Isolated systolic hypertension: primary care practice patterns in a Nigerian high-risk subpopulation

Ono, Agbani Ejaife; Oyekigho, Erhun Wilson; Adeleke, Ojo Araoye

doi:10.1590/s1516-31802006000200011

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…Within a broader intervention to address severe shortage of healthcare workforce must be efforts to address physician-related factors, including indifference towards elevated blood pressure among treated patients and insufficient awareness to treatment guidelines [47,48]. For example in southwestern Nigeria, Ono and colleagues [49] reported failure of primary care physicians to intensify antihypertensive medications. Moreover, they reported a tendency to keep patients on monotherapy or “no drug treatment” even in cases of repeated visits to the clinic.…”

Section: Methodsmentioning

confidence: 99%

Prevalence, determinants and systems-thinking approaches to optimal hypertension control in West Africa

et al. 2014

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BackgroundIn West Africa, hypertension, once rare, has now emerged as a critical health concern and the trajectory is upward and factors are complex. The true magnitude of hypertension in some West African countries, including in-depth knowledge of underlying risk factors is not completely understood. There is also a paucity of research on adequate systems-level approaches designed to mitigate the growing burden of hypertension in the region.AimsIn this review, we thematically synthesize available literature pertaining to the prevalence of hypertension in West Africa and discuss factors that influence its diagnosis, treatment and control. We aimed to address the social and structural determinants influencing hypertension in the sub-region including the effects of urbanization, health infrastructure and healthcare workforce.FindingsThe prevalence of hypertension in West Africa has increased over the past decade and is rising rapidly with an urban-rural gradient that places higher hypertension prevalence on urban settings compared to rural settings. Overall levels of awareness of one’s hypertension status remain consistently low in West African. Structural and economic determinants related to conditions of poverty such as insufficient finances have a direct impact on adherence to prescribed antihypertensive medications. Urbanization contributes to the increasing incidence of hypertension in the sub-region and available evidence indicates that inadequate health infrastructure may act as a barrier to optimal hypertension control in West Africa.ConclusionGiven that optimal hypertension control in West Africa depends on multiple factors that go beyond simply modifying the behaviors of the individuals alone, we conclude by discussing the potential role systems-thinking approaches can play to achieve optimal control in the sub-region. In the context of recent advances in hypertension management including new therapeutic options and innovative solutions to expand health workforce so as to meet the high demand for healthcare, the success of these strategies will rely on a new understanding of the complexity of human behaviors and interactions most aptly framed from a systems-thinking perspective.

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Section: Methodsmentioning

confidence: 99%

Prevalence, determinants and systems-thinking approaches to optimal hypertension control in West Africa

et al. 2014

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“…3,4 Health systems in SSA must overcome multiple challenges to effectively manage the rising epidemic of hypertension and diabetes, including medication shortages, lack of diagnostic equipment, poor patient and physician knowledge and training, absent or inadequate treatment guidelines, cost of long-term treatment, and lack of effective screening programs, among others. [5][6][7][8][9][10][11] In Tanzania, for example, primary care provision is limited and in 2012 there were only 7.1 health care workers per 10,000 people, 12,13 an inadequate number to effectively manage and prevent NCDs. Furthermore, recent surveys of Tanzanian health care facilities have demonstrated that many lack basic functioning diagnostic equipment such as blood pressure cuffs or glucometers, and the majority of facilities lack protocols for NCD management.…”

Section: Introductionmentioning

confidence: 99%

The Burden of Hypertension and Diabetes in an Emergency Department in Northern Tanzania

