Hypertension in Africa and Effectiveness of Its Management with Various Classes of Antihypertensive Drugs and in Different Socio-Economic and Cultural Environments

Salako, L.A.

doi:10.3109/10641969309037087

Cited by 14 publications

(8 citation statements)

References 6 publications

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“…[5][6][7][8][9] In addition, several other important findings were observed. First, the distributions of response values for SBP and DBP change were much greater within each race group than between the 2 groups.…”

Section: Discussionmentioning

confidence: 89%

Determinants of Blood Pressure Response to Quinapril in Black and White Hypertensive Patients

et al. 2004

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Abstract-Race has been considered an important factor in determining blood pressure response to treatment and selection of antihypertensive drug therapy. Data collected during a clinical trial that evaluated rapidity of medication up-titration with blood pressure response to monotherapy with the angiotensin-converting enzyme (ACE) inhibitor quinapril were used to characterize response in 533 black and 2046 white participants. Our objectives were to examine the influence of race and other factors on blood pressure response and to assess the degree to which nonrace factors account for apparent racial differences in response. Average systolic and diastolic blood pressure responses (baseline minus follow-up) to treatment were assessed with treatment groups combined. Crude systolic and diastolic blood pressure responses averaged 4.7 and 2.4 mm Hg less, respectively, in black compared with white participants; however, the response distributions largely overlapped. In multivariate linear regression models adjusted for study design variables and measured participant characteristics, the racial difference in systolic response was reduced by 51% to 2.3 mm Hg, and diastolic response by 21% to 1.9 mm Hg. In these models, participant characteristics, including age, gender, body size, and pretreatment blood pressure severity, significantly predicted either attenuated or enhanced blood pressure response to treatment. Our findings demonstrate that a large source of variability of blood pressure response to treatment is within, not between, racial groups, and that factors that vary at the level of the individual contribute to apparent racial differences in response to treatment. Key Words: ACE inhibitors Ⅲ antihypertensive therapy Ⅲ blood pressure response Ⅲ hypertension Ⅲ race R ace has long been considered an important factor in determining blood pressure (BP) response to treatment, at least to single antihypertensive drugs. [1][2][3][4] More specifically, blacks with hypertension have been reported to be less responsive to monotherapy with angiotensin-converting enzyme (ACE) inhibitors, 5 ␤-blockers, 6 -8 and angiotensin receptor blockers 9 than to diuretics and calcium antagonists. Many of these same studies have reported that white hypertensive patients respond better to these antihypertensive agents than do blacks. 10,11,1,3,4 Authoritative treatment guidelines such as the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 12 have acknowledged this evidence of lesser BP response among blacks to certain drug classes and have not dismissed the notion that race be considered when selecting antihypertensive drug therapy.There are concerns, however, with the interpretation of data from these studies. First, black and white hypertensives typically differ on baseline characteristics 13,14 that may confound racial differences in BP response; observed response differences have almost never been adjusted for potential confounding factors other than baseline BP. Second, when racial BP ...

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Section: Discussionmentioning

confidence: 89%

Determinants of Blood Pressure Response to Quinapril in Black and White Hypertensive Patients

et al. 2004

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“…It is estimated that up to 4.5% of the current global disease burden are due to hypertension [2]. Studies suggested that in Sub-Saharan Africa, overall hypertension prevalence is between 10 and 15% [3, 4]. As a result of the chronic nature of the disease and the complexities of treatment modalities, many hypertensive patients try to manage their disease through the use of different complementary and alternative medicine (CAM) practices.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Correlates of Complementary and Alternative Medicine Use among Hypertensive Patients in Gondar Town, Ethiopia

