Medication management of hypertension and diabetes mellitus at two referral health institutions in Bayelsa State, Nigeria: a prospective study

Abstract

Despite the call for timely diagnosis and management of hypertension (HTN) and diabetes mellitus (DM), recent developments in outcomes of their medication management in concerned patients remain largely unimpressive. This study is aimed at assessing the impact of pharmacist-led health educational intervention on outcomes of medication management as well as drug utilization among hypertensive and/or diabetic patients attending clinics at the Federal Medical Center and Niger Delta University Teaching Hospital in Bayelsa State, Nigeria. Following ethical approval, 430 hypertensive and/or diabetic patients were recruited and studied prospectively. Their blood pressure (BP), fasting plasma glucose (FPG), and drug utilization pattern (DUP) were first assessed after which patient- and healthcare professional- (comprising Physicians, Pharmacists, and Nurses) focused health-educational intervention was done. Subsequently, they were followed up for a period of 10 months. The parameters (including BP, FPG, DUP, and prevalence of resistant HTN) for those patients (n = 307) not lost to follow-up were determined and compared with their pre-intervention data. Data generated were analyzed using descriptive statistics, Student t-test, Fisher’s Exact and Chi-square tests. A 2-tailed p-value < 0.05 was considered significant. In this study, 66.1, 26.1, and 7.8% of the cohort had HTN alone, comorbid HTN and diabetes, and diabetes alone, respectively. Proportion of hypertensive patients with controlled BP increased from 31.5% before intervention to 51.2% after intervention (p < 0.0001) while the prevalence of resistant HTN reduced from 34.6% to 27.9% correspondingly. There was no significant difference in the proportion of diabetic patients with controlled FPG before and after intervention (p > 0.05). Diuretics (37.8% vs. 31.4%), calcium channel blockers (23.9% vs. 22.0%), and angiotensin converting enzyme inhibitors (16.4% vs. 16.4%) were the most prescribed antihypertensive drugs both pre- and postintervention, respectively. The most prescribed antidiabetic agents were the biguanides (52.6% vs 54.1%) and sulphonylureas (36.8% vs 37.3%), before and after intervention, respectively. The health educational intervention adopted in the study improved outcomes of medication therapy among the hypertensive patients but not in the diabetics. Diuretics and the biguanide (metformin) were the most prescribed drugs for HTN and diabetics, respectively.

Keywords: Blood pressure, hyperglycemia, health-educational intervention, Niger Delta