Evaluation of Drug Management of Essential Hypertension in the University of Cape Coast Hospital, Ghana
Hypertension and hypertension-related admissions, complications and death showed an increasing incidence and increasing rate respectively between 2004 and 2006 in the University of Cape Coast Hospital, Ghana, even though in other parts of the world like the America and Canada the management of the disease was under appreciable control. This study sought to compare the drug management of essential hypertension in the hospital with the 2007 European Society of Hypertension and European Society of Cardiology Guidelines for Arterial Hypertension Management (ESH/ESC guidelines). Two different tools (structured questionnaires and an observation check list) were used in the observational cross-sectional study carried out between February and July 2008. The first instrument consisted of two separately designed questionnaires directed at seven (7) prescribers and one hundred and twelve (112) confirmed hypertensive subjects who managed hypertension with drugs. The second instrument was an observational check list used to extract information from the clinical notes of seventy-one (71) hypertensive clients. The data collated was analyzed using Statistical Package for the Social Sciences version 12. The outcome of the analysis was then compared with the 2007 ESH/ESC guidelines. The majority of prescribers defined hypertension as a persistently raised BP beyond 140/90 mmHg for systolic and diastolic values, which was classified into mild, moderate and severe hypertension. Pharmacotherapy was initiated without following through with non-pharmacological management in mild or moderate hypertension as required by the guidelines. 71.4% of the prescribers had BP targets for treating hypertension which fell in line with the guidelines, and therefore employed diuretics, calcium channel blockers (CCBs), β-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and adrenergic-blocking antihypertensive drugs as medications for both initiation and maintenance (regular) management. CCBs had the highest use rate. In maintenance therapy, whereas monotherapy accounted for 29.6% of prescriptions, combination of two or more different classes of antihypertensive drugs accounted for 69% of prescriptions. Generally, hypertension management conformed to the 2007 ESH/ESC guidelines10 except in the diabetic hypertensive.
A Thesis submitted to the Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology In partial fulfillment of the requirements for the degree of Master of Science