Impact of the Healthy Heart Africa Program on the Adequacy of Blood Pressure Control in Kiambu County

Abstract

Background: Hypertension is one of the most important independent risk factors for cardiovascular disease worldwide. It has been steadily on the rise in Sub-Saharan Africa, where it is often insufficiently controlled in the vast majority of patients. In response to these problems, AstraZeneca, a British-Swedish Pharmaceutical Company, introduced the Healthy Heart Africa program to tackle the burden. The aim is to assess the impact of this program on the adequacy of blood pressure control. Methods: Multisite analytical retrospective cross-sectional study of hypertensive patients enrolled in outpatient clinics of two sub-county hospitals. Results: A total of 202 files were reviewed, 86 from the Healthy Heart Africa group and 116 from the non-HHA program group. The patients were predominantly female with a mean age of 59 years. Thiazide diuretics, Calcium channel blockers and Angiotensin-Converting Enzyme Inhibitors were the most prescribed class of antihypertensive drugs. Felodipine and lisinopril were the most frequently prescribed antihypertensive drugs in the Healthy heart program, whereas in the non-program group, nifedipine and enalapril were mostly preferred. Patients on the program drugs had fewer cases of CCF, peripheral neuropathy and hyperlipidemia compared to those on the non-program drugs. The prevalence of adequately controlled BP was 40.1%. There was no statistically significant difference in the BP control between the HHA program and the non-program groups (p=0.67). Diabetic patients were more likely to have uncontrolled BP (OR:0.4, p=0.03). Patients with peptic ulcers had better-controlled blood pressure (OR:2.6, p= 0.03). Conclusion: There was no significant difference in the prescribing patterns of antihypertensive drugs across the two hospitals. There was no statistically significant difference in the level of blood pressure control across patients on the HHA program’s drugs and non-program drugs. Patients who were on the program drugs had a lower prevalence of end-organ complications of diabetes and cardiovascular complications.