Antihypertensive Prescription Patterns of Nonspecialist General Practitioners in Lagos, Nigeria
DOI:
https://doi.org/10.60787/njgp.v14i1.128Keywords:
prescription, nonspecialist physicians, Antihypertensive medicationsAbstract
Context: Concerns have been expressed about the antihypertensive prescription patterns of nonspecialist physicians who care for the majority of patients with hypertension in developing countries.
Aims: The aim of the study was to assess the antihypertensive prescription pattern of nonspecialist general medical practitioners in Lagos, Nigeria.
Settings and Design: This was a cross‑sectional survey carried out among nonspecialist general medical practitioners within Lagos State, Nigeria.
Subjects and Methods: A total of 132 doctors completed questionnaires about their demographics, duration and location of practice, and antihypertensive prescription patterns.
Statistical Analysis Used: Continuous variables are presented as means or medians while categorical variables are presented as percentages. Comparison between means was done using the Student’s t‑test, while comparison between percentages was carried out using Chi‑square test.
Results: Majority (61.2%) considered thiazide diuretics their first choice antihypertensive. The most frequently prescribed antihypertensives were calcium channel blockers(CCBs) (88.6%), thiazide diuretics(85.6%), and angiotensin converting enzyme inhibitors(ACEIs) (84.8%). These were also the most frequently combined with the CCB‑thiazide diuretic combination being the most frequently prescribed (81.1%) followed by the ACEIs – thiazide diuretic combination (65.9%). The most frequently considered factors when prescribing antihypertensive medications were side effects of the medications (92.4%), additional benefits beyond blood pressure (BP) lowering (90.9%), patients’ BP at the time of presentation (89.4%), dosage frequency of the drug (87.9%), and available scientific evidence for efficacy in lowering BP(87.1%).
Conclusions: The antihypertensive prescription pattern of nonspecialist physicians practicing in Lagos aligns with current hypertension treatment guidelines.
Downloads
References
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: Analysis of worldwide data. Lancet 2005;365:217‑23.
Hansson L. The benefits of lowering elevated blood pressure: A critical review of studies of cardiovascular morbidity and mortality in hypertension. J Hypertens 1996;14:537‑44.
Neal B, MacMahon S, Chapman N; Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood‑pressure‑lowering drugs: Results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet 2000;356:1955‑64.
Bromfield SG, Bowling CB, Tanner RM, Peralta CA, Odden MC, Oparil S, et al. Trends in hypertension prevalence, awareness, treatment, and control among US adults 80 years and older, 1988‑2010. J Clin Hypertens (Greenwich) 2014;16:270‑6.
Bersamin A, Stafford RS, Winkleby MA. Predictors of hypertension awareness, treatment, and control among Mexican American women and men. J Gen Intern Med 2009;24 Suppl 3:521‑7.
Altun B, Arici M, Nergizoglu G, Derici U, Karatan O, Turgan C, et al. Prevalence, awareness, treatment and control of hypertension in Turkey (the PatenT study) in 2003. J Hypertens 2005;23:1817‑23.
Wu Y, Huxley R, Li L, Anna V, Xie G, Yao C, et al. Prevalence, awareness, treatment, and control of hypertension in China: Data from the China National Nutrition and Health Survey 2002. Circulation 2008;118:2679‑86.
Pereira M, Lunet N, Azevedo A, Barros H. Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries. J Hypertens 2009;27:963‑75.
Salako BL, Ajose FA, Lawani E. Blood pressure control in a population where antihypertensives are given free. East Afr Med J 2003;80:529‑31.
Isezuo AS, Njoku CH. Blood pressure control among hypertensives managed in a specialised health care setting in Nigeria. Afr J Med Med Sci 2003;32:65‑70.
Iseuzo SA, Omotoso AB, Gaye A, Corrah T, Araoye MA. One year survival among sub‑Saharan Africans with hypertensive heart failure. Trop Cardiol 2000;26:57‑60.
Sengul S, Erdem Y, Akpolat T, Derici U, Sindel S, Karatan O, et al.Controlling hypertension in Turkey: Not a hopeless dream. Kidney Int Suppl 2013;3:326‑31.
Mortality after 10 1/2 years for hypertensive participants in the Multiple Risk Factor Intervention Trial. Circulation 1990;82:1616‑28.
Morisky DE, Levine DM, Green LW, Shapiro S, Russell RP, Smith CR. Five‑year blood pressure control and mortality following health education for hypertensive patients. Am J Public Health 1983;73:153‑62.
Iseuzo SA, Opara TC. Hypertension awareness among Nigerian hypertensives in a tertiary health institution. Sahel Med J 2000;3:93‑7.
