Abstract
BackgroundHypertension is as prevalent in many developing countries, as in the developed world and is the leading cause of cardiovascular morbidity and mortality in Africa. The control of hypertension in this resource limited setting is inadequate, a situation that translates into poorer outcomes in form of increasing incidences of stroke, heart failure, kidney failure and therefore early cardiovascular death.MethodsThis was a chart review of all the patients seen during the months of September 2012 to February 2013. We determined the level of blood pressure control, basic investigations documented as well as the choice of hypertensive treatment among patients attending a hypertension clinic in a national referral hospital, Mulago.ResultsOf the 741 patients whose charts were reviewed the median age was 60 years, Inter quartile range (IQR) was 51–71. Six hundred forty-two (86.6%) were females. Blood pressure (BP) control defined as BP lowering to at least 140/90 was seen in only 198 (26.7%) patients. Biophysical measurement documentation was very low especially for waist and hip circumference at 0.3%. Majority of patients, 476 (64.2%) had at least one documented investigation for the complications of hypertension. Only 103 (13.9%) had all investigations documented in their charts. The investigations included; complete blood count (CBC), urinalysis, renal function tests (RFTs), Chest X-Ray (CXR), echocardiography (Echo) and electrocardiography (ECG). The commonly documented investigations were RFTs (45.5%), ECG (45.2%) and Echo (44.2%). The commonly prescribed anti hypertensive medications were; Angiotensin receptor blockers (ARBs)/Angiotensin converting enzyme inhibitors (ACEI) (72.74%), calcium channel blockers (72.3%) and thiazide diuretics (68.6%). Majority of patients were receiving three anti hypertensive medications 313 (42.2%), with 149 (43.6%) of these, on an ACEI/ARB, a calcium channel blocker and a thiazide diuretic.ConclusionBlood pressure control is suboptimal in a tertiary clinic setting at Mulago hospital and documentation of investigations is inadequate. ARB/ACEI, Calcium channel blockers and thiazide diuretics were the commonly prescribed anti hypertensive medications. There is a great need to investigate for renal and cardiac complications as well as exploring reasons for inadequate blood pressure control and consider appropriate interventions to avert bad outcomes.
Highlights
Hypertension is as prevalent in many developing countries, as in the developed world and is the leading cause of cardiovascular morbidity and mortality in Africa
Blood pressure less than 140/90 mmHg Blood pressure control as defined as at least 140/90 was seen in only 198 (26.7%) of the patients whose charts were reviewed
Blood pressure control was better among female patients
Summary
Hypertension is as prevalent in many developing countries, as in the developed world and is the leading cause of cardiovascular morbidity and mortality in Africa. The control of hypertension in this resource limited setting is inadequate, a situation that translates into poorer outcomes in form of increasing incidences of stroke, heart failure, kidney failure and early cardiovascular death. Hypertension is the leading cause of cardiovascular morbidity and mortality in Africa where it affects young and active adults [4, 5]. The control of hypertension in this resource limited setting is likely to be inadequate, a situation that translates into poorer outcomes in the form of Ssinabulya et al BMC Res Notes (2016) 9:487 increasing incidences of stroke, heart failure, kidney failure and cardiovascular death [6,7,8]. A meta analysis done by Lewington et al demonstrated that BP reduction of 20/10 is associated with more than a twofold reduction in stroke death rate, and with twofold differences in the death rates from ischemic heart disease and from other vascular causes. [10]
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