An evaluation of the management of hypertension among diabetic and non-diabetic patients at the Kenyatta national hospital

Abstract

Background: Globally, there are about 972 million adults with hypertension and this figure is expected to rise to about 1.56 billion by the year 2025. Diabetic hypertensive patients are more vulnerable to cardiovascular and renal complications compared to nondiabetic hypertensive patients. Nevertheless, optimal blood pressure control is paramount in these two patient populations. Broad Objective: To evaluate the management of hypertension among diabetic and nondiabetic patients at the Kenyatta National Hospital, Medical Outpatient Clinic. Methodology: A tertiary hospital based cross-sectional study was carried. This study comprised of two study groups: diabetic hypertensive patients and non-diabetic hypertensive patients. A total of 96 adult patients were enrolled into the study, with each group comprising of 48 patients. Convenience sampling method was used to select the patients. Data Collection and Analysis: Patient interviews were conducted and additional data was obtained from the patient's hospital file. Data was ana lysed using SPSS version 19.0 software. Results were presented in form of percentages, frequency distribution tables and graphs. Measures of central tendencies were calculated for the social demographic data and cross tabulations were also done to compare data between the two study groups. The level of significance was determined using Pearson chi square set at 0.05 and pvalues ~ 0.05 were considered to be statistically significant. Results: Of the 96 patients enrolled, the male to female ratio was 1:2, the mean age was 57 years (±11.1) and the mean duration of hypertension was 7.7 years (±6.3). Overall, 70% of the entire study population had inadequate blood pressure control. Among the diabetic patients, 75% had inadequate blood pressure control compared to 65% of the non-diabetic patients. Ninety percent of the diabetic patients were unaware of their ideal blood pressure target.compared to 92% of the non-diabetic patients. Equal numbers of patients (54%) from both the study groups were unaware of the duration for their antihypertensive drug therapy. Most of the patients reported to be able to maintain a

constant supply of their blood pressure medications and attend all their clinic appointments. Even so, 52% of the diabetic patients and 73% of the non-diabetic patients, reported to sometimes miss to take some of the doses oftheir blood pressure medications. More than 80% of the patients reported to be adherent to at least 4 lifestyle modification strategies, however, most of them still had inadequate blood pressure control. Three quarters of the diabetic patients were on 2 or more antihypertensive drugs compared to 98% of the non-diabetic patients. The most commonly prescribed antihypertensive drug class in the two study groups was angiotensin converting enzyme inhibitors / angiotensin receptor blockers. Conclusion: Only 30% of the entire study population was found to have adequate BP control. The management of hypertension, therefore, is still a challenge to both diabetic and non-diabetic patients and is largely associated with the negative influence of patient related factors. There was, however, no statistically significant difference of this observation between the two study groups. Recommendations: Patient involvement and understanding on hypertension is essential in the management of hypertension. There is, therefore, need for continuous patient education and counseling in order to improve the overall management of hypertension.