et al. 2019

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Introduction: Little is known about the burden of hypertension and diabetes on emergency department (ED) utilization and hospitalizations in sub-Saharan Africa.Methods: A retrospective review of adult ED patients in northern Tanzania was performed from September 2017 through March 2018. Hypertension was defined as documented diagnosis of hypertension or blood pressure ≥ 140/90 mm Hg. Diabetes was defined as documented diagnosis of diabetes mellitus or random glucose ≥ 200 mg/dL.Results: Of 3961 adult ED patients, 1359 (34.3%) had hypertension, 518 (13.1%) had diabetes, and 273 (6.9%) had both. Both hypertension (OR 1.42, 95% CI 1.23-1.63, P<.001) and diabetes (OR 2.05, 95% CI 1.66-2.54, P<.001) were associated with increased odds of admission. Of 2418 hospital admissions, 694 (28.7%) were for complications of hypertension or diabetes. Of 499 patients admitted for hypertensive complications, the most common admission diagnoses were: heart failure (163 patients, 32.7%); stroke (147 patients, 29.5%); and severe hypertension (139 patients, 27.9%). Of 278 patients admitted for diabetic complications, the most common admission diagnoses were: hyperglycemia (158 patients, 56.9%); infection (60 patients, 21.6%); and stroke (28 patients, 10.1%).Conclusions: The burden of hypertension and diabetes in a Tanzanian ED is high, and the ED may serve as an opportune location for case identification and linkage-to-care interventions. Given the large proportion of Africans with undiagnosed hypertension and diabetes, an ED-based screening program would likely identify many new cases of these diseases. The high burden of hypertension- and diabetes-related hospitalizations highlights the urgent need for improvements in primary preventative care in Tanzania.Ethn Dis.2019;29(4):559-566; doi:10.18865/ed.29.4.559

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“…18 studies were quantitative in nature, four qualitative [ 30 – 33 ], and two were mixed-method study [ 34 , 35 ]. Of the 18 studies, one was a cluster-randomized trial [ 36 ]; 4 were cohort studies [ 37 – 40 ]; one of which was retrospective [ 39 ] alongside 2 other retrospective studies [ 41 , 42 ] and one mixed-method retrospective study [ 35 ]; 10 were cross-sectional studies. Majority of the studies were carried out in South Africa (n = 9) and in Nigeria (n = 8), 4 in Cameroon, while the rest in the Democratic Republic of Congo, Ethiopia, Ghana, and Tanzania.…”

Section: Resultsmentioning

confidence: 99%

“…On the other hand, physician inertia and/or failure to intensive antihypertensive medication are common in the region. In southwestern Nigeria, Ono and colleagues [ 39 ] observed that physicians increasingly “ placed patients on monotherapy or "no drug treatment" ,. even in cases of uncontrolled systolic blood pressure .…”

Section: Resultsmentioning

confidence: 99%

A Narrative Synthesis of the Health Systems Factors Influencing Optimal Hypertension Control in Sub-Saharan Africa

et al. 2015

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IntroductionIn sub-Saharan Africa (SSA), an estimated 74.7 million individuals are hypertensive. Reducing the growing burden of hypertension in sub-Saharan Africa will require a variety of strategies one of which is identifying the extent to which actions originating at the health systems level improves optimal management and control.Methods and ResultsWe conducted a narrative synthesis of available papers examining health systems factors influencing optimal hypertension in SSA. Eligible studies included those that analyzed the impact of health systems on hypertension awareness, treatment, control and medication adherence. Twenty-five articles met the inclusion criteria and the narrative synthesis identified the following themes: 1) how physical resources influence mechanisms supportive of optimal hypertension control; 2) the role of human resources with enabling and/or inhibiting hypertension control goals; 3) the availability and/or use of intellectual resources; 4) how health systems financing facilitate and/or compromise access to products necessary for optimal hypertension control.ConclusionThe findings highlight the need for further research on the health systems factors that influence management and control of hypertension in the region.

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Isolated systolic hypertension: primary care practice patterns in a Nigerian high-risk subpopulation

Cited by 5 publications

References 25 publications

Prevalence, determinants and systems-thinking approaches to optimal hypertension control in West Africa

Prevalence, determinants and systems-thinking approaches to optimal hypertension control in West Africa

The Burden of Hypertension and Diabetes in an Emergency Department in Northern Tanzania

A Narrative Synthesis of the Health Systems Factors Influencing Optimal Hypertension Control in Sub-Saharan Africa

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