Adherence to International Guidelines in the Management of Hypertension in a Tertiary Hospital in Nigeria

Abstract

Purpose: The role of physicians in the overall management of hypertension and their adherence to the JNC VII, WHO/ISH and ESH guidelines were examined in this study. Method: Case notes of hypertensive patients diagnosed between 1 January 2004 and 30 September 2005, in the Cardiology Clinic of University of Benin Teaching Hospital were retrieved for evaluation. They were assessed for adherence to the JNC VII, WHO/ISH and ESH guidelines, in the management of hypertension. Result: Five hundred and one case notes were used in the study. Prevalence of hypertension was highest in the Grade 2 category (36%). More women (60%) than men (40%) were affected, with a diagnostic mean systolic blood pressure (SBP); male (164.0mmHg ± 21.9), female (163.7 mmHg ± 18.8) and mean diastolic blood pressure (DBP); male (100.1 mmHg ± 13.2), female (97.3 mmHg ± 13.1). After commencing treatment, mean SBP and DBP for male and female were (131.8 mmHg ± 11.6; 84.3 mmHg ± 7.5), and (132.3 mmHg ± 11.5 83.2 mmHg ± 7.6), respectively. The commonest co-morbidity was diabetes mellitus (18%). Co-morbidity was commonest in Grade 2 (34%) and Grade 3 hypertension (34%). Almost half of the subjects (49%) were on a two-drug combination while 14% were on monotherapy. Calcium channel blockers were the most commonly prescribed anti-hypertensive drug (31%) followed by diuretics (30%). In combination drug regimen, diuretics were the commonest (74%). There was no evidence of body weight management in hypertension. Conclusion: Physicians in this hospital fairly complied with the stated guidelines, but do not appear to have recommended lifestyle modifications to their hypertensive patients.