|Year : 2019 | Volume
| Issue : 4 | Page : 229-231
Blood pressure control in treated hypertensive Nigerians in South-South Nigeria: Experience from Benin city
Odigie Ojeh-Oziegbe1, Igboin Joseph Ikhidero2
1 School of Medicine, College of Medical Sciences; Department of Internal Medicine, Nephrology Division, University of Benin Teaching Hospital, Benin City, Nigeria
2 Consultant Physician/Cardiologist, University of Benin Teaching Hospital, Benin City, Nigeria
|Date of Submission||09-Dec-2018|
|Date of Decision||05-May-2019|
|Date of Acceptance||09-Sep-2019|
|Date of Web Publication||21-Nov-2019|
Consultant Physician/ Nephrologist, Department of Medicine, University of Benin/ University of Benin Teaching Hospital, Benin City
Source of Support: None, Conflict of Interest: None
Background: Systemic hypertension is the most common noncommunicable disease in Nigeria with a plethora of associated clinical conditions and target organ damage. Adequate blood pressure (Bp) reduction with antihypertensive medication is expected to reduce mortality and morbidity. However, although Bp is easy to measure and hypertension responds well to therapy, a significant number of hypertensive patients on medication are not well controlled and hence remain at risk for the complications of hypertension, since a significant number of patients do not reach the goal Bp of ≤140/90 mmHg. Methods: Case notes of 826 hypertensive patients seen over the past 5 years, who have had a minimum period of treatment of 6 months at the Medical Outpatient Department of the University of Benin Teaching Hospital, were retrospectively evaluated. All had antihypertensive medication prescribed and subjectively reported compliance with medications. Adequate Bp control was defined as a systolic Bp of <140 mmHg and a diastolic Bp of <90 mmHg according to the JNC VII definition. Results: There were 826 patients: 353 males and 473 females. Age range was 18–96 years. Mean age was males – 56.54 (±17.34) years and females – 53.83 (±15.1) years. Bp levels of <140/90 mmHg were found in a total of 40.92% of treated patients. Males had a total of 126 controlled out of 353 (35.69%) and females had a total of 212 controlled out of 473 (44.82%). Conclusion: Despite pharmacologic treatment, less than half of our treated patients were able to achieve adequate Bp control. These poor Bp control rates tend to reflect global trends. There is a need to objectively assess factors involved in Bp control so as to achieve a better outcome.
Keywords: Adequate control, blood pressure, diastolic, systolic
|How to cite this article:|
Ojeh-Oziegbe O, Ikhidero IJ. Blood pressure control in treated hypertensive Nigerians in South-South Nigeria: Experience from Benin city. CHRISMED J Health Res 2019;6:229-31
|How to cite this URL:|
Ojeh-Oziegbe O, Ikhidero IJ. Blood pressure control in treated hypertensive Nigerians in South-South Nigeria: Experience from Benin city. CHRISMED J Health Res [serial online] 2019 [cited 2021 Mar 6];6:229-31. Available from: https://www.cjhr.org/text.asp?2019/6/4/229/271327
| Introduction|| |
Hypertension has been estimated to affect approximately 1 billion people worldwide, and this figure is expected to increase to 1.5 billion by 2025.,, It is the number one risk factor for cardiovascular disease in Sub-Saharan Africa and thus has emerged as a major public health concern. This is especially true in the African region where the prevalence of hypertension has been found to be between 11% and 46% in adults aged 25 years and above.,, Figures from Ghana show the prevalence of 19.3% in rural areas to 54.6% in urban areas in studies from 11 surveys conducted between 1973 and 2009. In Nigeria, in a review of 43 studies, the prevalence of hypertension was found to range from 8% to 46.4%.
