Hypertension Management in Primary Health Care Centres: Blood Pressure Control and Classes of Antihypertensive Medication, Khartoum State, 2018
DOI:
https://doi.org/10.17140/PHOJ-6-156Keywords:
Hypertension control; Antihypertensive medication; Hypertension management.Abstract
BackgroundIn Sudan, the delivery of care based on the primary health care (PHC) level, which is the first contact with the health system. PHC is the level at which the modifiable risk factors for hypertension are addressed together with the treatment of known hypertensive patients. ObjectiveTo assess the management of hypertension in PHC in Khartoum State, 2018. Material and MethodsThe study was a descriptive cross-section, health centre’s based that covered six PHC centres in Khartoum State. The study in-terviewed all diagnosed Sudanese hypertensive patients more than 18-years of age who attended the selected PHC centres. The research team collected data using a structured questionnaire and measuring the blood pressure (BP) with a mercury sphygmo-manometer. The study variables were demographic characteristics and disease features as independent variables and hypertension control as the dependent variable. The statistician analyzed the data using the statistical package for the Social Science version 21.0 and the Chi-square (χ) test to obtain the p value to test the association between the addressed variables. The study group adopt ethical considerations throughout the study. ResultsOf the 384 hypertensive patients interviewed in this study, 57% were females and 47.7% were more than 60-years of age. A large percent of the subjects were either primary educated or illiterate (32.6%, 19.8% respectively). More than half of the hyperten-sive patients (52.1%) were uncontrolled and 52.9% had no comorbidities. Diabetes was predominant (39.3%) among those who had comorbidities. The majority of the patients (92.7%) were adherent to the medication. Of the studied patients, 58.1% used monotherapy. The most controlled patients were the elderly and middle-aged patients and the highly educated patients (p=0.005). Patients with a duration less than five-years were more likely to be controlled (p=0.036). The majority of the patients who used combined treatment were found to be controlled. ConclusionThis study concluded that the high prevalence of uncontrolled hypertensive patients attending PHC was mainly attributed to the use of monotherapy, presence of comorbidities and medication non-adherence. The latter is related to patients’ ignorance, financial constraints and dislike of using many drugs during the day. In addition, the use of combined therapy, elder age and high education were factors for better control.
References
World Health Organization (WHO). Report on the Regional Consultation on Hypertension Prevention and Control (Abu Dha-bi, United Arab Emirates, 20-22 December 2003). 2004. Web site. https://apps.who.int/iris/handle/10665/255066. Accessed June 6, 2021.
Federal Ministry of Health. Sudan Household Health Survey (SHHS) 2010, chronic diseases results. 2010. Website. http:// www. fmoh.gov.sd. Accessed September 26, 2016.
Federal Ministry of Health. Annual health statistical report 2008. 2008. Website. http://www.fmoh.gov.sd. Accessed September 26, 2016.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, IzzoJL, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure. Hypertension. 2003; 42(6): 1206-1252. doi: 10.1161/01. HYP.0000107251.49515.c2
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The seventh report of the Joint National Com-mittee on prevention, detection, evaluation and treatment of high blood pressure. JAMA. 2003; 289: 2560-272. doi: 10.1001/ jama.289.19.2560
Sabaté E, World Health Organization (WHO). Adherence to long-term therapies: Evidence for action. Web site. http://apps. who.int/medicinedocs/en/d/Js4883e/6.1.3.html. Accessed July 7, 2012.
Fung V, Huang J, Brand R, Newhouse JP, Hsu J. Hypertension treatment in a medicare population: Adherence and systolic blood pressure control. Clin Ther. 2007; 29(5): 972-984. doi: 10.1016/j. clinthera.2007.05.010
Krousel-Wood M, Thomas S, Muntner P, Morisky D. Medication adherence: A key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients. Curr Opin Cardiol. 2004; 19(4): 357-362. doi: 10.1097/01.hco.0000126978.03828.9e
Aziz AM, Ibrahim MI. Medication noncompliance – – a thriving problem. Med J Malaysia. 1999; 54(2): 192-199.
