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Hypertension in urban Black outpatients. Who gets treated and for how long?
Insights
High blood pressure (hypertension) is prevalent among Black patients in Johannesburg. Many patients started on hypertension treatment did not continue, highlighting a need for improved care strategies.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Hypertension is a significant health concern, particularly in specific patient populations.
- Understanding initial diagnosis and treatment patterns is crucial for effective management.
Purpose of the Study:
- To analyze the prevalence of hypertension among Black patients at Johannesburg General Hospital.
- To evaluate initial treatment decisions and long-term patient adherence to anti-hypertensive therapy.
Main Methods:
- Retrospective analysis of patient data from May 1975.
- Inclusion criteria: first-time attendees at the Medical Outpatient Department.
- Data collected on blood pressure, symptoms, age, and treatment initiation/continuation.
Main Results:
- Two-thirds of Black patients had diastolic blood pressure ≥ 90 mmHg; nearly one-third received hypertension treatment.
- Treatment initiation for moderate hypertension (90-119 mmHg) was influenced by blood pressure and symptoms, not age.
- Less than one-third of patients adhered to anti-hypertensive treatment for 1 year; initial blood pressure did not predict return for treatment.
Conclusions:
- Significant hypertension prevalence and poor treatment adherence observed.
- Urgent need for standardized hospital policies for hypertension management.
- Development and evaluation of strategies to improve patient compliance are essential.
Abstract:
Two-thirds of all Black patients who attended the Medical Outpatient Department of the Johannesburg General Hospital for the first time during May 1975 had recorded diastolic blood pressures of 90 mmHg or above. Almost one-third of all patients were treated for hypertension. About half of the patients with diastolic blood pressures between 90 and 119 mmHg were started on treatment, a decision which was predicted by diastolic blood pressure, recorded symptoms and systolic blood pressure, but not by age. Four of the 50 patients with diastolic blood pressures of 120 mmHg or above were not treated. Less than one-third of all patients started on anti-hypertensive treatment were still returning for treatment at the end of 1 year. There was no difference in initial diastolic blood pressure between those patients who did and those who did not return for treatment. Hospital policies are required for standardizing initial decision-making and long-term treatment of hypertension. Strategies to improve compliance by altering health care delivery and changing patient behaviour must be developed and evaluated.