Blood pressure control and burden of treatment in South African primary healthcare: A cross-sectional study

Pender, Kevin; Omole, Olufemi B.

doi:10.4102/phcfm.v11i1.2110

Cited by 4 publications

(5 citation statements)

References 26 publications

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“…Accumulative evidence showed that the prevalence of HTN is 1.3 billion, and this number is projected to increase to 1.56 billion by 2030 with an estimated global economic cost of $274 billion [ 1 , 2 , 3 , 4 ]. Despite the availability of advanced diagnostic options and the use of multiple antihypertensive medications, many studies have reported inadequate control of blood pressure among hypertensive individuals worldwide, including Africa [ 2 , 5 , 6 , 7 ]. This inability to control blood pressure even after adherence has been referred to as treatment-resistant hypertension (TRH).…”

Section: Introductionmentioning

confidence: 99%

Hypertension in African Populations: Review and Computational Insights

Mabhida

Mashatola

Kaur

et al. 2021

Genes

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Hypertension (HTN) is a persistent public health problem affecting approximately 1.3 billion individuals globally. Treatment-resistant hypertension (TRH) is defined as high blood pressure (BP) in a hypertensive patient that remains above goal despite use of ≥3 antihypertensive agents of different classes including a diuretic. Despite a plethora of treatment options available, only 31.0% of individuals have their HTN controlled. Interindividual genetic variability to drug response might explain this disappointing outcome because of genetic polymorphisms. Additionally, the poor knowledge of pathophysiological mechanisms underlying hypertensive disease and the long-term interaction of antihypertensive drugs with blood pressure control mechanisms further aggravates the problem. Furthermore, in Africa, there is a paucity of pharmacogenomic data on the treatment of resistant hypertension. Therefore, identification of genetic signals having the potential to predict the response of a drug for a given individual in an African population has been the subject of intensive investigation. In this review, we aim to systematically extract and discuss African evidence on the genetic variation, and pharmacogenomics towards the treatment of HTN. Furthermore, in silico methods are utilized to elucidate biological processes that will aid in identifying novel drug targets for the treatment of resistant hypertension in an African population. To provide an expanded view of genetic variants associated with the development of HTN, this study was performed using publicly available databases such as PubMed, Scopus, Web of Science, African Journal Online, PharmGKB searching for relevant papers between 1984 and 2020. A total of 2784 articles were reviewed, and only 42 studies were included following the inclusion criteria. Twenty studies reported associations with HTN and genes such as AGT (rs699), ACE (rs1799752), NOS3 (rs1799983), MTHFR (rs1801133), AGTR1 (rs5186), while twenty-two studies did not show any association within the African population. Thereafter, an in silico predictive approach was utilized to identify several genes including CLCNKB, CYPB11B2, SH2B2, STK9, and TBX5 which may act as potential drug targets because they are involved in pathways known to influence blood pressure. Next, co-expressed genes were identified as they are controlled by the same transcriptional regulatory program and may potentially be more effective as multiple drug targets in the treatment regimens for HTN. Genes belonging to the co-expressed gene cluster, ACE, AGT, AGTR1, AGTR2, and NOS3 as well as CSK and ADRG1 showed enrichment of G-protein-coupled receptor activity, the classical targets of drug discovery, which mediate cellular signaling processes. The latter is of importance, as the targeting of co-regulatory gene clusters will allow for the development of more effective HTN drug targets that could decrease the prevalence of both controlled and TRH.

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Section: Introductionmentioning

confidence: 99%

Hypertension in African Populations: Review and Computational Insights

Mabhida

Mashatola

Kaur

et al. 2021

Genes

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“…Lastly, it is concerning that only nine studies used validated questionnaires and tools to gather their data. 12,15,16,18,19,22,26,29,41 Using such tools makes it generalisable not only to SA but to the global population as such tools have been tested in different populations.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, most identified studies focusing on adherence to antihypertensives found adherence to medication to be inadequate. 13,14,15,16,17 A crosssectional study conducted in Sedibeng involving 251 participants showed that 16.7% of participants had controlled BP levels at the initial visit, which rose to 31.5% at their most recent visit. 14 These findings demonstrated that participants who missed one, two or three doses per week had increased odds of uncontrolled HTN (OR: 3.57, 95% CI: 1.20-10.57; p = 0.02).…”