Ataklte F, Erqou S, Kaptoge S, Taye B, Echouffo-Tcheugui JB, 35 Karaig EABA et al Kengne AP. Burden of undiagnosed hypertension in sub-Saharan Africa: A systematic review and meta-analysis. Hypertension. 2015; 65: 291-298. doi: 10.1161/HYPERTENSIONAHA.114.04394
Ahmed ME. Blood pressure in a multiracial urban Sudanese community. J Hum Hypertens. 2012; 4: 621-624.
Sherif SM, Elbaghir KA, Homieda MM. Prevalence of hyper-tension in an urban community in Sudan. Khartoum Med J. 2012; 1: 72-74.
Nicholas DD, Heiby JR, Hatzell TA. The quality assurance pro-ject: Introducing quality improvement to primary health care in less developed countries. Qual Assur Health Care. 1991; 3(3): 147-165. doi: 10.1093/intqhc/3.3.147
Abdalla EAM, Elfadl LA, Eltayeb WAH. Epidemiology of hy-pertension among adults in Al-Azhary area in Khartoum-State Su-dan: Community based study. International Journal of Pharmaceutical Science Invention. 2017; 6(1): 1-5.
Anteneh ZA, Yalew WA, Abitew DB. Prevalence and corre-lation of hypertension among adult population in Bahir Dar city, northwest Ethiopia: A community based cross sectional study. Int J Gen Med. 2015; 8: 175-185. doi: 10.2147/IJGM.S81513
Kingue S, Ngoe CN, Menanga AP, Jingi AM, Noubiap JJN, Fesuh B, et al. Prevalence and risk factors of hypertension in ur-ban areas of cameroon: A nationwide population-based cross-sec-tional study. J Clin Hypertens (Greenwich). 2015; 17(10): 819-824. doi: 10.1111/jch.12604
Shitengea ST, Mabuza LH. A survey of risk factors associat-ed with hypertension in the adult population of Kang, Kgalagadi North, Botswana. South African Family Practice. 2015; 57(3):177-182. doi: 10.1080/20786190.2014.976963
Balla SA, Abdalla AA, Elmukashfi TA, Ahmed HA. Hyper-tension among rural population in four states: Sudan 2012. Glob J Health Sci. 2014; 6(3): 206-212. doi: 10.5539/gjhs.v6n3p206
Al-Tuwijri AA, Al-Rukban MO. Hypertension control and co-morbidities in primary health care centers in Riyadh. Ann Saudi Med. 2006; 26(4): 266-271. doi: 10.5144/0256-4947.2006.266
Joffres MR, Hamet P, MacLean DR, L’italien GL, Fodor G. Distribution of blood pressure and hypertension in Canada and the United States. Am J Hypertens. 2001; 14: 1099-1105. doi: 10.1016/ s0895-7061(01)02211-7
Al-Shammari SA, Nass M, Al-Maatouq MA, Al-Quaiz JM. Family practice in Saudi Arabia: Chronic morbidity and quality of care. Int J Qual Health Care. 1996; 8(4): 383-387. doi: 10.1093/in-tqhc/8.4.383
Birtwhistle RV, Godwin MS, Delva MD, Casson RI, Lam M, Original Research | Volume 6 | Number 1 | MacDonald SE, et al. Randomized equivalence trial comparing three month and six month follow up of patients with hyperten-sion by family practitioners. BMJ. 2004; 328: 204. doi: 10.1136/ bmj.37967.374063.EE
Burt VL, Cutler JA, Higgins M, Horan MJ, Labarthe D, Whel-ton P, et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991. Hypertension. 1995; 26: 60-69. doi: 10.1161/01.hyp.26.1.60
Ambaw AD, Alemie GA, W/Yohannes SM, Mengesha ZB. Adherence to antihypertensive treatment and associated factors among patients on follow up at University of Gondar Hospital, Northwest Ethiopia. BMC Public Health. 2012; 12(1): 282. doi: 10.1186/1471-2458-12-282
