Investigating outcomes in the management of hypertension by specialists in a University Hospital
Keywords:Clinical audit, Outcome, Hypertension management, Specialist clinic, UPTH, Nigeria.
Background: Hypertension is an acknowledged risk factor for cardiovascular diseases and this risk is heightened with co-existence of other risk factors and long-term co-morbidities. This study reviewed outcomes in the management of hypertension at the medical outpatient clinic of the University of Port Harcourt Teaching Hospital, Nigeria.
Method: Cross-sectional survey using interviewer-administered questionnaires and review of records of 182 randomly selected regular patients at the medical out-patients’ clinic. Outcomes measured were patients’ adherence to treatment, prevailing/persistent risk factors, co-morbidities, trend in patients’ blood pressure and cholesterol levels over last three consecutive visits. Data were analysis using (SPSS) version 20.0.
Results: Of the 182 patients studied, 37.4% were males and 62.6% females. About half (45.0%) reported adherence to the treatment protocol. The main persisting risk factors were overweight (73.1%) and high low density lipoprotein cholesterol (81.0%) while the commonest co-morbidity was diabetes (26.9%). Proportion of clients with uncontrolled BP progressively declined over the last 3 visits (63.7 à 60.4à 54.4%) though not statistically significant (state p-value). Poor adherence was significantly associated with uncontrolled hypertension (p = 0.004).
Conclusion: Poor adherence with management plan was a significant hindrance to BP control. Findings also suggest benefits in regular follow-up of hypertensive patients. There is need for lifestyle and behavioural modifications in managing hypertension.
Miura K. Strategies for prevention and management of hypertension throughout life. Journal of epidemiology. 2004;14(4):112-7.
Walker BR, Colledge NR, Ralston SH, Penman I. Davidson's principles and practice of medicine: Elsevier Health Sciences; 2013.
Burt VL, Cutler JA, Higgins M, Horan MJ, Labarthe D, Whelton P, et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population data from the health examination surveys, 1960 to 1991. Hypertension. 1995;26(1):60-9.
Lackland DT, Keil JE, editors. Epidemiology of hypertension in African Americans. Seminars in nephrology; 1996.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-52.
Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, et al. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. BMJ: British Medical Journal. 2004;328(7440):634.
Lang T, Degoulet P, Aime F, Devries C, Jacquinet-Salord M-C, Fouriaud C. Relationship between alcohol consumption and hypertension prevalence and control in a French population. Journal of chronic diseases. 1987;40(7):713-20.
Slama M, Susic D, Frohlich ED. Prevention of hypertension. Current Opinion in Cardiology. 2002;17(5):531-6.
Leonardo AE, Victoria KI, Duke M. Some Risk factors among hypertensive Clients in an Outpatient Clinic of a Tertiary health centre, Southern Nigeria.
Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlöf B, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. The Lancet. 2010;375(9718):895-905.
Ogedegbe GO, Boutin-Foster C, Wells MT, Allegrante JP, Isen AM, Jobe JB, et al. A randomized controlled trial of positive-affect intervention and medication adherence in hypertensive African Americans. Archives of internal medicine. 2012;172(4):322-6.
Excellence NIfC. Principles for best practice in clinical audit: Radcliffe Publishing; 2002.
Hughes J, Humphrey C. Medical audit in general practice: a practical guide to the literature: Kings's Fund Centre; 1990.
Linnarsson R. Medical audit based on computer-stored patient records exemplified with an audit of hypertension care. Scandinavian journal of primary health care. 1993;11(1):74-80.
Donabedian A. The quality of care: How can it be assessed? Jama. 1988;260(12):1743-8.
Kirkwood BR. Essentials of medical statistics: Blackwell Scientific Publications; 1988.
Isezuo A, Njoku C. Blood pressure control among hypertensives managed in a specialised health care setting in Nigeria. African journal of medicine and medical sciences. 2003;32(1):65-70.
