Sustainable protocol-based management of hypertension in one institution in northern Malawi
Introduction: Across all WHO regions, Africa has the highest prevalence of hypertension with 46% of the population >25 years estimated to be hypertensive. Blood pressure (BP) control is poor, with <40% of hypertensives diagnosed, <30% of those diagnosed receiving medical treat...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
James Cook University
2023-01-01
|
| Series: | Rural and Remote Health |
| Online Access: | https://www.rrh.org.au/journal/article/7876/ |
| _version_ | 1828010877982343168 |
|---|---|
| author | Gwonde Hastings Raymond O'Connor Meadhbh Hunt Peter Harrington Joe Gallagher Mark Ledwidge |
| author_facet | Gwonde Hastings Raymond O'Connor Meadhbh Hunt Peter Harrington Joe Gallagher Mark Ledwidge |
| author_sort | Gwonde Hastings |
| collection | DOAJ |
| description |
Introduction: Across all WHO regions, Africa has the highest prevalence of hypertension with 46% of the population >25 years estimated to be hypertensive. Blood pressure (BP) control is poor, with <40% of hypertensives diagnosed, <30% of those diagnosed receiving medical treatment, and <20% with adequate control. We report an intervention to improve BP control in a cohort of hypertensive patients attending a single hospital in Mzuzu Malawi, by introducing a limited protocol of four antihypertensive medications taken once-daily.
Methods: A drug protocol based on international guidelines, drug availability in Malawi, cost and clinical effectiveness was developed and implemented. Patients were transitioned to the new protocol as they attended for clinic visits. Records of 109 patients completing at least three visits were assessed for BP control.
Results: Two-thirds of patients (n=73) were female and average age at enrolment was 61.6 &plusmn; 12.8 years. Median [interquartile range] systolic BP (SBP) was 152 [136;167] mm Hg at baseline and reduced over the follow-up period to 148 [135; 157, p<0.001 vs baseline]. Median diastolic BP (DBP) reduced from 90.0 [82.0; 100] mm Hg to 83.0 [77.0; 91.0], p<0.001 vs baseline. Patients with highest baseline blood pressures benefited most and there were no associations noted between BP responses and either age or gender.
Discussion: We conclude that a limited evidence based once-daily drug regimen can improve blood pressure control by comparison with standard management. Cost effectiveness of this approach will also be reported.
|
| first_indexed | 2024-04-10T09:06:50Z |
| format | Article |
| id | doaj.art-9fe2e161de5f419dba04bf0a9406b312 |
| institution | Directory Open Access Journal |
| issn | 1445-6354 |
| language | English |
| last_indexed | 2024-04-10T09:06:50Z |
| publishDate | 2023-01-01 |
| publisher | James Cook University |
| record_format | Article |
| series | Rural and Remote Health |
| spelling | doaj.art-9fe2e161de5f419dba04bf0a9406b3122023-02-21T06:53:15ZengJames Cook UniversityRural and Remote Health1445-63542023-01-012310.22605/RRH7876Sustainable protocol-based management of hypertension in one institution in northern MalawiGwonde Hastings0Raymond O'Connor1Meadhbh Hunt2Peter Harrington3Joe Gallagher4Mark Ledwidge5St John's Hospital, Mzuzu, MalawiSchool of Medicine, University of Limerick, Limerick, Ireland; and Mid-West GP Training Scheme, Irish College of General Practitioners, Ireland; Mid West GP Training Scheme, IrelandSchool of Medicine, University of Limerick, Limerick, IrelandgHealth Research Group, University College Dublin College of Health Sciences, Dublin, IrelandgHealth Research Group, University College Dublin College of Health Sciences, Dublin, IrelandSchool of Medicine, University College Dublin, Dublin, Ireland Introduction: Across all WHO regions, Africa has the highest prevalence of hypertension with 46% of the population >25 years estimated to be hypertensive. Blood pressure (BP) control is poor, with <40% of hypertensives diagnosed, <30% of those diagnosed receiving medical treatment, and <20% with adequate control. We report an intervention to improve BP control in a cohort of hypertensive patients attending a single hospital in Mzuzu Malawi, by introducing a limited protocol of four antihypertensive medications taken once-daily. Methods: A drug protocol based on international guidelines, drug availability in Malawi, cost and clinical effectiveness was developed and implemented. Patients were transitioned to the new protocol as they attended for clinic visits. Records of 109 patients completing at least three visits were assessed for BP control. Results: Two-thirds of patients (n=73) were female and average age at enrolment was 61.6 &plusmn; 12.8 years. Median [interquartile range] systolic BP (SBP) was 152 [136;167] mm Hg at baseline and reduced over the follow-up period to 148 [135; 157, p<0.001 vs baseline]. Median diastolic BP (DBP) reduced from 90.0 [82.0; 100] mm Hg to 83.0 [77.0; 91.0], p<0.001 vs baseline. Patients with highest baseline blood pressures benefited most and there were no associations noted between BP responses and either age or gender. Discussion: We conclude that a limited evidence based once-daily drug regimen can improve blood pressure control by comparison with standard management. Cost effectiveness of this approach will also be reported. https://www.rrh.org.au/journal/article/7876/ |
| spellingShingle | Gwonde Hastings Raymond O'Connor Meadhbh Hunt Peter Harrington Joe Gallagher Mark Ledwidge Sustainable protocol-based management of hypertension in one institution in northern Malawi Rural and Remote Health |
| title | Sustainable protocol-based management of hypertension in one institution in northern Malawi |
| title_full | Sustainable protocol-based management of hypertension in one institution in northern Malawi |
| title_fullStr | Sustainable protocol-based management of hypertension in one institution in northern Malawi |
| title_full_unstemmed | Sustainable protocol-based management of hypertension in one institution in northern Malawi |
| title_short | Sustainable protocol-based management of hypertension in one institution in northern Malawi |
| title_sort | sustainable protocol based management of hypertension in one institution in northern malawi |
| url | https://www.rrh.org.au/journal/article/7876/ |
| work_keys_str_mv | AT gwondehastings sustainableprotocolbasedmanagementofhypertensioninoneinstitutioninnorthernmalawi AT raymondo039connor sustainableprotocolbasedmanagementofhypertensioninoneinstitutioninnorthernmalawi AT meadhbhhunt sustainableprotocolbasedmanagementofhypertensioninoneinstitutioninnorthernmalawi AT peterharrington sustainableprotocolbasedmanagementofhypertensioninoneinstitutioninnorthernmalawi AT joegallagher sustainableprotocolbasedmanagementofhypertensioninoneinstitutioninnorthernmalawi AT markledwidge sustainableprotocolbasedmanagementofhypertensioninoneinstitutioninnorthernmalawi |