Antihypertensive Regimens in Stabilized Hypertensive Patients at a Malagasy Tertiary Hospital

Introduction Hypertension remains a major public health challenge globally, with increasing prevalence in sub-Saharan Africa. Achieving blood pressure control often requires combination antihypertensive therapy, yet data on treatment patterns in African settings remain limited. This study aimed to describe antihypertensive treatment regimens among stabilized hypertensive patients at a tertiary care center in Madagascar. Methodology A descriptive cross-sectional study was conducted at the Cardiology Department of University Hospital Morafeno Toamasina from June 30 to December 30, 2025. Consecutive sampling included patients aged ≥18 years with controlled hypertension (systolic blood pressure <140 mmHg and/or diastolic blood pressure <90 mmHg) on antihypertensive therapy for ≥3 months. Data on sociodemographic characteristics, clinical variables, cardiovascular risk factors, target organ complications, and treatment regimens were collected. Bivariate analysis with odds ratios (OR) and 95% confidence intervals (CI) was performed to identify factors associated with different treatment patterns. Results Among 126 stabilized hypertensive patients, polytherapy predominated, with 122 patients (96.83%) receiving combination therapy. Bitherapy was prescribed to 56 (44.44%) patients, tritherapy to 51 (40.48%) patients, quadritherapy to 15 (11.90%) patients, and monotherapy to only 4 (3.17%) patients. Calcium channel blockers (CCBs) were the most frequently prescribed drug class, used in 98 (77.8%) patients, followed by angiotensin receptor blockers (ARBs) in 88 (69.8%) patients and thiazide diuretics in 65 patients (51.6%). The ARB + CCB combination was the dominant bitherapy regimen, representing 32 (57.1%) of 56 bitherapy patients, while the renin-angiotensin system (RAS) blocker + CCB + thiazide backbone accounted for 29 (56.9%) of 51 tritherapy patients. Significant associations included cardiac complications with quadritherapy (OR=12.88, 95% CI: 3.61-45.89, p<0.001), high cardiovascular risk with quadritherapy (OR=4.47, 95% CI: 1.42-14.08, p=0.009) and tritherapy (OR=2.44, 95% CI: 1.15-5.18, p=0.023), absence of cardiac complications with bitherapy (OR=0.08, 95% CI: 0.01-0.63, p=0.003), absence of neurological complications with bitherapy (OR=0.31, 95% CI: 0.10-0.99, p=0.044), and absence of high cardiovascular risk with bitherapy (OR=0.19, 95% CI: 0.08-0.45, p<0.001). Conclusions This study demonstrates a rational, risk-stratified approach to antihypertensive therapy at University Hospital Morafeno Toamasina, with treatment intensity guided by cardiovascular risk and target organ complications. Cardiac complications emerged as the strongest predictor of treatment intensification. These findings provide valuable baseline data for quality improvement initiatives and highlight the feasibility of guideline-concordant hypertension management in resource-limited African settings.