Target Organ Damage and the Long Term Effect of Nonadherence to Clinical Practice Guidelines in Patients with Hypertension: A Retrospective Cohort Study

Abstract

Background There was limited published data on target organ damage (TOD) and the effect of nonadherence to practice guidelines in Ethiopia. This study determined TOD and the long term effect of nonadherence to clinical guidelines on hypertensive patients. Methods An open level retrospective cohort study has been employed at cardiac clinic of Gondar university hospital for a mean follow-up period of 78 months. Multivariate Cox regression was conducted to test associating factors of TOD. Results Of the total number of 612 patients examined, the overall prevalence of hypertensive TOD was 40.3%. The presence of comorbidities, COR = 1.073 [1.01–1.437], AOR = 1.196 [1.174–1.637], and nonadherence to clinical practice guidelines, COR = 1.537 [1.167–2.024], AOR = 1.636 [1.189–2.251], were found to be predicting factors for TOD. According to Kaplan-Meier analysis patients who were initiated on appropriate medication tended to develop TOD very late: Log Rank [11.975 (p = 0.01)]. Conclusion More than forty percent of patients acquired TOD which is more significant. Presence of comorbidities and nonadherence to practice guidelines were correlated with the incidence of TOD. Appropriate management of hypertension and modification of triggering factors are essential to prevent complications.

Blood Glucose Level, Blood Pressure, and Medication Behavior are related to Cardiovascular Complication in Hypertension Patient at Sikumana Public Health Center

“…Inability to consume drugs of antihypertension has been a factor associated with the incidence of cardiovascular complications in patients with hypertension in this study. The results of this study are consistent with the results of the study of Abegaz et al (2017) who found that the right treatment tends to develop target organ damage (TOD) which is very slow, meaning that non-compliance in taking antihypertensive drugs will accelerate damage to target organs or target organs demage in patients with hypertension. Researchers found that non-compliance with the consumption of drugs of anti-hypertension is caused by patients feeling no complaints, forgetting, and busy with daily activities.…”

Epidemiology of hypertensive heart disease in Poland: findings from the Global Burden of Disease Study 2016

“…Other studies have found large differences in the proportion of LVH among hypertensive patients across age, gender, duration of hypertension, and geographic location, with rates ranging from 2% in Ethiopia [6], 23% in Spain [15] and 28% in Nigeria [16] to as high as 33% in Greece [7]. Similarly, the rates of hypertension-related HF vary considerably across populations.…”

“…Prevalence was modeled with DisMod-MR 2.1, a Bayesian meta-regression tool developed specifically for the GBD study that ensures consistency of epidemiological parameters for the conditions studied [10,12]. A range of additional analytical techniques were applied to correct for biases and inconsistencies in the data, as described in the GBD publica-tions [6][7][8][9][10][11][12]. DALYs were calculated as the sum of years of life lost due to premature mortality and years lived with disability (a measure of non-fatal health loss); hence DALY, as a measure of overall disease burden, expresses lost years of healthy life [12].…”

“…Hypertension, especially long-lasting and poorly controlled, is the leading risk factor for premature death and disability [2][3][4][5]. These adverse outcomes are mainly driven by acute and late consequences of high blood pressure that lead to damage of the target organs, such as arterial blood vessels, heart, and kidneys [6][7][8].…”

“…The prevalence of cardiac damage caused by hypertension varies across age, gender, and ethnicity [6,7]. Cardiac complications caused by hypertension include a wide range of asymptomatic and symptomatic disease stages.…”