monotherapy, 69% of patients received a CCB, 13% an ACEI and 11.0% an ARB. A total of 2,918 patients received combination therapy, and CCBs were the most frequently (89.6%) prescribed component of such therapy. Prescriptions of beta-blockers (BBs) decreased and those of CCBs and diuretics (D) increased with age (p<0.001). The rate of patients with adequately controlled BP less than 140/90 mmHg was 40.3% in the CCB group, 37.6% in the D group, and 36.9% in the BB group (p<0.001). In patients receiving combination therapy, those with CCB+D had the best rate of BP control (40.7%). The rate of patients with adequately controlled BP was lower in winter than in summer at both a target BP of 140/90 mmHg (36.2% vs. 43.8%, p<0.001) and a target BP of 130/85 mmHg in patients younger than 60 years old (15.5% vs. 18.6%, p<0.02). In diabetic patients, the target BP (130/80 mmHg) was achieved in only 11.3%, which was lower (p<0.05) than the rate in non-diabetic patients (13.1%). In conclusion, the present cross-sectional study showed that CCBs were the most frequently prescribed agent for the treatment of hypertension in Japan. The rate of adequate BP control was less than 50% and was even worse in patients with DM and in winter. Our results indicate that physicians should treat hypertension more intensively to achieve the target BP.
The age-specific relevance of blood pressure to cause-specific mortality is best assessed by collaborative meta-analysis of individual participant data from the separate prospective studies. Methods Information was obtained on each of one million adults with no previous vascular disease recorded at baseline in 61 prospective observational studies of blood pressure and mortality. During 12.7 million person-years at risk, there were about 56 000 vascular deaths (12 000 stroke, 34000 ischaemic heart disease [IHD], 10000 other vascular) and 66 000 other deaths at ages 40-89 years. Meta-analyses, involving "time-dependent" correction for regression dilution, related mortality during each decade of age at death to the estimated usual blood pressure at the start of that decade. Findings Within each decade of age at death, the proportional difference in the risk of vascular death associated with a given absolute difference in usual blood pressure is about the same down to at least 115 mm Hg usual systolic blood pressure (SBP) and 75 mm Hg usual diastolic blood pressure (DBP), below which there is little evidence. At ages 40-69 years, each difference of 20 mm Hg usual SBP (or, approximately equivalently, 10 mm Hg usual DBP) is associated with more than a twofold difference in the stroke death rate, and with twofold differences in the death rates from IHD and from other vascular causes. All of these proportional differences in vascular mortality are about half as extreme at ages 80-89 years as at,ages 40-49 years, but the annual absolute differences in risk are greater in old age. The age-specific associations are similar for men and women, and for cerebral haemorrhage and cerebral ischaemia. For predicting vascular mortality from a single blood pressure measurement, the average of SBP and DBP is slightly more informative than either alone, and pulse pressure is much less informative. Interpretation Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.
Cardiovascular diseases constitute a major public health problem both in the developed and developing countries. The profile of morbidity and mortality however, varies between regions and countries and even within countries. The importance of recognizing the cardiovascular conditions that prevail in a particular area is very important in health planning and for improving healthcare services. We therefore set out to describe the cardiac morbidity pattern from our echocardiographic data. Between August 2002 and September 2004 (24 months), we reviewed the echocardiographic diagnosis of all patients aged 15 years referred for echocardiography. Information obtained from the records included age, gender, names of referring hospital/physician, clinical diagnosis and echocardiogram findings. Data was analyzed using SPSS version 10.0 software. A total of 594 persons were referred for echocardiographic examination in the 2 year study period. Of these, 489 (82.3%) had an abnormal echocardiogram. We analyzed those with abnormal echocardiograms. There were 272 males and 217 females. The male to female ratio was 1.3:1. Hypertensive heart disease was the commonest echocardiographic diagnosis, present in 228 (46.6%) of the patients. This is followed by dilated cardiomyopathy seen in 82 (16.8%) and then rheumatic heart disease in 55 (11.2%). Other findings were Non dilated cardiomyopathy (6.1%), Hypertrophic cardiomyopathy (5.7%), pericardial diseases (3.7%), Ischemic heart disease (4.7%), Cor pulmonale (1.4%) and Endomyocardial fibrosis (0.4%) of patients. It was noted that majority of the cases were advanced with irreversible myocardial damage. Systemic hypertension remains the most important cause of CVD morbidity in savanna region of Nigeria. Addressing the major cardiovascular risk factors especially systemic hypertension will go a long way in reducing the burden of cardiovascular diseases.
