Treatment of hypertension in Bahrain.

Abstract

To evaluate the adequacy of blood pressure (BP) control and therapeutic appropriateness of antihypertensive drug(s) prescribed, taking into consideration laboratory parameters and the presence of comorbidities, in hypertensive patients. Therapeutic audit of medical records of hypertensive patients from 9 primary care health centers in Bahrain using World Health Organization/International Society of Hypertension guidelines criteria. The recommended target BP <140/<90 mmHg was achieved in 37 (16.5%) patients with a mean BP of 126 +/- 6 / 80 +/- 5 mmHg. Groups with inadequate BP control were 15 (6.7%) with normal systolic BP (SBP) and high diastolic BP (DBP), 59 (26.3%) with high SBP and normal DBP, and 113 (50.4%) with high SBP and high DBP. Pulse pressure of the controlled group was 46.3 +/- 5.9, whereas pulse pressures of the inadequately controlled groups with BP cutoffs <140/> or =90, > or =140/<90, and > or =140/> or =90 mmHg were 37.4 +/- 6.1, 72.7 +/- 13.5, and 59.7 +/- 13.6 mmHg, respectively. Of the 281 treated hypertensive patients, 56.6% were on monotherapy; BP of patients on combination therapy versus monotherapy did not differ. The choice of antihypertensives in relation to comorbidities and laboratory findings revealed that many hypertensive patients with dyslipidemia were on beta-blockers and diuretics, 39.3% of patients with ischemic heart disease were on beta-blockers, approximately 20% of patients with hyperuricemia were on diuretics, and 27.6% and 10.4% of patients with isolated systolic hypertension were on diuretics and calcium-channel blockers, respectively. BP control was achieved in 1 of 6 treated patients. In several instances, metabolic abnormalities and comorbidities were apparently not considered while prescribing antihypertensives. A rational drug therapy approach is needed in treating hypertension to achieve better control rates.