Abstract
IntroductionImplementation of lifestyle modification (LM), a cornerstone of hypertension control has been reported to be more challenging than pharmacotherapy. We studied the LM prescription patterns of general medical practitioners (GPs) in Lagos, Nigeria for blood pressure control.MethodsGPs were assessed using anonymous self-administered questionnaire on the prescription of salt restriction, weight management, cessation of tobacco use, physical exercise, and consumption of DASH-like diet for blood pressure control. Chi-square, Fisher's exact and Student t-test were used to test for differences as appropriate. Logistic regression model was constructed to identify the determinants of adequate LM prescription.ResultsA total of 213 GPs (38% females) participated in the survey. LM prescription was over 90% for the following: salt restriction (96.7%), tobacco cessation (94.8%), weight management (94.4%). The remaining were 81.2% and 75.1% for healthy diet and physical activity respectively. The median LM prescription score (of the GPs) was 18.0 [15.0-50.0]. The single significant predictor of adequate LM prescription was total patient load of the GPs (AOR:0.98, 95% CI: 0.97-0.99, p=0.006). Eleven (5.2%), 190 (89.2%), and 12 (5.6%) GPs initiated LM prescription at blood pressure values >140/90mmHg, =140/90mmHg and <140/90mmHg respectively. LM initiation at BP <140/90mmHg was associated with female gender, shorter work experience, working in tertiary care facility and ignorance about hypertension prevention (p<0.05).ConclusionLM is widely prescribed for the treatment of hypertension, but rarely prescribed for its prevention in Nigeria. Interventions to reduce physician's patient load may engender improved LM prescription.
Highlights
Unhealthy lifestyle including unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol may cause blood pressure (BP) elevation as well as initiate other cardiovascular risk factors such as diabetes, dyslipidemia and excessive body weight [1,2]
general medical practitioners (GPs) practicing in facilities affiliated to tertiary care facilities prescribed lifestyle modification (LM) for BP control more than those practicing in primary and secondary care facilities
Interventions to reduce physicians' patient load may engender improved LM prescription and HTN care by GPs in Nigeria
Summary
Unhealthy lifestyle including unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol may cause blood pressure (BP) elevation as well as initiate other cardiovascular risk factors such as diabetes, dyslipidemia and excessive body weight [1,2]. Civilization breeds unhealthy lifestyle noted in physical inactivity, as well as in transition to more processed foods from staple cereals, vegetables, and fruits [1,2] All these are drivers of increasing hypertension (HTN) prevalence and poor BP control. Appropriate lifestyle modification (LM) might delay or prevent the onset of HTN in normotensive individuals [5,6] It might prevent the initiation of drug therapy in grade 1 hypertension [5,6]. Since 2013, class IA recommendation status was assigned to LM by the European hypertension guidelines [5] These lifestyle interventions include weight control, cessation of tobacco use, regular physical exercise, moderation of alcohol intake, salt restriction, and consumption of a Dietary Approaches to Stop Hypertension (DASH)-like diet [1,5,6,8]. The aim of this study was to evaluate the LM prescription patterns for BP control by Lagos based general medical practitioners (GPs)
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