Discretionary salt intake (habitual) of male and female Nigerian hypertensive patients presenting in hospital was assessed and this was correlated with their blood pressure. Their salt intake was assessed by questionnaires and direct interview following detailed explanation. They were categorised into low, moderate and high salt intake groups according to a standard criterion. The 114 hypertensive patients (52 males; 62 females) were aged 26-80 years (mean 52.2+/-1.8 (S.E.M.) males; 53.7+/-1.7 females, P=0.5). Those on medication were generally poorly compliant with uncontrolled blood pressure at presentation. Fifty percent belonged to the moderate salt intake group. No female reported high salt intake. In the males, the mean DBP in the high salt intake group was significantly higher than in the moderate and low intake groups (123.5+/-4.4, 108.3+/-3.9 and 99.3+/-7.7 mmHg; P<0.02 and P<0.009, respectively). There was no significant difference between the mean DBP of the low and moderate salt intake groups (P>0.1). The SBP is also consistently higher from the low to the high salt intake groups (162.1+/-15.5, 179.3+/-7.4 and 180.8+/-7.6 mmHg, respectively), although the difference is not statistically significant (P>0.1). The BMI did not differ between the salt groups (P>0.5) and there was no correlation between BMI and blood pressure (P>0.05). The study suggests that the higher the salt intake, the higher the blood pressure, particularly the diastolic, in male hypertensive patients. The picture in the female is unclear, since none reported a high salt intake. Reduced salt intake might, therefore, be beneficial in black hypertensive patients, in the setting of common presentation at the stage of cardiac decompensation.
Various epidemiological surveys from different countries have documented the unsatisfactory control of arterial hypertension. The aim of this study was to assess the current status of treatment and control of hypertension in Italy.
A random sample of general practitioners (GP) working in several Aziende Sanitarie Locali (Local health offices-ASL) throughout Italy were invited to take part in the study. Each doctor had to recruit a random sample of 15-20 hypertensive patients receiving antihypertensive drugs among those attending his/her office for any reason. A standard medical history, specifically oriented to hypertension and its pharmacological treatment, was taken for each patient. Three blood pressure (BP) measurements were made, with the patient seated for at least 5 minutes, using an accurate automatic device (A&D UA-732), and the mean was taken as each patient's BP.
A total of 73 GPs (17% of the invited sample), working in 14 Italian ASL (six in the north of the country, four in the center and four in the south and islands), agreed to participate in the study. They recruited an average of 17 patients each, for a total of 1204 hypertensive subjects (663 women and 541 men) 633 of whom were 65 years old or more, mean age 64 +/- 11 years, range 25-94 years. More than half (56%) had been taking antihypertensive drugs for at least five years; 42% were taking one drug, 40% two, 16% three and 2% four drugs. Respectively, 63% and 23% had systolic BP (SBP) > or = 140 and > or = 160 mmHg; 28% and 14% had diastolic BP (DBP) > or = 90 and 95 mmHg. In 71%, BP was < 160/95 mmHg, but only 33% had BP lower than 140/90 mmHg. BP control was similar in males and females, but worse in the elderly. Nine percent of patients complained of symptomatic side effects, usually mild. Only 8% admitted to poor compliance with the antihypertensive therapy, and their BP was significantly less well controlled.
Control of BP in patients receiving antihypertensive drugs is still far from optimal in Italy, just as in other countries. This situation seems more related to the fact that doctors do not tackle the problem aggressively, than to the patients' degree of compliance with therapy.
Previous studies have revealed a high prevalence of white coat effect among treated hypertensive patients. The difference between clinic and ambulatory blood pressure seems to be more pronounced in older patients. This abnormal rise in blood pressure BP in treated hypertensive patients can lead to a misdiagnosis of refractory hypertension. Clinicians may increase the dosage of antihypertensive drugs or add further medication, increasing costs and producing harmful secondary effects. Our aim was to evaluate the discrepancy between clinic and ambulatory blood pressure in hypertensive patients on adequate antihypertensive treatment and to analyse the magnitude of the white coat effect and its relationship with age, gender, clinic blood pressure and cardiovascular or cerebrovascular events.