Section: Level Of Adherencementioning

confidence: 99%

Factors influencing treatment adherence in hypertension and HIV management in South Africa: A comparative literature review

Enslin

Mallya

2022

S Afr Fam Pract

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Methods: A comprehensive literature review was carried out. PubMed, ScienceDirect, Cochrane and Embase were searched for English publications between 2000 and 2021.Results: A total of 50 articles covering quantitative and qualitative studies were included. Many studies identified poor adherence levels to antihypertensive treatment, reaching a substandard adherence rate of 41.9%, whilst most studies on the HIV-positive population reported good levels of adherence, with adherence rates of more than 90%. Being of the male gender, advanced age, low socioeconomic status and a low level of education were associated with unsatisfactory adherence rates in both groups. Within the HIV group, more participants had better knowledge concerning the extent of their disease and its required treatments. Conclusion:The results present substandard adherence levels to antihypertensives compared with antiretroviral (ARV) adherence, despite the influence of more non-adherence factors in the HIV group. The authors recommend better adherence counselling for patients with HTN during every clinic visit, regular healthcare worker training and the implementation of ART adherence programmes in patients with hypertension.

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“…It assesses a broad range of behavioural and emotional burden in the procedure of undertaking and engaging treatments associated with medication-taking, self-care activities, and healthcare costs. The scale consists of three domains of treatment burden: (1) medication regimen (4-item), (2) navigating the healthcare system (5-item), (3) lifestyle changes, social and financial impacts (6-item) [ 52 ]. Each item is scored on an 11-point Likert scale, ranging from 0 = not a problem to 10 = big problem.…”

Section: Methodsmentioning

confidence: 99%

A community-based nurse-led medication self-management intervention in the improvement of medication adherence in older patients with multimorbidity: protocol for a randomised controlled trial

et al. 2021

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Background Older patients suffering from multimorbidity are at high risk of medication nonadherence. It has been well established that self-management support is an effective strategy to enhance medication adherence for patients with chronic conditions. However, little is known about the effect of the medication self-management intervention in older patients with multimorbidity. This paper presents the protocol for a study that aims to evaluate the effectiveness of a nurse-led medication self-management intervention in improving medication adherence and health outcomes for community-dwelling older patients with multimorbidity. Methods The study protocol follows the recommendations of the Standard Protocol Items: Recommendations for Interventional Trials 2013 statement. This study is a multicentre, single-blind, two-arm randomised controlled trial. Older patients with multimorbidity will be recruited from three community health centres in Changsha, China. A total of 136 participants will be randomly allocated to receive usual care or usual care plus the medication self-management intervention. The intervention will be delivered by community nurses. The 6-week intervention includes three face-to-face education sessions and two weekly follow-up phone calls. Participants in the control group continue to receive all respects of usual care offered by community healthcare providers, including chronic disease management, drug prescription, referral to hospital specialists, health education and consultations regarding patients’ diseases and treatments during centre visits. The primary outcome is medication adherence as measured by the 5-item Medication Adherence Report Scale. Secondary outcomes include medication self-management capacity (medication knowledge, medication beliefs, medication social support, medication skills, and medication self-efficacy), treatment experiences (medication treatment satisfaction and treatment burden), quality of life, and utilisation of healthcare services. All outcomes will be measured at baseline, immediately post-intervention, and at 3-month post-intervention. Discussion This study will provide evidence about the effectiveness of a medication self-management intervention, delivered by nurses, for older patients with multimorbidity and adherence problems. It is expected that the results of the study, if proven effective in improving patients’ adherence and health outcomes, will provide evidence-based self-management support strategies for healthcare providers in routine chronic disease management in community settings. Trial registration The trial is registered at ChiCTR.org.cn (ChiCTR2000030011; date February 19, 2020).

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Blood pressure control and burden of treatment in South African primary healthcare: A cross-sectional study

Cited by 4 publications

References 26 publications

Hypertension in African Populations: Review and Computational Insights

Hypertension in African Populations: Review and Computational Insights

Factors influencing treatment adherence in hypertension and HIV management in South Africa: A comparative literature review

A community-based nurse-led medication self-management intervention in the improvement of medication adherence in older patients with multimorbidity: protocol for a randomised controlled trial

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