Tesfaye A, Kumela K, Wolde M. Blood pressure control as-sociates and antihypertensive pharmacotherapy patterns in tikur anbessa general specialized hospital chronic care department, Ad-dis Ababa, Ethiopia. American Journal of Biomedical and Life Sciences. 2015; 3(3): 41-48. doi: 10.11648/j.ajbls.20150303.13
Inkster ME, Donnan PT, MacDonald TM, Sullivan FM, Fahey T. Adherence to antihypertensive medication and association with patient and practice factors. J Hum Hypertens. 2006; 20(4): 295-297. doi: 10.1038/sj.jhh.1001981
Asgedom SW, Gudina EK, Desse TA. Assessment of blood pressure control among hypertensive patients in Southwest Ethi-opia. PLoS One. 2016; 11(11): e0166432. doi: 10.1371/journal. pone.0166432
Bader RJK, Koprulu F, Hassan NAGM, Ali AAA, Elnour AA. Predictors of adherence to antihypertensive medication in north-ern United Arab Emirates. East Mediterr Health J. 2015; 21(5): 309- 318. doi: 10.26719/2015.21.5.309
Abdulaziz A, Ibrahim A, Ayman A, Samia K, Nisrin Z. Control and Management of Hypertension at a University Health Centre in Oman. Sultan Qaboosuni Med J. 2011; 8(2): 179-182.
Barrera L, Millett C, Blangiardo M, Pape UJ, Majeed A. Dif-Submit your article to this journal | https://openventio.org/submit-manuscript/ Original Research | Volume 6 | Number 1 | Karaig EABA et al ferences in the classification of hypertensive controlled patient in primary care: Cross sectional study. JRSM Short Reports. 2012; 3: 72. doi: 10.1258/shorts.2012.012008
Paulsen MS, Andersen M, Munck AP, Larsen PV, Hansen DG, Jacobsen IA, et al. Socio-economic status influences blood pres-sure control despite equal access to care. Fam Pract. 2012; 29(5): 503-510. doi: 10.1093/fampra/cmr130
Sandoval D, Bravo M, Koch E, Gatica S, Ahlers I, Henriquez O, et al. Overcoming barriers in the management of hypertension: the experience of the cardiovascular health program in chilean pri-mary health care centers. Int J Hypertens. 2012; 2012: 405892. doi: 10.1155/2012/405892
Franklin SS, Jacobs MJ, Wong ND, L’Italien GJ, Lapuerta P. Pre-dominance of isolated systolic hypertension among middle-aged and elderly US hypertensives: analysis based on National Health and Nutrition Examination Survey (NHANES) III. Hypertension. 2001; 37(3): 869-874. doi: 10.1161/01.hyp.37.3.869
Fox JC, Leight K, Sutradhar SC, Demopoulos LA, Gleim GW, Lewin AJ, et al. Te JNC 7 approach compared to conven-tional treatment in diabetic patients with hypertension: A dou-ble-blind trial of initial monotherapy vs. combination therapy. J Clin Hypertens (Greenwich). 2004; 6: 437-442. doi: 10.1111/j.1524- 6175.2004.03488.x
Jamerson K, Bakris GL, Dahlof B, Pitt B, Velazquez E, Gupte J, et al. Exceptional early blood pressure control rates: The ACCOMPLISH trial. Blood Press. 2007; 16: 80-86. doi: 10.1080/08037050701395571
Neutel JM, Smith DH, Weber MA, Schofield L, Purkayastha D, Gatlin M. Efficacy of combination therapy for systolic blood pressure in patients with severe systolic hypertension: The Systol-ic Evaluation of Lotrel Efficacy and Comparative Terapies (SE-LECT) study. J Clin Hypertens (Greenwich). 2005; 7: 641-646. doi: 10.1111/j.1524-6175.2005.04615.x
Moser M, Pickering T, Sowers JR. Combination drug terapy in the management of hypertension: When, with what, and how? J Clin Hypertens (Greenwich). 2000; 2: 94-98. doi: 10.7573/dic.212531
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Public Health - Open Journal (PHOJ) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.