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A survey of hypertensive practices at two community health centres in Cape Town


Brian Rayner
Marc Blockman
Donette Baines
Yvonne Trinder

Abstract

Background. Control of hypertension remains an elusive goal, but doctors'  non-compliance with guidelines, patient attitudes and adherence to  treatment, and poor delivery of care at clinics are important contributing factors.

Objectives. To determine the overall quality of hypertensive care, and  compliance with current hypertension guidelines at community health centres (CHCs) in the Western Cape.

Methods. Consecutive patients attending hypertension clinics at two CHCs were selected to participate. A questionnaire was designed to determine patient demographics, doctors' compliance with hypertension guidelines, factors leading to treatment non-adherence, and delivery of care. Accuracy  of blood pressure (BP) recording was evaluated by comparing the  clinic BP with that measured using an approved manometer.

Results. One hundred and sixty-one patients were evaluated, 100 from CHC 1 and 61 from CHC 2. There was no difference in both control systolic and diastolic BP measured by the hypertension nurse (147.9 v. 144.8  mmHg, p = 0.45, and 89.3 v. 85.6 mmHg, p = 0.14) respectively. All clinic BP readings were recorded to the nearest 10 mmHg mercury. The  difference in both systolic and diastolic BP > 10 mmHg between the clinic and control BP was significantly greater at CHC 2 than CHC 1 (28% v. 56%, p = 0.005, and 43% v. 64%, p = 0.007) respectively. Overall, 39.8% of patients had a systolic and diastolic BP < 140 and< 90 mmHg. The mean number of antihypertensive drugs was 2.4 per patient. The use of  non-steroidal antiinflammatory drugs (NSAIDs) and tricyclic antidepressants was high at both centres, and few patients underwent basic investigations, lifestyle interventions, risk stratification or global cardiovascular risk  reduction.


Conclusions. 39.8% of patients achieved a BP < 140/90 mmHg. There is  significant scope for improvement in prescription of medication, application  of uniform lifestyle changes, and avoidance of NSAIDs and tricyclic antidepressants. Major deficiencies were identified in BP measurement, assessment of target organ damage, risk stratification and the reduction of overall  cardiovascular risk.


Journal Identifiers


eISSN: 2078-5135
print ISSN: 0256-9574