ADHERENCE TO ESSENTIAL HYPERTENSION TREATMENT GUIDELINES IN A TERTIARY HOSPITAL IN NIGERIA
Keywords:Hypertension, Adherence, Treatment Guidelines, WHOISH
Objective: This study determined the level of prescribers’ adherence to the World Health Organization/International Society of Hypertension (WHO/ISH) guidelines for the management of hypertension at the Lagos University Teaching Hospital (LUTH), Nigeria.
Methods: This study employed a retrospective cross-sectional design. Two groups were used: Group A (300 patients) were treated before the guidelines review in 2003, while Group B (200 patients) were treated after. The two study groups were compared, and systolic blood pressure of 130 mm Hg or above was taken as the index of hypertension.
Results: There were 198 (66%) male patients in Group A, while Group B had 136 (68%) males. The highest age for Group A was 50–59 y for 89 (30%) patients, unlike group B that had 58 (29%) patients in aged 40–49 y as the highest. The highest blood pressure range for patients in Group A was 150–159 mm Hg for 64 (21%) patients, unlike Group B that had 43 (22%) patients as the highest in the same range. Furosemide was present in 282 (24%) prescriptions for group A patients. However, atenolol was present in 61 (20%) prescriptions for the same group. In group B, Furosemide was prescribed in 197 (97%) encounters, while Nifedipine was found in 81(40%) prescriptions.
Conclusion: Prescribers at LUTH complied substantially with WHO/ISH guidelines in the management of hypertension. Diuretics and beta-blockers were used before the guideline review. After the review, diuretics and calcium channel blockers were the most frequently prescribed antihypertensives.
World Health Organization. Hypertension Available from http://www.who.int/news-room/fact-sheets/detail/hypertension. [Last accessed on 25 Oct 2019]
Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: a systematic review. J Hypertens 2004;22:11-9.
Michael R. The American society of hypertension and the international society of hypertension guidelines for hypertension management: an in-depth guide. Specialty Pharm Times 2014;53:31.
Odili VU, Oghagbon EK, Ugwa NA, Ochei UM, Agghomo OE. Adherence to international guidelines int eh management of hypertension in a tertiary Hospital in Nigeria. Trop J Pharm Res 2008;7:945-52.
James PA, Oparil S, Cartel BL, Cusham WC, Dennison Himmelfarb C, Handler J, et al. Evidence-based guideline for the management of high blood pressure in adults report from the panel members appointed to the Eight Joint National Committee (JNC 8). JAMA 2014;311:507-20.
Ale OK, Braimoh RW. Awareness of hypertension guidelines and the diagnosis and evaluation of hypertension by primary care physicians in Nigeria. Cardiovasc J Afr 2017;28:72-6.
Basopo V, Mujasi P. To what extent do prescribing practices for hypertension in the private sector in Zimbabwe follow the national treatment guidelines? An analysis in insurance medical claims. J Pharm Policy Prac 2017;10:37.
Solanki ND, Patel P. Drug utilization pattern and pharmacoeconomic analysis of antihypertensive drugs prescribed in secondary care hospital in Gujarat India. Asian J Pharm Clin Res 2017;10:120-4.
Vyas ND, Gor AP, Suthar JV. Evaluation of prescribing pattern of fixed dose combinations of antihypertensives and antidiabetic agents. Asian J Pharm Clin Res 2017;10:164-6.
Varakantham V, Kurakula SAK, Bharatraj DK. Antihypertensive prescription pattern and compliance to JNC 7 AND JNC 8 AT tertiary care Government Hospital, Hyderabdd, India: a cross-sectional retrospective study. Hosp Pharm 2018;53:107-12.
Nasytion A. Drug therapy problems in management of hypertensive outpatients admitted to four Indonesian primary health centers. Asian J Pharm Clin Res 2016;9:87-90.
Sari SP, Darajat AF, Nursanti B. Drug interactions among patients with hypertension taking angiotensin-converting enzyme inhibitors in an Indonesian hospital. Int J Appl Pharm 2018;10:138-41.
Venkataraman R, Rashid M, Shashikantha B, Soumya A, Vijayan G, Manuel GG, et al. Prescribing pattern of antihypertensive medication and adherence to Joint National Commission–8 guideline in a rural tertiary care Indian Teaching Hospital. J Basic Clin Physiol Pharmacol 2019. Doi:10.1515/jbcpp-2019-0133
Sessoms J, Reid K, Williams I, Hinton I. Provider adherence to the national guideline for managing hypertension in African Americans. Int J Hypertens 2015. https://doi.org/ 10.1155/2015/498074
Heneghan C, Perera R, Mant D, Glasziou P. Hypertension guideline recommendations in general practice: awareness, agreement, adoption, and adherence. Br J Gen Pract 2008;57:948-52.
Milchak JL, Carter BL, James PA, Ardey G. Measuring adherence to practice guidelines for the management of hypertension. Evaluation Literature Hypertension 2004;44:602-8.
Ahmad N, Hassan Y, Tangiisuran B, Meng OL, Abd Aziz N, Ahmad FU, et al. Guideline adherence and hypertension control at a tertiary hospital in Malayia. J Eval Clin Pract 2013;19:798-804.
Rajagopal SS, Kandasamy K, Natarajan A. Impact of pharmacist intervention in screening and education on blood pressure in a rural area in southern India. Asian J Pharm Clin Res 2016;9(Suppl 3):339-43.