Jafar TH, Levey AS, Jafary FH, White F, Gul A, Rahbar MH, et al.Ethnic subgroup differences in hypertension in Pakistan. J Hypertens 2003;21:905‑12.
Oliveria SA, Lapuerta P, McCarthy BD, L’Italien GJ, Berlowitz DR, Asch SM. Physician‑related barriers to the effective management of uncontrolled hypertension. Arch Intern Med 2002;162:413‑20.
Inui TS, Yourtee EL, Williamson JW. Improved outcomes in hypertension after physician tutorials. A controlled trial. Ann Intern Med 1976;84:646‑51.
Pai PG, Shenoy J, Sanji N. Prescribing patterns of antihypertensive drugs in a South Indian tertiary care hospital. Drug Invent Today 2011;3:38‑40.
Etuk E, Isezuo SA, Chika A, Akuche J, Ali M. Prescription pattern of anti‑hypertensive drugs in a tertiary health institution in Nigeria. Ann Afr Med 2008;7:128‑32.
Almas A, Ur Rehman Iqbal S, Ehtamam A, Khan AH. Spectrum of antihypertensive therapy in South Asians at a tertiary care hospital in Pakistan. BMC Res Notes 2011;4:318.
AxonRN, Nietert PJ, EganBM. Antihypertensive medication prescribing patterns in a university teaching hospital. J Clin Hypertens (Greenwich) 2010;12:246‑52.
Jafar TH, Jessani S, Jafary FH, Ishaq M, Orakzai R, Orakzai S, et al.General practitioners’ approach to hypertension in urban Pakistan: Disturbing trends in practice. Circulation 2005;111:1278‑83.
Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB. Designing Clinical Research. 4th ed. Wolters Kluwer/Lippincott Williams and Wilkins; 2013.
Onuoha O. (Partnerships and Communications Officer‑African Public Health Alliance 15%+Campaign). Media/Public Statement: Conference of African Ministers of Education Abuja; 25 April, 2012. Available from: http://www.who.int/workforcealliance/media/news/2012/African
MinistersofEducation_statement.pdf. [Last accessed on 2015 Mar 17].
Ogundipe S, Obinna C, Olawale G. Shortage of Medical Personnel: Tougher Times Ahead for Nigerians (2). The Vanguard Newspapers; 3rd February, 2015. Available from: http://www.vanguardngr.
com/2015/02/shortage-medical-personnel-tougher‑times-aheadnigerians‑2. [Last accessed on 2015 Mar 17].
Whitworth JA, Chalmers J. World health organisation‑international society of hypertension (WHO/ISH) hypertension guidelines. Clin Exp Hypertens 2004;26:747‑52.
James PA, Oparil S, Carter BL, Cushman WC, Dennison‑Himmelfarb C, Handler J, et al. 2014 evidence‑based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311:507‑20.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr., et al. The Seventh Report of the Joint National Committee on Prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. JAMA 2003;289:2560‑72.
Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial
Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007;25:1105‑87.
Okonta JM, Nduka V, Idodo VE. Prescribing pattern of antihypertensive and antidiabetic agents in a secondary healthcare institution in Nigeria. J Pharm Sci Res 2013;5:12‑7.
Ukwe CV, Ubaka CM. Antihypertensive drug prescribing in a tertiary hospital in Eastern Nigeria. Trop J Pharm Res 2012;11:297‑305.
Ojji DB, Ajayi SO, Mamven MH, Alfa J, Albertino D. Pattern of prescription of anti‑hypertensive medications in a tertiary health care facility in Abuja, Nigeria. Ethn Dis 2013;23:480‑3.
Phillips CO, Kashani A, Ko DK, Francis G, Krumholz HM. Adverse effects of combination angiotensin II receptor blockers plus angiotensin‑converting enzyme inhibitors for left ventricular
dysfunction: A quantitative review of data from randomized clinical trials. Arch Intern Med 2007;167:1930‑6.
Lakhdar R, Al‑Mallah MH, Lanfear DE. Safety and tolerability of angiotensin‑converting enzyme inhibitor versus the combination of angiotensin‑converting enzyme inhibitor and angiotensin receptor blocker in patients with left ventricular dysfunction: A systematic review and meta‑analysis of randomized controlled trials. J Card Fail 2008;14:181‑8.
Moore MA. Choosing initial antihypertensive drug therapy for the uncomplicated hypertensive patient. J Clin Hypertens (Greenwich) 2001;3:37‑44.
Published
Issue
Section
License
Copyright (c) 2024 Nigerian Journal of General Practice
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
How to Cite
