Control of hypertension in a General Hospital Clinic, what are we achieving? - abstract

ABSTRACT

The records of 272 hypertensive patients attending the Spanish Town Hospital during the last four months of 1982 were assessed with respected to their last clinic visit. The ages ranged from 23 to 84 years, with a peak in the 6th decade. Sixty-eight per cent had been attending clinic for more than three years; 22 percent could be categorised as WHO Grade III hypertension and 19 percent as WHO Grade II. Based on either the initial blood pressure reading or a recent value while off treatment, 26 percent of patients had mild hypertension (diastolic B.P. 95-105 mm Hg Torr), 44 percent moderate (diastolic B.P. 105-110 mm Hg Torr) and 32 percent severe (diastolic B.P. 115-130 mm Hg Torr). Eight per cent had very severe hypertension (diastolic B.P. > 130 mm Hg Torr). All but 12 of the patients had been prescribed one or more of the seven antihypertensive drugs available in the Jamaica Government Medical Service. Twenty-seven per cent of subjects were on a one daily drug regimen, 41 percent on twice daily, 29 percent on thrice daily and four times daily on greater medication frequency. Thiry-two per cent were on a single drug only, 49 percent on two drugs and 19 percent on triple drug therapy. Thirty-one per cent of patients were on reserpine-containing compounds. 0nly 38 percent of patients had blood pressure levels below 150/100mm Hg Torr on the day of last clinic attendance. If the last three visits were analysed, the figure only rose to 42 percent. Control correlation best with frequency of medications - 5.7 percent of patients on once daily drugs were well controlled; 46 percent on reserpine containing compounds were well controlled and 63 percent with strokes were now well controlled. Reviewing the patients assessed as having poorly contolled hypertension, 32 percent were thought by the investigator either to be on an inappropriate drug or to have an inadequate drug dosage. Comments on patient compliance were only recorded in 24 percent of cases if the last three clinic attendances were reviewed, and drug side-effects in 15 percent. A sub-group of 100 poorly controlled pateints were interviewed to ascertain possible reasons for this. Seventy-eight had poor drug compliance, and 42 reported drug side-effects. Other reasons for non-compliance included failure of appreciation of the need for continued treatment, failure of appreciation of the risk of untreated hypertension, belief that the pressure was normal as long as they felt well, drug non-availability in hospital pharmacies and inability to afford the transportation costs of having the precription repeated monthly. Inappropriate drug therapy, inappropriate reduction of drug dosages, and being told by medical or paramedical personnel that they no longer needed treatment were also significant problems (AU)