We included 50 consecutive moderate/severe hypertensive patients, 58% female, mean age 68 +/- 10 years (48-88), clinic blood pressure (3 visits) > 160/90 mm Hg, on antihypertensive adequate treatment > 2 months with good compliance and without pseudohypertension. The patients were submitted to clinical evaluation (risk score), clinic blood pressure and heart rate, electrocardiogram and ambulatory blood pressure monitoring (Spacelabs 90,207). Systolic and diastolic 24 hour, daytime, night-time blood pressure and heart rate were recorded. We considered elderly patients above 60 years of age (80%). We defined white coat effect as the difference between systolic clinic blood pressure and daytime systolic blood pressure BP > 20 mm Hg or the difference between diastolic clinic blood pressure and daytime diastolic blood pressure > 10 mm Hg and severe white coat effect as systolic clinic blood pressure--daytime systolic blood pressure > 40 mm Hg or diastolic clinic blood pressure--daytime diastolic blood pressure > 20 mm Hg. The patients were asked to take blood pressure measurements out of hospital (at home or by a nurse). The majority of them performed an echocardiogram examination.
Clinic blood pressure was significantly different from daytime ambulatory blood pressure (189 +/- 19/96 +/- 13 vs 139 +/- 18/78 +/- 10 mm Hg, p < 0.005). The magnitude of white coat effect was 50 +/- 17 (8-84) mm Hg for systolic blood pressure and 18 +/- 11 (-9 +/- 41) mm Hg for diastolic blood pressure. A marked white coat effect (> 40 mm Hg) was observed in 78% of our hypertensive patients. In elderly people (> 60 years), this difference was greater (50 +/- 15 vs 45 +/- 21 mm Hg) though not significantly. We did not find significant differences between sexes (males 54 +/- 16 mm Hg vs 48 +/- 17 mm Hg). In 66% of these patients, ambulatory blood pressure monitoring showed daytime blood pressure values < 140/90 mm Hg, therefore refractory hypertension was excluded. In 8 patients (18%) there was a previous history of ischemic cardiovascular or cerebrovascular disease and all of them had a marked difference between systolic clinic and daytime blood pressure (> 40 mm Hg). Blood pressure measurements performed out of hospital did not help clinicians to identify this phenomena as only 16% were similar (+/- 5 mm Hg) to ambulatory daytime values.
Some hypertensive patients, on adequate antihypertensive treatment, have a significant difference between clinic blood pressure and ambulatory blood pressure measurements. This difference (White Coat Effect) is greater in elderly patients and in men (NS). Although clinic blood pressure values were significantly increased, the majority of these patients have controlled blood pressure on ambulatory monitoring. In this population, ambulatory blood pressure monitoring was of great value to identify a misdiagnosis of refractory hypertension, which could lead to improper decisions in the therapeutic management of elderly patients (increasing treatment) and compromise cerebrovascular or coronary circulation.
This programme of overviews of randomised trials was established to investigate the effects of angiotensin-converting-enzyme (ACE) inhibitors, calcium antagonists, and other blood-pressure-lowering drugs on mortality and major cardiovascular morbidity in several populations of patients. We did separate overviews of trials comparing active treatment regimens with placebo, trials comparing more intensive and less intensive blood-pressure-lowering strategies, and trials comparing treatment regimens based on different drug classes.
The hypotheses to be investigated, the trials to be included, and the outcomes to be studied were all selected before the results of any participating trial were known. Individual participant data or group tabular data were provided by each trial and combined by standard statistical techniques.
The overview of placebo-controlled trials of ACE inhibitors (four trials, 12,124 patients mostly with coronary heart disease) revealed reductions in stroke (30% [95% CI 15-43]), coronary heart disease (20% [11-28]), and major cardiovascular events (21% [14-27]). The overview of placebo-controlled trials of calcium antagonists (two trials, 5520 patients mostly with hypertension) showed reductions in stroke (39% [15-56]) and major cardiovascular events (28% [13-41]). In the overview of trials comparing blood-pressure-lowering strategies of different intensity (three trials, 20,408 patients with hypertension), there were reduced risks of stroke (20% [2-35]), coronary heart disease (19% [2-33]), and major cardiovascular events (15% [4-24]) with more intensive therapy. In the overviews comparing different antihypertensive regimens (eight trials, 37,872 patients with hypertension), several differences in cause-specific effects were seen between calcium-antagonist-based therapy and other regimens, but each was of borderline significance.
Strong evidence of benefits of ACE inhibitors and calcium antagonists is provided by the overviews of placebo-controlled trials. There is weaker evidence of differences between treatment regimens of differing intensities and of differences between treatment regimens based on different drug classes. Data from continuing trials of blood-pressure-lowering drugs will substantially increase the evidence available about any real differences that might exist between regimens.
