W O Erhun1, E O Agbani, E E Bolaji. 1. Department of Clinical Pharmacy and Pharmacy Administration, Obafemi Awolowo University, Ile-Ife, Nigeria.
Abstract
OBJECTIVE: To gain insight into the control of hypertension and to suggest possible interventions within a selected black population treated with combination diuretics (amiloride 5mg + hydrochlorothiazide 50mg) and/or methyldopa for uncomplicated essential hypertension. DESIGN AND SETTING: A 2-year retrospective cohort review of the outpatient medical records of a State Comprehensive Health Center in southwestern Nigeria. Free primary health service, including free drugs, is provided in the health facility for all patients. PATIENTS AND METHODS: The study population included outpatients continuously registered at the health centre between June 1999 and June 2002, aged >/=36 years, with 2-6 months' history of hypertension or newly diagnosed hypertension and followed for 6 months after diagnosis. They were managed with methyldopa 250mg and/or combination diuretics (amiloride 5mg + hydrochlorothiazide 50mg) or a combination in two different regimens for at least 6 months. Participating physicians measured patients' blood pressure with a validated device and recorded demographics and medical history. Patients were considered to have hypertension if systolic blood pressure was >140mm Hg and diastolic blood pressure was >90mm Hg. RESULTS: Bivariate regression analysis revealed that systolic blood pressure contributed moderately to the variances of drug and regimen decisions. Among the 128 hypertensive patients with average and modal ages of 57.2 +/- 11.1 and 60 years, respectively, only 37.5% had controlled blood pressure after the first treatment; with 10.2% and 4% of the study population needing, respectively, three and five re-treatments within 6 months to achieve target blood pressure levels. CONCLUSION: A high percentage of uncontrolled blood pressure and re-treatment rates were observed within the study population. A more aggressive management strategy that individualises diuretic therapy by titrating dose to systolic blood pressure and prioritises lifestyle modification in middle-aged and elderly black hypertensive patients is suggested.
OBJECTIVE: To gain insight into the control of hypertension and to suggest possible interventions within a selected black population treated with combination diuretics (amiloride 5mg + hydrochlorothiazide 50mg) and/or methyldopa for uncomplicated essential hypertension. DESIGN AND SETTING: A 2-year retrospective cohort review of the outpatient medical records of a State Comprehensive Health Center in southwestern Nigeria. Free primary health service, including free drugs, is provided in the health facility for all patients. PATIENTS AND METHODS: The study population included outpatients continuously registered at the health centre between June 1999 and June 2002, aged >/=36 years, with 2-6 months' history of hypertension or newly diagnosed hypertension and followed for 6 months after diagnosis. They were managed with methyldopa 250mg and/or combination diuretics (amiloride 5mg + hydrochlorothiazide 50mg) or a combination in two different regimens for at least 6 months. Participating physicians measured patients' blood pressure with a validated device and recorded demographics and medical history. Patients were considered to have hypertension if systolic blood pressure was >140mm Hg and diastolic blood pressure was >90mm Hg. RESULTS: Bivariate regression analysis revealed that systolic blood pressure contributed moderately to the variances of drug and regimen decisions. Among the 128 hypertensivepatients with average and modal ages of 57.2 +/- 11.1 and 60 years, respectively, only 37.5% had controlled blood pressure after the first treatment; with 10.2% and 4% of the study population needing, respectively, three and five re-treatments within 6 months to achieve target blood pressure levels. CONCLUSION: A high percentage of uncontrolled blood pressure and re-treatment rates were observed within the study population. A more aggressive management strategy that individualises diuretic therapy by titrating dose to systolic blood pressure and prioritises lifestyle modification in middle-aged and elderly black hypertensivepatients is suggested.
Authors: D R Berlowitz; A S Ash; E C Hickey; R H Friedman; M Glickman; B Kader; M A Moskowitz Journal: N Engl J Med Date: 1998-12-31 Impact factor: 91.245
Authors: W D Hall; C M Ferrario; M A Moore; J E Hall; J M Flack; W Cooper; J D Simmons; B M Egan; D T Lackland; M Perry; E J Roccella Journal: Am J Med Sci Date: 1997-04 Impact factor: 2.378
Authors: B J Materson; D J Reda; W C Cushman; B M Massie; E D Freis; M S Kochar; R J Hamburger; C Fye; R Lakshman; J Gottdiener Journal: N Engl J Med Date: 1993-04-01 Impact factor: 91.245
Authors: L Hansson; A Zanchetti; S G Carruthers; B Dahlöf; D Elmfeldt; S Julius; J Ménard; K H Rahn; H Wedel; S Westerling Journal: Lancet Date: 1998-06-13 Impact factor: 79.321