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Cardiovascular medicine
Research
Hypertension treatment practices and its determinants among ambulatory patients: retrospective cohort study in Ethiopia
  1. Derbew Fikadu Berhe1,2,
  2. Katja Taxis3,
  3. Flora M Haaijer-Ruskamp1,
  4. Afework Mulugeta4,
  5. Yewondwossen Tadesse Mengistu5,
  6. Peter G M Mol1
  1. 1 Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  2. 2 Department of Pharmacy, Mekelle University, Mekelle, Tigray, Ethiopia
  3. 3 Department of Pharmacy, Unit Pharmacotherapy, Epidemiology and Economics, University of Groningen, Groningen, Netherlands
  4. 4 School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
  5. 5 Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
  1. Correspondence to Dr Peter G M Mol; p.g.m.mol{at}umcg.nl

Abstract

Objectives We examined determinants of achieving blood pressure control in patients with hypertension and of treatment intensification in patients with uncontrolled blood pressure (BP).

Design A retrospective cohort study in six public hospitals, Ethiopia.

Participants Adult ambulatory patients with hypertension and with at least one previously prescribed antihypertensive medication in the study hospital.

Outcome Controlled BP (<140/90 mm Hg) and treatment intensification of patients with uncontrolled BP.

Results The study population comprised 897 patients. Their mean age was 57 (SD 14) years, 63% were females, and 35% had one or more cardiometabolic comorbidities mainly diabetes mellitus. BP was controlled in 37% of patients. Treatment was intensified for 23% patients with uncontrolled BP. In multivariable (logistic regression) analysis, determinants positively associated with controlled BP were treatment at general hospitals (OR 1.89, 95% CI 1.26 to 2.83) compared with specialised hospitals and longer treatment duration (OR 1.04, 95% CI 1.01 to 1.06). Negatively associated determinants were previously uncontrolled BP (OR 0.30, 95% CI 0.21 to 0.43), treatment regimens with diuretics (OR 0.68, 95% CI 0.50 to 0.94) and age (OR 0.99, 95% CI 0.98 to 1.00). The only significant—positive—determinant for treatment intensification was duration of therapy (OR 1.05, 95% CI 1.02 to 1.09).

Conclusions The level of controlled BP and treatment intensification practice in this study was low. The findings suggest the need for in-depth understanding and interventions of the identified determinants such as uncontrolled BP on consecutive visits, older age and type of hospital.

  • hypertension
  • antihypertensive medication
  • blood pressure control
  • treatment intensification
  • ambulatory patients
  • Ethiopia
  • hospital
  • observational study

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-015743

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    Footnotes

    • Contributors DFB, KT and PGMM designed and performed the research, analysed and interpreted the data. FMH-R, AM, YTM designed the study. All authors participated in writing the manuscript, also read and approved the final version.

    • Funding The study was part of a PhD project to the first author funded by the Netherlands Organization for International Cooperation in Higher Education (NUFFIC).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Ethiopian Health Research Ethical Review Committees of (1) the College of Health Sciences, Mekelle University, (2) St Paul's Hospital Millennium Medical College and (3) the Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available for this specific study.