Positive benefits of a pharmacist-managed hypertension clinic in Nigeria
Introduction
A large proportion of hypertensive patients in Nigeria live with untreated or uncontrolled blood pressure (BP), although reductions in elevated BP have been shown to reduce the risk of cardiovascular mortality and morbidity.1 While there is considerable evidence for the benefit of drug treatment in reducing BP,2 published guidelines for the management of hypertensive patients recommend that strategies should be implemented at the primary care level.3, 4 Pharmacy-based programmes are cost effective, can be used to determine the ideal drug and when/how it should be used, and can provide ancillary programmes to support appropriate physician prescribing and optimal patient adherence.5
A recent investigation into BP control in hypertensive Nigerian blacks managed with alpha methyldopa and combination diuretics at the primary care level6 revealed a treatment gap; only 37.5% of the studied patients had controlled BP after their first treatment, and 10.2 and 4% of the study population needed three and five treatments within 6 months, respectively, to achieve target BP levels. In nearly all cases, diuretic therapy was not individualized and lifestyle modification was not prioritized.6 A pharmacist-managed hypertension clinic was therefore set up in the facility as an intervention. We report the benefits of the provision of additional practice-based support by pharmacists at the health centre facility on BP control in this low-income population. This is the first report on this topic in Nigeria.
Section snippets
Methods
This was a 1-year prospective, randomized cohort study of the outpatients of a state comprehensive health centre in South-western Nigeria. Free primary health services including free drugs were provided for all patients. The study population comprised 51 Nigerian patients with uncomplicated hypertension aged 45 years or more, with a 0.2–3-year history of hypertension, registered at the Comprehensive Health Centre, Ife between October 2002 and March 2003. They were invited into the
Results
Fifty-one patients were enrolled in the study; 15 males and 36 females. Of these, 33.3, 43.1 and 19.6% were normal weight, overweight and obese, respectively, and only 3.9% suffered from extreme obesity at enrolment according to ‘Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: the Evidence Report’.8 The patients were either non-alcohol drinkers or did so at a frequency and volume that was considered to be inconsequential.10 About 63%
Discussion
Supposition from the retrospective study of Erhun et al.6 showed that hypertensive Nigerian blacks ignore routine check ups and seldom go to clinic except when highly inconvenienced by the disease. This may explain the high level of unchecked BP in patients managed by physicians at the health centre during the years covered by the retrospective study,6 and it perhaps explains why a number of the patients enrolled into this study did not attend again after at least one normal BP reading (Fig. 1)
Conclusion
The pharmaceutical service provided by a pharmacist-managed hypertension clinic improved BP control, reduced treatment failures and recorded remarkable patient satisfaction. The impact of this intervention on clinical outcomes such as mortality and morbidity will be the focus of further studies.
Acknowledgements
The authors acknowledge the support of the Medical Officer and clinic staff of the Comprehensive Health Centre, Sabo, Ile-Ife as well as the support of the Hospital Management Board, Osogbo, Osun State, Nigeria.
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