Levels of hypertension treatment and control have been noted to vary between Europe and North America, although direct comparisons with similar methods have not been undertaken. In this study, we sought to estimate the relative impact of hypertension treatment strategies in Germany, Sweden, England, Spain, Italy, Canada, and the United States by using sample surveys conducted in the 1990s. Hypertension was defined as a blood pressure of 160/95 mm Hg or 140/90 mm Hg, plus persons taking antihypertensive medication. "Controlled hypertension" was defined as a blood pressure less than threshold among persons taking antihypertensive medications. Among persons 35 to 64 years, 66% of hypertensives in the United States had their blood pressure controlled at 160/95 mm Hg, compared with 49% in Canada and 23% to 38% in Europe. Similar discrepancies were apparent at the 140/90 mm Hg threshold, at which 29% of hypertensives in the United States, 17% in Canada, and </=10% in European countries had their blood pressure controlled. At the 140/90 mm Hg cutpoint, two thirds to three quarters of the hypertensives in Canada and Europe were untreated compared with slightly less than half in the United States. Although guidelines vary among countries, resulting in different case definitions, this does not account entirely for the varying success of different national control efforts. Low treatment and control rates in Europe, combined with a higher prevalence of hypertension, could contribute to a higher burden of cardiovascular disease risk attributable to elevated blood pressure compared with that in North America.
In spite of the plethora of anti-hypertensives, hypertension remains an important cause of morbidity and mortality among Nigerian hypertensive population. To determine blood pressure control rate, defined as the proportion of treated hypertensive population with systolic and diastolic blood pressures less than 140 mmHg and 90 mmHg respec tively. One hundred and ten (110) treated adult Nigerian hypertensives aged 28-80 (mean 46.02 +/- 15.20) years with male: female ratio of 1:1.4 who have been commenced on treatment for at least 6 months were selected by simple random sampling for determination of blood pressure control rate and its determinant factors using clinic blood pressures. Blood pressure control rate was 42.70%. Pre-treatment mean blood pressure was significantly higher than the value at least 6 months post commencement of treatment: (170.09 +/- 15.20/108.98 +/- 15.85 mmHg versus 146.10 +/- 24.50/93.8 +/- 21.90 mmHg) (t=8.73; p<0.05). In the group with uncontrolled blood +/- 17.91 mmHg in 42 (66.6%), rose by 10.50 +/- 1.0 mmHg in 8 (12.70%) and was unchanged in 13 (20.66%) patients. Diastolic blood pressure fell by 22.22 +/- 14.58 mmHg in 32 (50.8%), rose by 7.88 +/- 6.66 mmHg in 16 (25.40%) and was unchanged in 15 (23.80%) patients. Clinic compliance and family history of hypertension were associated with satisfactory blood pressure control. Blood pressure control rate among the study population was low. Compliance and family re-enforcement should be encouraged.
We studied the differences between recommendations given in the 1999 World Health Organization-International Society of Hypertension (WHO/ISH) Guidelines and doctors' risk estimation and willingness to give antihypertensive drugs.
A population-based sample, the WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (WHO MONICA) (n = 5997), was classified according to the 1999 WHO/ISH Hypertension Guidelines risk stratification scheme. A total of 54 subjects were randomly drawn from the 12 different risk categories. Written case stories were constructed based on risk-factor levels for each selected subject.
Doctors (n = 139), comprising general practitioners (GPs, n = 110) and specialists in internal medicine or cardiology (specialists, n = 29), in northern Sweden assessed 12 cases each.
Factors used in risk assessment, estimation of cardiovascular risk, and willingness to give antihypertensive drugs.
In a multivariate logistic regression model including all doctors, most major risk factors were significantly associated with a higher estimated risk and willingness to give drug treatment. Estimated risk was lower than the risk classified by 1999 WHO/ISH Hypertension Guidelines, and there was no difference between GPs and specialists in this respect. The use of antihypertensive drugs was much lower than advocated by the guidelines, but specialists were more inclined to give antihypertensive drug treatment than GPs.
Doctors estimated the cardiovascular risk as being less severe than the recommendation given in the 1999 WHO/ISH Hypertension Guidelines. Moreover, their willingness to prescribe antihypertensive drugs was also lower than that advocated by the guidelines. The control of hypertension is poor in the community today, and this seems to be the way the profession wants to have it.