Erku

Mekuria

2016

Evidence-Based Complementary and Alternative Medicine

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Background. Complementary and alternative medicine (CAM) therapies are being widely used by hypertensive patients worldwide. However, evidences regarding CAM use by hypertensive patients in Ethiopia are limited. This study aimed at assessing prevalence and correlates of CAM use among hypertensive patients attending ambulatory clinic at Gondar University Referral Hospital (GURH), Ethiopia. Methods. A cross-sectional study was employed on 423 patients visiting GURH. Descriptive statistics and bivariate and multivariate logistic regression tools were used to analyze/come up with the prevalence and correlates of CAM use. Results. The prevalence of CAM use in our study was found to be 67.8% and herbal based medicine was the most commonly utilized CAM therapies. Majority of CAM users (70.2%) did not disclose CAM use for their physician. However, nearly half of CAM users (48.4%) were satisfied with the result of CAM use. Conclusions. The higher prevalence of CAM use among hypertensive patients coupled with a very low disclosure rate to their health care providers can have a marked potential to cause ineffective hypertensive management and adverse effects due to CAM use. Health care providers should be open to discussing the use of CAM with their patients as it will lead to better health outcome.

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“…It is estimated to cause 4.5% of the current global disease burden and is often as prevalent in many developing countries as in developed countries [2]. While reliable data from large scale, population based studies in sub-Saharan Africa are few, the evidence suggests that overall hypertension prevalence is between 10-15%, with specific settings (for example, some urban centers) often having twice these prevalence rates [3-5]. More importantly, hypertension awareness, treatment and control are quite poor in sub-Saharan Africa [3,6].…”

Section: Introductionmentioning

confidence: 99%

Complementary and alternative medicine in the management of hypertension in an urban Nigerian community

Osamor

Owumi

2010

BMC Complement Altern Med

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BackgroundHypertension is a common non communicable condition worldwide. In developing countries (including Nigeria), the use of complementary and alternative medicine (CAM) is common. This study investigated the frequency and factors associated with use of CAM among hypertensive subjects in an urban Nigerian community. Perspectives about the management of hypertension were obtained from CAM practitioners in the community.MethodsFour hundred and forty hypertensive subjects in Idikan community, Ibadan, were interviewed using a semi-structured survey instrument. Association between categorical variables was tested using the chi-square test. Logistic regression analysis was done to identify independent predictor variables of CAM use, with CAM use as the outcome variable and the demographic and belief items as predictor variables. In-depth interviews were conducted with all known CAM practitioners in the community on issues relating to their beliefs, knowledge, practice and experiences in managing patients with hypertension in the community.ResultsIn the study sample, 29% used CAM in the management of their hypertension. Among those using CAM, the most common forms used were herbs (63%) and garlic (21%). Logistic regression analysis revealed that four variables were independent predictors of CAM use: being male (OR 2.58, p < 0.0001), belief in supernatural causes of hypertension (OR 2.11, p = 0.012), lack of belief that hypertension is preventable (OR 0.57, p = 0.014) and having a family history of hypertension (OR1.78, p = 0.042). Other factors such as age, educational level and occupation were not independent predictors of CAM use. Interviews with CAM practitioners revealed that they believed hypertension was caused by evil forces, stress or "too much blood in the body". They also thought they could cure hypertension but that reduced costs (compared to hospitals) was one of the reasons most of their clients consult them.ConclusionsThe use of CAM is common among hypertensive subjects in this urban Nigerian community. Men were more than twice as likely to use CAM and belief in supernatural causes of hypertension was the most notable belief predicting CAM use. Interviews with CAM practitioners yielded useful perspectives about the role they play in hypertension management in the community. This study adds to the small but growing literature about the use of CAM in hypertension in sub Saharan Africa. Further studies in hypertension and other non communicable disease are needed.

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Hypertension in Africa and Effectiveness of Its Management with Various Classes of Antihypertensive Drugs and in Different Socio-Economic and Cultural Environments

Cited by 14 publications

References 6 publications

Determinants of Blood Pressure Response to Quinapril in Black and White Hypertensive Patients

Determinants of Blood Pressure Response to Quinapril in Black and White Hypertensive Patients

Prevalence and Correlates of Complementary and Alternative Medicine Use among Hypertensive Patients in Gondar Town, Ethiopia

Complementary and alternative medicine in the management of hypertension in an urban Nigerian community

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