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Managing hypertension with combination diuretics and methyldopa in nigerian blacks at the primary care level
W O Erhun1, E O Agbani, E E Bolaji
1Department of Clinical Pharmacy and Pharmacy Administration, Obafemi Awolowo University, Ile-Ife, Nigeria.
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.
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