Investigating outcomes in the management of hypertension by specialists in a University Hospital

Abstract

Background: Hypertension is an acknowledged risk factor for other cardiovascular diseases and this risk is heightened with the co-existence of other risk factors and long-term co-morbidities. This study reviewed clinical outcomes in the management of hypertension at the medical outpatient clinic of the University of Port Harcourt Teaching Hospital, Nigeria.

Method: Cross-sectional survey and review of records of 182 randomly selected regular patients at the medical out-patients’ clinic. Outcomes measured were patients’ adherence to treatment, persisting risk factors, co-morbidities, trend in patients’ blood pressure over last three consecutive visits. Descriptive and analytic statistics were conducted using (SPSS) version 20.0.

Results: A majority of the patients were females (62.6%) and about half (45.0%) reported adherence to the treatment protocol. Common persisting risk factors were overweight (73.1%) and high low density lipoprotein cholesterol (81.0%) while co-morbidity was diabetes (26.9%). Proportion of clients with uncontrolled BP progressively declined over the last 3 consecutive visits (63.7 → 60.4 → 54.4%). The progressive declines were statistically significant with p-value of 0.039 and 0.001 respectively. Poor adherence (p = 0.01), older ages (p = 0.047), and shorter duration of illness (p = 0.023) were significantly associated with uncontrolled hypertension.

Conclusion: Adherence to treatment protocol and regular follow-up of hypertensive patients were modifiable predictors of adequate BP control. Most of the persisting risk factors are related to behavioural and dietary practices among hypertensive subjects. Findings have implications for periodic clinical audit as a strategy for clinical governance and quality improvement.

Keywords: clinical audit, outcome, hypertension management, specialist clinic, UPTH, Nigeria