Goal blood pressure (BP) was defined by the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (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. However, there are few reports that address BP control among special subgroups of hypertensives by reference to targeted BP. We therefore conducted a study to evaluate BP control of 4049 hypertensives in 47 hospital-based hypertension units in Spain. Overall, 42% of patients achieved goal BP (<140 mm Hg systolic and <90 mm Hg diastolic). Only 13% of diabetic patients and 17% of those with renal disease achieved the BP goal (<130 mm Hg systolic and <85 mm Hg diastolic), and only 10% and 12%, respectively, achieved the even more rigorous goal (<130 mm Hg systolic and <80 mm Hg diastolic). Likewise, only 18% of patients in JNC-VI risk group C and 17% of WHO/ISH high-risk patients attained a goal BP <130 mm Hg systolic and <85 mm Hg diastolic. BP control (<125 mm Hg systolic and <75 mm Hg diastolic) was extremely low (2%) in patients with proteinuria >1 g/d. Poorer BP control was observed among patients at high risk, with diabetes, renal disease, or obesity, than in lower-risk groups. BP control was lower for systolic than for diastolic BP. In >50% of uncontrolled patients, no measures were taken by doctors to optimize pharmacologic treatment, and approximately one-third of patients were still using drug monotherapy. Control of BP, particularly of systolic BP, is still far from optimal in hospital-based hypertension units. Patients at high risk, with diabetes or proteinuria, warrant focused attention. Moreover, a more aggressive behavior of doctors treating uncontrolled hypertension is needed.
Throughout the past 50 years, heart disease has been the leading cause of death in the United States. Although declines in coronary heart disease (CHD) mortality have been noted, there is still uncertainty about the magnitude of the decline and whether the trend is similar for sudden cardiac death (SCD).
We examined temporal trends in SCD and nonsudden CHD death in the Framingham Heart Study original and offspring cohorts from 1950 to 1999. SCD was defined as a death attributed to CHD with preceding symptoms that lasted less than 1 hour; all deaths were adjudicated by a physician panel. Log-linear Poisson regression was used to estimate CHD mortality and SCD risk ratios (RRs); RRs were adjusted for age and gender. There were 811 CHD deaths: 453 nonsudden and 358 SCDs. Ninety-one (20%) of nonsudden CHD deaths and 173 (48%) of SCDs were in subjects free of antecedent CHD. From 1950-1969 to 1990-1999, overall CHD death rates decreased by 59% (95% CI 47% to 68%, P(trend)<0.001). Nonsudden CHD death decreased by 64% (95% CI 50% to 74%, P(trend)<0.001), and SCD rates decreased by 49% (95% CI 28% to 64%, P(trend)<0.001). These trends were seen in men and women, in subjects with and without a prior history of CHD, and in smokers and nonsmokers.
The risks of SCD and nonsudden CHD mortality have decreased by 49% to 64% over the past 50 years. These trends were evident in subjects with and without heart disease, which suggests important contributions of primary and secondary prevention to the decreasing risk of CHD death and SCD.
A prospective questionnaire study of the misconceptions of hypertension by hypertensive patients was carried out in 1365 male and female hypertensive patients aged between 21-80 years. About 40% of the study population could not define hypertension, but even those who did appeared to be in denial of the disease. About 24% were unaware of the causes of hypertension; the most common cause mentioned was psychosocial stress. Between 0.6% and 14% of subjects were unaware of the effect of risk factors, like obesity, cigarette smoking, exercise, excessive alcohol and salt consumption, or hypertension. Interestingly, some feel that regular sexual intercourse worsens hypertension. Eight percent of subjects had no fear of the effect of poor compliance to antihypertensive medication, while 10% were anxious about the heavy financial burden imposed by hypertension management, Sixty-five percent of subjects feel that they will require no more medication once they achieve control of their blood pressure. Twenty-one percent of respondents are of the opinion that they will achieve a permanent cure only from alternative medical practitioners and will consider using alternative medicine in future. The study confirms the importance of medical education for patients irrespective of their level of education, as many of these patients still entertain that gross misconceptions may have negative impact on outcome.
To describe the drug utilization pattern among hypertensive patients in a tertiary care setting, assess the short-term outcome of anti-hypertensive drugs usage and identify points for future intervention to improve outcomes.
A cross sectional retrospective drug use review was conducted between 1st June and 31st August 2002 on randomly selected 200 case notes of hypertensive patients at a tertiary care facility in South-Western Nigeria.
