Abstract
Purpose: To evaluate doctors’ adherence to Malaysian Clinical Practice Guideline (CPG) 2008 in established hypertensive patients with cardiovascular diseases and factors associated with guideline adherence and hypertension control in Pulau Pinang Hospital, Malaysia. Methods: Prescriptions written by 13 doctors for 320 established hypertensive patients with cardiovascular diseases (25 patients per doctor) were noted on first visit. Two hundred and sixty (81%) of the enrolled 320 patients (20 patients per doctor) were followed up until the second visit. Blood pressure (BP) noted on the second visit was related to the prescription written on the first visit. Results: One hundred and ninety one (73.5%) patients received guidelines-compliant pharmacotherapy. CPG adherence had statistically significant association with left ventricular hypertrophy (LVH) (Ф =-0.241, p < 0.01) and diabetes (Ф =-0.228, p < 0.01). One hundred and fifty four (59.2 %) patients were on goal BP. Hypertension control had statistically significant association with guidelines compliance (Ф = 0.175, p < 0.01), angiotensin converting enzyme (ACE) inhibitors (Ф = 0.195, p < 0.01), diabetes (Ф = -0.148, p = 0.017), LVH (Ф = -0.153, p = 0.017) and monotherapy (Ф = - 0.168, p < 0.01). Conclusion: Prescribing practices were fairly compliant with guidelines. Doctors poorly adhered to guidelines in hypertensive patients with diabetes and LVH. Significantly better hypertension control was seen in patients who were on ACE inhibitors and guidelines-adherent therapy.Keywords: Guidelines, Adherence, Hypertension control, Diabetes, Cardiology
Highlights
The goal of hypertension therapy and control is to reduce morbidity and mortality by preventing cardiovascular, cerebrovascular and renovascular diseases
In 2004, 40.5 % of Malaysians aged ≥ 30 years were suffering from hypertension, and only 28.6 % of the treated hypertensive patients were on goal Blood pressure (BP) [7]
A large-scale study in various cardiology clinics will be needed to confirm this. Another possible reason for poor adherence with hypertension guidelines in patients with left ventricular hypertrophy might be due to the fact that only a single antihypertensive class, Angiotensin receptor blocker, is recommended by Clinical Practice Guideline (CPG) (2008) as first choice, compared to the wider range of antihypertensive classes recommended for coronary heart disease and heart failure
Summary
The goal of hypertension therapy and control is to reduce morbidity and mortality by preventing cardiovascular, cerebrovascular and renovascular diseases. Various hypertension management guidelines have been published, disseminated and regularly updated. These guidelines provide concise, evidence based recommendations to the prescribers in order to achieve optimal hypertension control [3]. No study has been conducted in Malaysia to evaluate doctors’ compliance with Malaysian clinical practice guidelines on management of hypertension (CPG 2008) [3] in patients with cardiovascular diseases. This study was conducted to evaluate doctors’ adherence to medication recommendations of Malaysian clinical practice guidelines on management of hypertension (CPG 2008). This study aimed to evaluate factors associated with guidelines adherence and hypertension control in established hypertensive patients with cardiovascular diseases
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