While the technical workforce and medications used to treat hypertension are available worldwide as well as in Nigeria, inadequate blood pressure (Bp) control has been widely documented in the developed and in the developing world, including Nigeria.,
It has been shown that in spite of the availability of a wide range of antihypertensives, hypertension and its complications are still important causes of adult morbidity and mortality in Sub-Saharan Africa and the rest of the world.,
Hypertension has been estimated to account for 13.5% of deaths worldwide, and it is the most common treatable risk factor for cardiovascular disease. It has also been found to be a major cause of cardiac failure, myocardial infarction, retinopathy, cerebrovascular accidents, and hypertensive nephrosclerosis leading to renal failure, among others., These studies have also shown that a reduction in Bp effectively prevents these cardiovascular events. Furthermore, systemic hypertension has been found to be a leading risk factor for cardiovascular disease among Negroid, and excess morbidity and mortality have been observed among blacks relative to their Caucasian counterparts.,
Fortunately, studies have proved conclusively that Bp reductions to optimal levels are directly related to a more favorable disease outcome. Thus, the reduction of Bp to optimal levels with pharmacological agents has been found to be beneficial. However, several studies have shown that only about 5%–55% of treated hypertensives are adequately controlled using the cutoff point of 140/90 mmHg as the goal Bp.,,
This study is notable in the sense that it suggests that factors other than that of affordability of antihypertensive medication may play a significant role in adequate Bp control.
| Methods|| |
The case files of 826 hypertensive patients attending clinic at the Medical Outpatient Department of the University of Benin Teaching Hospital were retrospectively evaluated. Bp readings, taken at routine clinic visits, were assessed. Mean Bp value of each patient over the last three clinic visits were calculated and taken for the value of this study. Hypertension was defined as a systolic Bp (SBp) >140 mmHg and a diastolic Bp (DBp) >90 mmHg according to JNC 7.
Control in treated patients was defined as the number of patients achieving the goal Bp of 140/90 mmHg divided by the total number of patients and expressed as a percentage.
The permission was taken from Institutional Ethics Committee prior to starting the project. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
| Results|| |
[Table 1] and [Table 2] show the mean blood pressures, ages, serum creatinine and total cholesterol levels of the sample patients, as well as their mean systolic and diastolic blood pressure total control rates.
- Records of 826 treated hypertensive patients were evaluated
- Age range was from 19 to 96 years
- Males were 353 (42.74%) and females were 473 (57.26%) of the treated population
- Mean age was: males 56.54 ± 17.34 years and females 53.83 ± 15.1 years
- Sociodemographic variables showed that 120 (12.19%) were single, 613 (74.2%) were married, 111 (13.4%) were widowed, and 2 were divorced/separated
- Mean serum creatinine was: males 1.2 ± 0.38 mg/dl and females 1.19 ± 0.36 mg/dl
- Mean total cholesterol was: males 205 ± 45.2 and females 208 ± 52.2
- Mean SBp was: males 154 ± 22.6 mmHg and females 208 ± 52.2 mmHg
- Total percentage of patients at goal Bp of ≤ 140/90 mmHg was 41%. Percentage of males at goal Bp was 35.69% and females were 44.82%. Females were better controlled than males
- Systolic control rate was 41.89% and diastolic control rate was 71.5%, showing that difficult control was mainly with the SBp. DBp was better controlled than SBp [Table 1] and [Table 2].
| Discussion|| |
The current study found that only 40.92% of our patients achieved the goal Bp of 140/90 mmHg. These study results are important in several ways. The main objective of antihypertensive therapy is to lower the Bp to optimal levels using pharmacological agents, as this has been found to markedly reduce the complications of hypertension. If, however, the treated patients do not achieve their goal Bp, then they continue to be at risk for the complications of hypertension, especially cardiovascular disorders. In addition, they are also at risk from the side effects of medications without the optimum benefits of those medications. Our result is close to that of Isezuo and Njoku in Uthman Dan Fodio University Teaching Hospital, which had a control rate of 42.7%, a figure which is slightly higher than the results obtained in our environment, and much higher than that observed by Salako et al., who did their studies in a patient population where antihypertensive medication were given free and found a control rate of 36%. Our results, however, are higher than that of Yusuf and Balogun who found 29% of their patients were adequately controlled.
| Conclusion|| |
The number of patients reaching goal Bp of 140/90 mmHg is still poor, and in keeping with studies, both in Nigeria and other places in the world.
There is a need to do a widespread audit of the effects of antihypertensive therapy to find out whether we are actually achieving the setout targets in Bp control in our treated hypertensive patients. Further studies are required to find out those factors associated with poor Bp control in treated hypertensive patients. This will enable important changes to be made to enable more treated patients benefit from the advantages of Bp lowering and hence reduce the risks from the complications of hypertension.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Siegel D. Barriers to and strategies for effective blood pressure control. Vasc Health Risk Manag 2005;1:9-14.
