Inadequate control of blood pressure in Nigerians with diabetes

To observe the extent to which blood pressure (BP) was reduced to below 140/90 mm Hg in Nigerians with diabetes (DM), data were collected using structured questionnaire, standard sphygmomanometer, and measurement of fasting blood glucose (FBG). Two hundred forty-four subjects (85 males) aged 17-84 years with a mean duration of DM of 7.9 years and who regularly attended the clinic for diabetes at least monthly for no less than 6 months were involved. Eleven percent, 13 of the 115 treated hypertensives, had BP controlled to levels below 140/90 mm Hg. Nifedipine was the most frequently prescribed antihypertensive (44.30%), followed by alpha-methyldopa (15.7%) and then the angiotensin-converting enzyme inhibitors (ACEIs) captopril and lisinopril (11.3%). Thiazides (9.7%) or thiazide-based fixed combination tablets were prescribed in about 25% of the patients. Eighteen percent were on more than one antihypertensive concurrently and dosages were often at threshold. The majority of the hypertensives with BP below 140/90 mm Hg were on thiazide-based medications. In 152 participants, the presence of hypertension did not affect glycemic control (chi2 = 4.41, df = 2, P = .1) observed and 60% of the entire population had FBC < or = 7.9 mmol/L. Lack of access to care does not explain these findings and suggests an area for improvement. Fortunately, the data also show that thiazides were associated with better control of BP at a cost that was affordable without jeopardizing diabetic control.