Evaluation of the Management of Hypertension Among Adult Patients in Murang’a South Sub-county Hospital.

Abstract

Background The rising numbers of hypertension globally and in Kenya is a major public health issue. Several studies have revealed that the control of blood pressure among adult patients is suboptimal. Despite high prevalence of hypertension in Murang’a County, there has not been a single published study done on the level and pattern of its control. Study objective The main objective was to evaluate the management of hypertension among adult patients in Murang’a South Sub-County Hospital, Kenya. Methodology It was a rural hospital based cross-sectional study which was conducted in an outpatient hypertensive medical clinic in Murang’a South Sub-County Hospital. This was after seeking ethical approval from the Kenyatta National Hospital and University of Nairobi Ethics and Research Committee. Simple random sampling was employed to recruit 198 adult outpatients who were hypertensive. Customized pretested data collection forms and interview guides were used for abstracting the data on participant’s demographic characteristics, details of drugs prescribed, adherence to medication and lifestyle practices. Descriptive and exploratory analysis was carried out using STATA version14 and presented as numbers, proportions, tables and figures. Inferential statistical tests were also carried out comparing traits of participants with controlled and uncontrolled BP using Fischer’s exact or Pearson’s chi square test. Results Out of 167participants, 124(74.0%) were females. The mean age was 62 years with standard deviation of 12.1. Majority of the participants were overweight (73, 43.7%) and had gone up to primary level of education (94, 56.3%). Among the participants, 102 (61.1%) had hypertension for 1-5 years. Diuretics were the commonest at 129(77.3%) among the classes of drugs used for management of hypertension. Slightly over half of the participants were on two drug regimens (93, 56.9%) a third of which comprised of angiotensin converting enzyme inhibitors plus a diuretic (33, 34.0%). Use of triple therapy was less common at 43 (25.8%). Multivariate analysis revealed that xv the independent predictors of blood pressure control included adherence to medication (COR=4.6, 95% CI=2.09-9.95, P=0.001), salt restriction (COR 3.6 CI-1.29-10.04, P=0.014) and concurrent use of three drug combinations (COR 0.81 CI-0.67-0.98, P=0.031) The independent predictors for non-adherence to medication were lack of finances by the patients (COR=0.084, 95% CI= 0.388-0.180, P=0.001), inadequate knowledge on antihypertensive treatment (COR=0.213, CI=0.061-0.742, P=0.015), among others. Conclusion Diuretics and angiotensin converting enzyme inhibitors were the most preferred pharmacotherapy for patients in Muranga South Sub County Hospital. Blood pressure control rate was below fifty percent and the adherence rate was high. The major determinants of non-adherence were lack of finances and forgetfulness. In addition, proper lifestyle practices among the participants were inadequate.