Reported adherence to antihypertensive treatment and outcome at post-mortem in southwestern Nigerians

Abstract

Background: Systemic hypertension is referred to as a silent killer. Knowledge of disease and religious use of medication could mitigate against complications in hypertensives. This study evaluated outcome among decedent essential hypertensive patients in southwestern Nigeria
in relation to their compliance with prescribed antihypertensive medication. Materials and Methods: This is a 10‑year retrospective review of routine postmortem data. Archival postmortem records from January 1, 2008 to December 31, 2017 in the Department of Pathology, University College Hospital, Ibadan, Nigeria, were reviewed. Data extracted from the records included age, gender, knowledge of hypertension status, systolic and diastolic blood pressure at time of diagnosis, reported adherence to medications, complications of systemic hypertension, duration of survival from diagnosis to demise, cause of death, body length, and heart weight at autopsy. Descriptive, Students t‑test, Chi‑square test, Pearson correlation and Cox proportional-hazards model statistics was conducted using SPSS version 20 (IBM SPSS Statistics for windows, IBM Corp., Armonk, N.Y., USA). P < 0.05 was considered significant. Results: Eighty‑one cases met the inclusion criteria, consisting of 60 males and 21 females with overall mean age of 55.65 ± 12.1 years. Seventy‑five (91.7%) cases were known hypertensives prior to admission or demise while 6 (8.3%) were not known hypertensives. The duration of survival from diagnosis to death ranged from 1‑month (0.08 years) to 31 years with overall mean duration of 5.2 years. Fifty‑two (63.4%) of the 75 known hypertensive cases had documented medication compliance. Medication noncompliant cases had lower mean survival interval (5 vs. 8 years), died younger (53.5 ± 10.8 years vs. 54.8 ± 15.5 years), had higher mean blood pressures (systolic blood pressures: 197 ± 45.8 mmHg vs. 180 ± 55.4 mmHg; diastolic blood pressures: 117 ± 27.2 mmHg vs. 101 ± 32.8 mmHg) and heavier heart weights (476 ± 142 g vs. 390.8 ± 107.6 g). However, only the difference in heart weight was statistically
significant (P < 0.036). Age and mean systolic blood pressures were correlated with interval from diagnosis to death (r = 0.5, P < 0.000; r = −0.4, P < 0.017, respectively). Death from complications of hypertension and all‑cause mortality occurred with higher frequencies among medication noncompliant cases (40 vs. 12). Conclusion: Noncompliance with antihypertensive medication is associated with more cardiovascular and all‑cause mortality among Southwestern Nigerians with essential hypertension.