Hendriks ME, Wit F, Roos M, Brewster LM, Akande TM, de Beer IH, et al. Hypertension in sub-Saharan Africa: cross-sectional surveys in four rural and urban communities. PloS one. 2012;7(3):e32638.
SPSS I. IBM SPSS statistics base 20. Chicago, IL: SPSS Inc. 2011.
Ejim E, Okafor C, Emehel A, Mbah A, Onyia U, Egwuonwu T, et al. Prevalence of cardiovascular risk factors in the middle-aged and elderly population of a Nigerian rural community. Journal of tropical medicine. 2011;2011.
Humayun A, Shah AS, Sultana R. Relation of hypertension with body mass index and age in male and female population of Peshawar, Pakistan. J Ayub Med Coll Abbottabad. 2009;21(3):63-5.
Takashima Y, Miwa Y, Mori T, Hashimoto M, Uchino A, Yuzuriha T, et al. Sex differences in the risk profile and male predominance in silent brain infarction in community-dwelling elderly subjects: the Sefuri brain MRI study. Hypertension Research. 2010;33(7):748-52.
Tedesco M, Di Salvo G, Caputo S, Natale F, Ratti G, Iarussi D, et al. Educational level and hypertension: how socioeconomic differences condition health care. Journal of human hypertension. 2001;15(10):727-31.
Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. Jama. 2009;302(4):401-11.
Muller MD, Ryan EJ, Bellar DM, Kim C-H, Williamson ME, Glickman EL, et al. Effect of acute salt ingestion upon core temperature in healthy men. Hypertension Research. 2011;34(6):753-7.
Michikawa T, Nishiwaki Y, Okamura T, Asakura K, Nakano M, Takebayashi T. The taste of salt measured by a simple test and blood pressure in Japanese women and men. Hypertension Research. 2009;32(5):399-403.
Shapo L, Pomerleau J, McKee M. Epidemiology of hypertension and associated cardiovascular risk factors in a country in transition: a population based survey in Tirana City, Albania. Journal of epidemiology and community health. 2003;57(9):734-9.
Ariff F, Suthahar A, Ramli M. Coping styles and lifestyle factors among hypertensive and non-hypertensive subjects. Singapore medical journal. 2011;52(1):29-34.
Brown CD, Higgins M, Donato KA, Rohde FC, Garrison R, Obarzanek E, et al. Body mass index and the prevalence of hypertension and dyslipidemia. Obesity research. 2000;8(9):605-19.
Reisin E, Graves JW, Yamal J-M, Barzilay JI, Pressel SL, Einhorn PT, et al. Blood pressure control and cardiovascular outcomes in normal-weight, overweight, and obese hypertensive patients treated with three different antihypertensives in ALLHAT. Journal of hypertension. 2014;32(7):1503-13.
Davis JL, Zelman K. FINAFLEX-BREAKING NEWS!!!
Van Wijk BL, Klungel OH, Heerdink ER, de Boer A. The association between compliance with antihypertensive drugs and modification of antihypertensive drug regimen. Journal of hypertension. 2004;22(9):1831-7.
Schulman BA. Active patient orientation and outcomes in hypertensive treatment: application of a socio-organizational perspective. Medical care. 1979;17(3):267-80.
How to Cite
The Journal is owned, published and copyrighted by the Nigerian Medical Association, River state Branch. The copyright of papers published are vested in the journal and the publisher. In line with our open access policy and the Creative Commons Attribution License policy authors are allowed to share their work with an acknowledgement of the work's authorship and initial publication in this journal.
This is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author.
The use of general descriptive names, trade names, trademarks, and so forth in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations. While the advice and information in this journal are believed to be true and accurate on the date of its going to press, neither the authors, the editors, nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
TNHJ also supports open access archiving of articles published in the journal after three months of publication. Authors are permitted and encouraged to post their work online (e.g, in institutional repositories or on their website) within the stated period, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). All requests for permission for open access archiving outside this period should be sent to the editor via email to firstname.lastname@example.org.