Blood Pressure Control Status of Hypertensive Patients Attending an Out-Patient Specialist Clinic in Ghana
Hypertension is a major cardiovascular disease risk factor, yet with availability of innovative and effective medical therapy its control is still a huge challenge in sub-Saharan Africa including Ghana. We undertook a cross-sectional study among hypertensive patients attending an out-patient specialist clinic in a semi-urban community in Ghana to determine blood pressure control rate and characterize antihypertensive medication use among the patients. Three hundred and fifty four (354) hypertensive patients aged between 23 - 79 years with the mean age (± SD) of 46.9 (± 12.1) years were studied. The mean duration of hypertension was 5.5 years (range 1 month to 45 years). Two hundred and sixteen (61.02%) of the patients were prescribed one antihypertensive, 53(14.97%) were prescribed two antihypertensives and 3 (0.85%) were prescribed three antihypertensives; with antihypertensive class being calcium channel blockers in 76.2% of the patients, beta-blockers in 11.4% of the patients, centrally acting agents in 6.9 % of the patients, and angiotensin-converting enzyme (ACE) inhibitors in 3.0% of the patients. The commonest calcium channel blocker, ACE inhibitor and beta-blocker prescribed were nifedipine, lisinopril, and atenolol respectively. One hundred and thirty-eight (39.0%) patients had adequate blood pressure control. Among patients with poor blood pressure control, 74 (34.3%) had blood pressure >160/l00mmHg (hypertension stage II). In conclusion, our study shows that majority of the hypertensive patients studied had poorly controlled blood pressure which indicates a higher future burden of cardiovascular diseases.
Hypertension, Blood Pressure, Control Rate, Antihypertensive, Ghana
Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: a systematic review. J Hypertens 2004; 22: 11–19.
Awuah RB, Anarfi JK, Agyemang C, Ogedegbe G, Aikins A de-Graft. Prevalence, awareness, treatment and control of hypertension in urban poor communities in Accra, Ghana. J Hypertens 2014; 32: 1203–10. doi:10.1097/HJH.0000000000000165.
Anion J. Mortality from stroke and other complications of hypertension in Accra Ghana. W Afr J Med 1984; 3: 85–90.
Cappuccio FP, Micah FB, Emmett L, Kerry SM, Antwi S, Martin-Peprah R, et al. Prevalence, detection, management, and control of hypertension in Ashanti, West Africa. Hypertension 2004; 43: 1017–22. doi:10.1161/01.HYP.0000126176.03319.d8.
Owusu IK, Boakye YA. Prevalence and Aetiology of Heart Failure in Patients Seen at a Teaching Hospital in Ghana. J Cardiovasc Dis Diagn 2013.
Oladapo OO, Salako L, Sadiq L, Shoyinka K, Adedapo K, Falase AO. Target-organ damage and cardiovascular complications in hypertensive Nigerian Yoruba adults: a cross-sectional study: cardiovascular topics. Cardiovasc J Afr 2012; 23: 379–384.
Bosu WK. Epidemic of hypertension in Ghana: a systematic review. BMC Public Health 2010; 10: 418. doi:10.1186/1471-2458-10-418.
Agyemang C. Rural and urban differences in blood pressure and hypertension in Ghana, West Africa. Public Health 2006; 120: 525–533.
Addo J, Amoah AG, Koram KA. The changing patterns of hypertension in Ghana: a study of four rural communities in the Ga District. Ethn Dis 2006; 16: 894–899.
Owusu IK. Causes Of Heart Failure As Seen In Kumasi Ghana. Internet J Third World Med 2007; 4.
Plange-Rhule J, Phillips R, Acheampong JW, Saggar-Malik AK, Cappuccio FP, Eastwood JB. Hypertension and renal failure in Kumasi, Ghana. J Hum Hypertens 1999; 13.
Amoah AGB, Kallen C. Aetiology of heart failure as seen from a National Cardiac Referral Centre in Africa. Cardiology 2000; 93: 11–18.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003; 42: 1206–1252.
Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997; 349: 1269–76. doi:10.1016/S0140-6736(96)07493-4.
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: 327.
Brundtland GH. Reducing risks to health, promoting healthy life. Jama 2002; 288: 1974–1974.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. The Lancet 2005; 365: 217–223.
Pobee JO. Community-based high blood pressure programs in sub-Saharan Africa. Ethn Dis 1992;3:S38–45.
Akinkugbe OO. Non-communicable diseases in Nigeria, the next epidemics: Nigeria preparedness. Third Bienn Abayomi Bamidele Meml Lect Niger J Clin Pr 2000; 3: 37–42.
Oo A. Epidemiology of cardiovascular disease in developing countries. J Hypertens Suppl Off J Int Soc Hypertens 1990; 8: S233-8.
Adedoyin RA, Mbada CE, Balogun MO, Martins T, Adebayo RA, Akintomide A, et al. Prevalence and pattern of hypertension in a semiurban community in Nigeria. Eur J Cardiovasc Prev Rehabil Off J Eur Soc Cardiol Work Groups Epidemiol Prev Card Rehabil Exerc Physiol 2008; 15: 683–7.
Kadiri S. Tackling cardiovascular disease in Africa. BMJ 2005; 331: 711–2. doi:10.1136/bmj.331.7519.711.
Chobanian AV. Control of hypertension--an important national priority. N Engl J Med 2001; 345: 534–5. doi:10.1056/NEJM200108163450709.
Jones JK, Gorkin L, Lian JF, Staffa JA, Fletcher AP. Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population. BMJ 1995; 311: 293–5.
Swales JD. Current clinical practice in hypertension: the EISBERG (Evaluation and Interventions for Systolic Blood pressure Elevation-Regional and Global) project. Am Heart J 1999; 138: 231–7.