Diuretics were the most frequently prescribed anti-hypertensive class (39.4%), followed by centrally acting agents (23.3%), calcium channel blockers (21%), angiotensine converting enzyme (ACE) inhibitors (8.6%) and beta blockers (1.9%). Aspirin was the most frequently prescribed adjoining non-anti-hypertensive drugs (39.7%), followed by anxiolytics (23.6%), other non-steroidal anti-inflammatory drugs (NSAIDs) (14.8%), metformin (6.7%), glibenclamide (5.9%), paracetamol (5.9%) and Mist. Magnesium Trisilicate (3.3%). All patients made out-of-pocket payments for their prescribed anti-hypertensive drugs at the study site. Blood pressure control was adequate in only 33.9% of patients. There was no significant difference in blood pressure control between male and female hypertensives ( p > 0.05). Anti-hypertensive drugs were changed at least once in 44% of patients and blood pressure control was significantly better in patients with at least one change ( p < 0.05). Adherence with drug therapy was documented as adequate in 82.5% of patient. Diabetes mellitus (NIDDM) (39.6%) and osteoarthritis (22.9%) were the most frequent co-morbidities. Potential harmful drug interactions were identified in 3.8% (49) of patients.
Diuretics and centrally acting agents were the most frequently prescribed anti-hypertensive drugs in a tertiary care setting in Nigeria. Physicians' prescribing decisions appear significantly influenced by cost consideration.
To assess whether a physician-nurse team model could improve long-term hypertension control rates by active intervention and modification of antihypertensive drug regimens based on home blood pressure (BP) measurements.
This study consisted of patients referred to a hypertension specialty clinic between July 1999 and June 2002 for the evaluation and management of uncontrolled hypertension. Patients were evaluated initially by a physician. A treatment plan was designed and implemented subsequently by a hypertension nurse specialist. Each patient was given an automated digital home BP monitor and requested to provide 42 BP readings taken during 7 days at intervals of 1, 3, 6, 9, and 12 months after dismissal from the clinic. The mean of these weekly values was reviewed by the physician-nurse team, and the treatment regimen was adjusted to achieve a goal BP of less than 135/85 mm Hg.
One hundred six consecutively referred patients were enrolled in the study (mean+/-SD age, 64+/-14 years; 58% female; baseline BP, 156+/-16/85+/-11 mm Hg). Ninety-four patients submitted BP data after 1 month, and 78 patients completed the entire 12-month study period. Overall, mean BP decreased to 138+/-17/78+/-8 mm Hg at 1 month and to 131+/-9/75+/-7 mm Hg at 12 months (P<.01 vs baseline). The percentage of patients who achieved BP control to less than 135/85 mm Hg increased from 0% at baseline to 63% at 12 months. Intensification of antihypertensive drug therapy was required, on average, in 24% of patients at each study interval. The mean number of drugs increased from 1.2 at baseline to 2.0 at 12 months (P<.01).
The use of home BP measurement by a physician-nurse team has the potential to significantly improve long-term hypertension control rates in a geographically dispersed patient population. This model should reduce both cost and inconvenience associated with the treatment of hypertension.
To observe the extent to which blood pressure (BP) was reduced to below 140/90 mm Hg in Nigerians with diabetes (DM), data were collected using structured questionnaire, standard sphygmomanometer, and measurement of fasting blood glucose (FBG). Two hundred forty-four subjects (85 males) aged 17-84 years with a mean duration of DM of 7.9 years and who regularly attended the clinic for diabetes at least monthly for no less than 6 months were involved. Eleven percent, 13 of the 115 treated hypertensives, had BP controlled to levels below 140/90 mm Hg. Nifedipine was the most frequently prescribed antihypertensive (44.30%), followed by alpha-methyldopa (15.7%) and then the angiotensin-converting enzyme inhibitors (ACEIs) captopril and lisinopril (11.3%). Thiazides (9.7%) or thiazide-based fixed combination tablets were prescribed in about 25% of the patients. Eighteen percent were on more than one antihypertensive concurrently and dosages were often at threshold. The majority of the hypertensives with BP below 140/90 mm Hg were on thiazide-based medications. In 152 participants, the presence of hypertension did not affect glycemic control (chi2 = 4.41, df = 2, P = .1) observed and 60% of the entire population had FBC < or = 7.9 mmol/L. Lack of access to care does not explain these findings and suggests an area for improvement. Fortunately, the data also show that thiazides were associated with better control of BP at a cost that was affordable without jeopardizing diabetic control.
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