Choice of antihypertensive medications among physicians and its impact on blood pressure control among Nigerians living with hypertension

Abstract

Background: Hypertension, if untreated or uncontrolled, leads to damage of vital organs such as the brain, heart and the kidneys among others. These complications have been shown to be severer in black Africans. Benefit of treatment has been repeatedly demonstrated by many studies. Therefore, many guidelines have been produced by relevant bodies in different countries in order to assist physicians in making the right choices for blood pressure (BP) control. Most of these bodies produce the guidelines based on the peculiarities of hypertension in their respective population. Several reports have shown how different hypertension is, in black Africans, still there is no published unified guideline for its treatment in this population.

Methods: This was a survey of known hypertensives who were on follow up visit. Their prescriptions were assessed for drug name, class and number. Their blood pressures at that visit were also recorded. Prevalence of single therapy and combination therapy were determined. Compliance with the AHA recommended 2 – drug combination was determined. The percentage of BP control as well as the prescribed drugs in each group were also obtained.

Results: Those on single agents were 13% out of which 52% were controlled. 87% were on various combination of 2 or more drugs of whom 41.9% of those on 2 drugs and 21.1% of those on more than 2 drugs had controlled BP. BP control in those on 2 drugs was better than in those with > 2 drugs, (p=0.0027).

ACEI were the commonest used drug either as single agent (55.9%) or as 2 – drug combination as seen in 54.8% of the subjects on 2 – drug combination. 13 different 2 – drug combinations were identified with the best control in ARB + Diuretic, ACEI + Diuretic and CCB + Diuretic. The least control was observed in the ACEI + CCB group. Compliance with AHA recommendation was good but still 7.7% were under unacceptable group while another 7.7% were unclassified.

Conclusion: ACE-Is are becoming the drugs of choice both as monotherapy and as combination therapy. Despite good compliance to AHA recommendation on drug combination, overall control is still a problem which calls for a revisit of these recommendations in Africans.

Keywords: Ahtihypertensives; Physicians; Impact; Blood Pressure; Nigerians