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A survey of hypertensive practices at two community health centres in Cape Town
Brian Rayner1, Marc Blockman, Donette Baines
1Division of Hypertension, Department of Medicine, University of Cape Town, South Africa. brian.rayner@uct.ac.za
Insights
Hypertension control is challenging, with only 39.8% of patients achieving target blood pressure. Improvements are needed in medication, lifestyle changes, and cardiovascular risk reduction strategies.
Area of Science:
- Cardiology
- Public Health
Background:
- Effective hypertension management is crucial but often hindered by factors like physician non-compliance with guidelines, patient adherence issues, and suboptimal clinic care.
- Controlling high blood pressure remains a significant challenge in primary care settings.
Purpose of the Study:
- To assess the quality of hypertension care and adherence to guidelines in Western Cape community health centers (CHCs).
- To identify areas for improvement in hypertension management within CHCs.
Main Methods:
- A questionnaire was administered to 161 patients at two CHCs to gather data on demographics, physician compliance, and treatment adherence.
- Blood pressure (BP) accuracy was verified by comparing clinic readings with measurements from an approved manometer.
Main Results:
- Only 39.8% of patients achieved a blood pressure below 140/90 mmHg.
- Significant discrepancies in BP measurement accuracy were noted between the two CHCs.
- High usage of NSAIDs and tricyclic antidepressants was observed, with limited basic investigations and lifestyle interventions.
Conclusions:
- Achieving target blood pressure remains suboptimal, with only 39.8% of patients meeting the <140/90 mmHg goal.
- There are critical deficiencies in BP measurement, risk stratification, and cardiovascular risk reduction.
- Improvements are necessary in medication prescribing, consistent lifestyle advice, and avoiding contraindicated medications like NSAIDs.
Background:
Control of hypertension remains an elusive goal, but doctors' non-compliance with guidelines, patient attitudes and adherence to treatment, and poor delivery of care at clinics are important contributing factors.
Objectives:
To determine the overall quality of hypertensive care, and compliance with current hypertension guidelines at community health centres (CHCs) in the Western Cape.
Methods:
Consecutive patients attending hypertension clinics at two CHCs were selected to participate. A questionnaire was designed to determine patient demographics, doctors' compliance with hypertension guidelines, factors leading to treatment non-adherence, and delivery of care. Accuracy of blood pressure (BP) recording was evaluated by comparing the clinic BP with that measured using an approved manometer.
Results:
One hundred and sixty-one patients were evaluated, 100 from CHC 1 and 61 from CHC 2. There was no difference in both control systolic and diastolic BP measured by the hypertension nurse (147.9 v. 144.8 mmHg, p = 0.45, and 89.3 v. 85.6 mmHg, p = 0.14) respectively. All clinic BP readings were recorded to the nearest 10 mmHg mercury. The difference in both systolic and diastolic BP > 10 mmHg between the clinic and control BP was significantly greater at CHC 2 than CHC 1 (28% v. 56%, p = 0.005, and 43% v. 64%, p = 0.007) respectively. Overall, 39.8% of patients had a systolic and diastolic BP < 140 and < 90 mmHg. The mean number of antihypertensive drugs was 2.4 per patient. The use of non-steroidal anti-inflammatory drugs (NSAIDs) and tricyclic antidepressants was high at both centres, and few patients underwent basic investigations, lifestyle interventions, risk stratification or global cardiovascular risk reduction.
Conclusions:
39.8% of patients achieved a BP < 140/90 mmHg. There is significant scope for improvement in prescription of medication, application of uniform lifestyle changes, and avoidance of NSAIDs and tricyclic antidepressants. Major deficiencies were identified in BP measurement, assessment of target organ damage, risk stratification and the reduction of overall cardiovascular risk.
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