Drug prescription/blood pressure control in patients on monotherapy attending a tertiary hospital in Nigeria

Onyinye O. Akunne, Aduragbenro D. A. Adedapo

Abstract


Background: Current treatment guidelines for treatment of hypertension stipulate the use of diuretics or calcium channel blockers (CCBs) as first-line treatment. Although, many studies have been carried out to study prescription pattern and blood pressure (BP) control in this region none has independently compared the effect of different antihypertensive drug classes given as monotherapy on BP control. This study compares the BP lowering efficacy of different classes of antihypertensive drugs given as monotherapy in black hypertensive patients with or without complications.

Methods: This prospective cross-sectional study evaluated the influence of antihypertensive prescription on BP controls among consecutive patients present on clinic days from November 2011 to April 2012. Patients were treated with either angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, beta-blocker, CCB, centrally acting adrenergic drug or diuretic. The primary outcome was BP reading <140/90 mmHg in patients without complication or <130/80 mmHg in patients with complication.

Results: Of 264 patients, 228 patients received one drug whereas 36 received no drug. More than half of those on non-pharmacological intervention had good BP control (n=21), patients on diuretic (28.8%) had a significantly higher BP control (p=0.014) than those on other classes of drugs. Only 58% of the patients had good BP control. Diastolic BP reduced with an increase in age.

Conclusions: Inthis study, diuretics significantly reduced BP compared with other antihypertensive class. Although clinical trials also suggest the use of CCB as first‑line treatment, cost considerations are necessary.


Keywords


Hypertension, Drug utilization, Monotherapy, Nigeria

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References


Mendis S, Puska P, Norrving B. Global Atlas on Cardiovascular Disease Prevention and Control. Geneva: World Health Organization (in collaboration with the World Heart Federation and World Stroke Organization); 2011.

Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217-23.

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(12):327-40.

Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665.

Whitworth JA, World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21:1983-92.

Bloch MJ, Basile JN. Treating the black hypertensive in 2010: achieve lower targets while awaiting more definitive evidence. J Clin Hypertens (Greenwich). 2011;13:1-4.

Turnbull F, Woodward M, Neal B, Barzi F, Ninomiya T, Chalmers J, et al. Do men and women respond differently to blood pressure-lowering treatment? Results of prospectively designed overviews of randomized trials. Eur Heart J. 2008;29(21):2669-80.

ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288(23):2981-97.

Amira CO, Okubadejo NU. Antihypertensive pharmacotherapy in a developing economy: pattern, acquisition costs and conformity to international guidelines in a tertiary-care setting. J Hum Hypertens. 2006;20(11):894 7.

Katibi IA, Olarinoye JK. Antihypertensive therapy among hypertensive patients as seen in the middle belt of Nigeria. Ann Afr Med. 2004;3(4):177-80.

Odili VU, Oghagbon EK, Ugwa NA, Ochei UM, Aghomo OE. Adherence to international guidelines in the management of hypertension in a tertiary hospital in Nigeria. Trop J Pharm Res. 2008;7(2):945-52.

Tamuno I, Babashani M. Blood pressure control among hypertensive patients in a tertiary health care facility in northern Nigeria. Res J Med Sci. 2012;6(1):26-31.

Sani MU, Mijinyawa MS, Adamu B, Abdu A, Borodo MM. Blood pressure control among treated hypertensives in a tertiary health institution. Niger J Med. 2008;17(3):270-4.

Salako BL, Ajose FA, Lawani E. Blood pressure control in a population where antihypertensives are given free. East Afr Med J. 2003;80(10):529-31.

Ebrahim S, Smith GD. Lowering blood pressure: a systematic review of sustained effects of non-pharmacological interventions. J Public Health Med. 1998;20(4):441-8.

Stevens VJ, Obarzanek E, Cook NR, Lee IM, Appel LJ, Smith West D, et al. Long-term weight loss and changes in blood pressure: results of the Trials of Hypertension Prevention, phase II. Ann Intern Med. 2001;134(1):1-11.

Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344(1):3-10.

Virdis A, Giannarelli C, Neves MF, Taddei S, Ghiadoni L. Cigarette smoking and hypertension. Curr Pharm Des. 2010;16(23):2518-25.

Wright JD, Hughes JP, Ostchega Y, Yoon SS, Nwankwo T. Mean systolic and diastolic blood pressure in adults aged 18 and over in the United States, 2001-2008. Natl Health Stat Report 2011;1-22, 24.

Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med. 1993;329(20):1456-62.

Ellison DH, Loffing J. Thiazide effects and adverse effects: insights from molecular genetics. Hypertension. 2009;54(2):196-202.