Treatment of hypertension in adult patients at Ruiru sub-county hospital in Kenya

Abstract

Background Hypertension or high blood pressure has been on the rise globally. It has emerged as a major global public health issue and one of the leading causes of cardiovascular disease. Use of blood pressure lowering medications in treatment of hypertension has been shown to reduce the risk of occurrence of cardiovascular and renal events. Proper and judicious use of such medications is always recommended to ensure adequate control of blood pressure levels in hypertensive patients. Poor control of blood pressure has been reported worldwide and use of international treatment guidelines in making decisions about treatment of hypertension would result in better blood pressure control. Study Objective The main aim of this study was to assess the treatment of hypertension in adult hypertensive patients attending the Medical Outpatient Clinic at Ruiru Sub-county Hospital, Kenya. Methodology The study was a descriptive cross-sectional study involving review of records of active adult hypertensive patients on antihypertensive therapy enrolled at Ruiru Sub-county Hospital’s Medical Outpatient Clinic. Qualitative data was also obtained from prescribers through interviews. Ethical approval was granted by the Kenyatta National Hospital and University of Nairobi Ethical and Research Committee. Patient files were systematically sampled and retrieved from the hospital’s records department. A customized, pre-tested data collection tool was used to collect socio-demographic, clinical and treatment data from patient files. Descriptive and exploratory data analysis was carried out using STATA Version 10. Deductive analysis was also carried out on qualitative data from interviews. Results In this study, 247 patients’ files were reviewed and of these, 87% were female. The most commonly prescribed classes of antihypertensives were angiotensin converting enzyme inhibitors (ACEIs) at 48% of all prescriptions followed by thiazide diuretics at 40%. Among the individual drugs, Enalapril was the most frequently prescribed at 48% of all prescriptions xv followed by Hydrochlorthiazide at 40%. Two-drug regimens were the most popular at 44% of all prescriptions followed by monotherapies at 40%. Adherence rate of 82% to JNC-8 treatment guidelines was observed with most deviations occurring in treatment of Stage 1 hypertension where an adherence rate of only 45% was observed. The blood pressure (BP) control rate in this study was found to be at 46% among the hypertensive patients. The independent predictor variables influencing control of blood pressure were found to be sex of the patient, number of antihypertensives prescribed and being on a beta blocker. On a multiple logistic regression model, only the sex of the patient was found to statistically influence blood pressure control. The average monthly acquisition cost of drugs per hypertensive patient for the hospital was found to be Ksh. 87. A dose of carvedilol was found to be the most expensive at an average acquisition cost of Ksh.308 per month per prescription. The least expensive drugs were hydrochlorothiazide, furosemide, nifedipine retard and enalapril 5mg at Ksh.8, Ksh.15, Ksh.17 and Ksh.24 respectively per monthly dose per prescription. Conclusion and recommendations Prescribing patterns of antihypertensive drugs in this study were generally consistent with treatment guidelines where most patients were on ACEIs and thiazide diuretics. Adherence to latest treatment guidelines was found to be at 82%. This high level of adherence may have been responsible for the higher than usual level of BP control observed. Training and constant evaluation of prescribing practices in hospitals is still required to reduce deviations that cannot be justified