World Health Organization. Hypertensive Fact Sheet. Department of Sustainable Development and Healthy Environment. World Health Organization; 2011.
Gaziano TA. Economic burden and the cost-effectiveness of treatment of cardiovascular diseases in Africa. Heart 2008;94:140-4.
World Health Organization. Global Status Report on Non-Communicable Diseases 2010. Geneva: World Health Organization; 2011.
World Health Organization. Global Health Observatory Data Repository (Online Database). Geneva: World Health Organization; 2001.
Addo J, Agyemang C, Smeeth L, de-Graft Aikins A, Edusei AK, Ogedegbe O, et al.
Areview of population-based studies on hypertension in Ghana. Ghana Med J 2012;46:4-11.
Ogah OS, Okpechi I, Chukwuonye II, Akinyemi JO, Onwubere BJ, Falase AO, et al.
Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review. World J Cardiol 2012;4:327-40.
Salako BL, Ajose FA, Lawani E. Blood pressure control in a population where antihypertensives are given free. East Afr Med J 2003;80:529-31.
Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: A systematic review. J Hypertens 2004;22:11-9.
Okwuonu CG, Ojimadu NE, Okaka EI, Akemokwe FM. Patient-related barriers to hypertension control in a Nigerian population. Int J Gen Med 2014;7:345-53.
Chijioke C, Anakwue R, Okolo T, Ekwe E, Eze C, Agunyenwa C, et al.
Awareness, treatment, and control of hypertension in primary health care and secondary referral medical outpatient clinic settings at Enugu, Southeast Nigeria. Int J Hypertens 2016;2016:5628453.
Falase AO, Aje A, Ogah OS. Management of hypertension in Nigerians-ad hoc or rational basis. Niger J Cardiol 2015;12:158-64.
Guwatudde D, Nankya-Mutyoba J, Kalyesubula R, Laurence C, Adebamowo C, Ajayi I, et al.
The burden of hypertension in Sub-Saharan Africa: A four-country cross sectional study. BMC Public Health 2015;15:1211.
Arima H, Barzi F, Chalmers J. Mortality patterns in hypertension. J Hypertens 2011;29 Suppl 1:S3-7.
Beaglehole R, Epping-Jordan J, Patel V, Chopra M, Ebrahim S, Kidd M, et al.
Improving the prevention and management of chronic disease in low-income and middle-income countries: A priority for primary health care. Lancet 2008;372:940-9.
Katarzyna S, Szczyrek M, Jastrzebska I, Pasal M, Zwolak A, Danituk J. Hypertension, the Silent Killer. J Preclin Clin Res 2011;5:43-6.
Tedla FM, Brar A, Browne R, Brown C. Hypertension in chronic kidney disease: Navigating the evidence. Int J Hypertens 2011;2011:132405.
Lackland DT. Racial differences in hypertension: Implications for high blood pressure management. Am J Med Sci 2014;348:135-8.
Flack JM, Ferdinand KC, Nasser SA. Epidemiology of hypertension and cardiovascular disease in African Americans. J Clin Hypertens (Greenwich) 2003;5:5-11.
McInnes GT. How important is optimal blood pressure control? Clin Ther 2004;26 Suppl A:A3-11.
Jokisalo E, Enlund H, Halonen P, Takala J, Kumpusalo E. Factors related to poor control of blood pressure with antihypertensive drug therapy. Blood Press 2003;12:49-55.
Onder G, Gambassi G, Sgadari A, Williamson JD, Cesari M, Landi F, et al.
Impact of hospitalization on blood pressure control in Italy: Results from the Italian group of pharmacoepidemiology in the elderly (GIFA). Pharmacotherapy 2003;23:240-7.
Bizien MD, Jue SG, Panning C, Cusack B, Peterson T. Blood pressure control and factors predicting control in a treatment-compliant male veteran population. Pharmacotherapy 2004;24:179-87.
Isezuo AS, Njoku CH. Blood pressure control among hypertensives managed in a specialised health care setting in Nigeria. Afr J Med Med Sci 2003;32:65-70.
Yusuff KB, Balogun O. Physicians' prescribing of anti-hypertensive combinations in a tertiary care setting in South Western Nigeria. J Pharm Pharm Sci 2005;8:235-42.
[Table 1], [Table 2]