TREATMENT RESPONSE IN ADULT PATIENTS WITH HYPERTENSION ATTENDING A SECONDARY HEALTH CARE CENTER IN SOUTH-WEST NIGERIA

I.A. Azeez1, M.D. Dairo2 and J.O. Akinyemi3

  1. Department of Family Medicine, University College Hospital, Ibadan.
  2. Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria.
  3. Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria.

Abstract

Background: There has been an increase in prevalence of hypertension worldwide and a trend towards poor control of hypertension. Despite the development of new guidelines on management of hypertension, it remains a difficult disease to control.

Methods: The study was a prospective cohort study of 386 patients aged 18 to 70 years with uncontrolled hypertension. A simple random sampling technique with computer generated random numbers was used for selection.

Results: Majority (58.3%) of the respondents who were overweight had diastolic blood pressure of less than 100 mmHg while 55 (41.7%) respondents who were overweight had diastolic blood pressure of 100mmHg to 110mmHg. Forty (42.1%) of the respondents who were obese had diastolic blood pressure of less than 100mmHg while 55 (57.9%) respondents who were obese had diastolic blood pressure of 100mmHg to 110mmHg. The association was statistically significant (2 = 9.845, p-value = 0.02). There was a significant difference between the mean first Systolic Blood pressure and the mean third systolic blood pressure. (< 0.001, 95% CI 19.01- 23.04). Also there was a significant difference between the mean first Diastolic Blood pressure and the mean third Diastolic Blood pressure. (p < 0.001, 95% CI 11.13-11.56).

Conclusion: This study has shown that increasing body weight was associated with high blood pressures and health education on management of hypertension had significant effect in reducing blood pressures and subsequently leading to better control of hypertension.

Keywords: Treatment response, Hypertension, Secondary healthcare center, Nigeria

Correspondence:

Dr. I.A Azeez
Dept. of Family Medicine,
University College Hospital,
Ibadan.
E-mail: kunleayilola14@gmail.com

Introduction

There has been an increase in prevalence of hypertension worldwide and a trend towards poor control of hypertension. Hypertension is defined as a persistent systolic blood pressure (BP) reading of 140 mmHg or greater and or a diastolic blood pressure reading of 90mmHg or greater.1,2 In Nigeria, it is the main risk factor for stroke, heart failure, ischemic heart disease and kidney failure.3 Higher prevalence of hypertension and its complications have been found in people of African descent.

The prevalence of hypertension has been found to be 44% in Western Europe and 28% in North America.4 However, Azubuike and Kurmi reported 24.2% in their study conducted in Sanga, Kaduna Northern Nigeria.5 Despite the development of new drugs and guidelines in management of hypertension, it remains a difficult disease to control. In the United States of America, blood pressure control was achieved in 48.4% of hypertensive patients on pharmacotherapy.6,7 Literature review has shown that in about a third of hypertensive patients blood pressure has been controlled by monotherapy, in about another third, blood pressure was controlled by bi-therapy and the remaining third by three or more drugs. A difficult to treat hypertension is defined as blood pressure of >140/90mm Hg, or >130/80mmHg in diabetics and patients with chronic kidney disease despite use of at least three antihypertensive drugs prescribed at optimal doses. 8,9 Controlled blood pressure is a blood pressure of less than 140/90mmHg in hypertensives and less than 130/80 in hypertensive diabetics and patients with chronic renal failure. Failure of adherence to prescribed drug is a major cause of poor blood pressure control, particularly in chronic diseases like hypertension.10.11 With good adherence to medication and strict lifestyle changes, the control of hypertension is a possibility and can be achieved.12

Most patients with hypertension will require two or more anti-hypertensive drugs to achieve targeted blood pressure levels. The recommendation of the current International guidelines for optimization of drug treatment includes the need for prompt initiation of drug treatment, selection of the most appropriate antihypertensive agents and the use of monotherapy or combination therapy based on the level of blood pressure. Also included is the presence of other cardiovascular risk factors, target organ damage, or concomitant conditions.2 Combination therapy was found to be more efficacious than monotherapy in most patients with hypertension.7

Factors associated with blood pressure control were found to be type of health insurance, nonsmoker status, and increased number of medications used.13 It is a common finding that hypertensive patients in the community fail to meet treatment goals according to the reports of a study conducted by Fahey et al. It is projected that only 25 to 40 percent of treated hypertensives achieve blood pressure goals.14

Multivariate analysis on discharge of patients showed that the predictors of good blood pressure control were diuretics and beta- blockers and the predictors of poor blood pressure control were diabetes, chronic kidney disease, diabetic nephropathy and cerebrovascular disease. Patients with diabetes, renal disease and cerebrovascular disease were more likely to have poor control of their blood pressure.15

The eventual public health goal of treatment for hypertension is to reduce cardiovascular and renal morbidity and mortality. To prevent complications, it is important to develop patient-centered interventions that will educate patients on the importance of achieving good blood pressure control.15, 16

In the majority of patients, to reduce systolic blood pressure has been considerably more difficult than reducing diastolic blood pressure. Lifestyle modifications, efficacious and adequate antihypertensive medication doses, or appropriate drug combinations must be prescribed to have adequate blood pressure control.2

Non-pharmacological therapy is an essential part of treatment of all patients with hypertension. This include decreasing dietary sodium to less than 2.4g per day; increasing exercise to at least 30 minutes per day, four days per week; restricting alcohol consumption to two drinks per day for men and one drink per day for women; following the dietary approaches to stop hypertension eating plan (high in fruits, vegetables, potassium, calcium and magnesium; low in fat and salt); and attaining a weight loss goal of 4.5kg or more.17 Pharmacological management include use of diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta-blockers, alpha adrenergic blockers, vasodilators and centrally acting drugs.18 This study aims to determine the effect of health education on blood pressure reduction and assess the response to treatment over time in adult hypertensive patients presenting to the State Hospital, Oyo.