Salako BL, Ogah OS, Adebiyi AA, Oladapo OO, Aje A, Adebayo AK, et al. Blood pressure control and left ventricular hypertrophy in hypertensive Nigerians. Ann Afr Med 2009; 8.
Ayodele OE, Alebiosu CO, Salako BL. Differential control of systolic and diastolic blood pressure in blacks with essential hypertension. J Natl Med Assoc 2004; 96: 310–4.
Isezuo AS, Njoku CH. Blood pressure control among hypertensives managed in a specialised health care setting in Nigeria. Afr J Med Med Sci 2003; 32: 65–70.
Rayner B, Schoeman HS. A cross-sectional study of blood pressure control in hypertensive patients in general practice (the I-TARGET study). Cardiovasc J Afr 2009; 20: 224–7.
Addo J, Agyemang C, Smeeth L, Aikins A de-Graft, Edusei AK, Ogedegbe O. A Review of Population-Based Studies on Hypertension in Ghana. Ghana Med J 2012; 46: 4.
Burt VL, Cutler JA, Higgins M, Horan MJ, Labarthe D, Whelton 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: 60–9.
Norman R, Gaziano T, Laubscher R, Steyn K, Bradshaw D, South African Comparative Risk Assessment Collaborating Group. Estimating the burden of disease attributable to high blood pressure in South Africa in 2000. South Afr Med J Suid-Afr Tydskr Vir Geneeskd 2007; 97: 692–8.
Opie LH, Seedat YK. Hypertension in sub-Saharan African populations. Circulation 2005; 112: 3562–3568.
Wolf-Maier K, Cooper RS, Banegas JR, et al. HYpertension prevalence and blood pressure levels in 6 european countries, canada, and the united states. JAMA 2003; 289: 2363–9. doi:10.1001/jama.289.18.2363.
Edwards R, Unwin N, Mugusi F, Whiting D, Rashid S, Kissima J, et al. Hypertension prevalence and care in an urban and rural area of Tanzania. J Hypertens 2000; 18: 145–152.
Rayner B. Combination therapy in hypertension. South Afr Fam Pract 2007; 49: 22–4. doi:10.1080/20786204.2007.10873513.
Achieng’ L, Joshi MD, Ogola EN, Karari E. Adequacy of blood pressure control and level of adherence with antihypertensive therapy. East Afr Med J 2009;86:499–506. doi:10.4314/eamj.v86i11.55826.
Mutua EM, Gitonga MM, Mbuthia B, Muiruri N, Cheptum JJ, Maingi T. Level of blood pressure control among hypertensive patients on follow-up in a Regional Referral Hospital in Central Kenya. Pan Afr Med J 2014; 18. doi:10.11604/pamj.2014.18.278.4308.
Agyemang C, Bruijnzeels MA, Owusu-Dabo E. Factors associated with hypertension awareness, treatment, and control in Ghana, West Africa. J Hum Hypertens 2005; 20: 67–71. doi:10.1038/sj.jhh.1001923.
Adebolu FA, Naidoo M. Blood pressure control amongst patients living with hypertension presenting to an urban district hospital outpatient clinic in KwaZulu-Natal. Afr J Prim Health Care Amp Fam Med 2014; 6: 1–6. doi:10.4102/phcfm.v6i1.572.
Mensah GA. Epidemiology of stroke and high blood pressure in Africa. Heart 2008; 94: 697–705. doi:10.1136/hrt.2007.127753.
Marfo AF, Owusu-Daaku FT, Addo MO, Saana II. Ghanaian hypertensive patients understanding of their medicines and life style modification for managing hypertension. Int J Pharm PharmSci 2014; 6: 165–170.
Jolles EP, Padwal RS, Clark AM, Braam B. A qualitative study of patient perspectives about hypertension. ISRN Hypertens 2013; 2013.
Neaton JD, Wentworth D. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Overall findings and differences by age for 316,099 white men. Multiple Risk Factor Intervention Trial Research Group. Arch Intern Med 1992; 152: 56–64.
Stokes J 3rd, Kannel WB, Wolf PA, Cupples LA, D’Agostino RB. The relative importance of selected risk factors for various manifestations of cardiovascular disease among men and women from 35 to 64 years old: 30 years of follow-up in the Framingham Study. Circulation 1987; 75: V65-73.
Franklin SS, Larson MG, Khan SA, Wong ND, Leip EP, Kannel WB, et al. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation 2001; 103: 1245–9.
Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA 1991; 265: 3255–64.
Staessen JA, Gasowski J, Wang JG, Thijs L, Hond ED, Boissel J-P, et al. Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. The Lancet 2000; 355: 865–72. doi:10.1016/S0140-6736(99)07330-4.
Liu L, Wang JG, Gong L, Liu G, Staessen JA. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertens 1998; 16: 1823–9.
ESH/ESC Task Force for the Management of Arterial Hypertension. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 2013; 31: 1925–38. doi:10.1097/HJH.0b013e328364ca4c.
Ragot S, Sosner P, Bouche G, Guillemain J, Herpin D. Appraisal of the knowledge of hypertensive patients and assessment of the role of the pharmacists in the management of hypertension: results of a regional survey. J Hum Hypertens 2005; 19: 577–84. doi:10.1038/sj.jhh.1001859.
Karaeren H, Yokusoglu M, Uzun S, Baysan O, Koz C, Kara B, et al. The effect of the content of the knowledge on adherence to medication in hypertensive patients. Anadolu Kardiyol Derg 2009; 9: 183–188.
Flack JM, Neaton J, Grimm R, Shih J, Cutler J, Ensrud K, et al. Blood pressure and mortality among men with prior myocardial infarction. Circulation 1995; 92: 2437–2445.