Cardiovascular Journal of Africa: Vol 27 No 6 (November/December 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 6, November/December 2016 AFRICA 361
Uncontrolled hypertension among patients managed in
primary healthcare facilities in Kinshasa, Democratic
Republic of the Congo
TM Kika, FB Lepira, PK Kayembe, JR Makulo, EK Sumaili, EV Kintoki, JR M’Buyamba-Kabangu
Abstract
Background: Uncontrolled hypertension remains an impor-
tant issue in daily clinical practice worldwide. Although the
majority of patients are treated in primary care, most of the
data on blood pressure control originate from population-
based studies or secondary healthcare.
Objective: The aim of this study was to evaluate the frequency
of uncontrolled hypertension and associated risk factors
among hypertensive patients followed at primary care facili-
ties in Kinshasa, the capital city of Democratic Republic of
the Congo.
Methods: A sample of 298 hypertensive patients seen at
primary healthcare facilities, 90 men and 208 women, aged ≥
18 years, were consecutively included in this cross-sectional
study. The majority (66%) was receiving monotherapy, and
diuretics (43%) were the most used drugs. According to
2007 European Society of Hypertension/European Society
of Cardiology hypertension guidelines, uncontrolled hyper-
tension was defined as blood pressure ≥ 140/90 or ≥ 130/80
mmHg (diabetes or chronic kidney disease). Logistic regres-
sion analysis was used to identify the determinants of uncon-
trolled hypertension.
Results: Uncontrolled hypertension was observed in 231
patients (77.5%), 72 men and 159 women. Uncontrolled systol-
ic blood pressure (SBP) was more frequent than uncontrolled
diastolic blood pressure (DBP) and increased significantly with
advancing age (p = 0.002). The proportion of uncontrolled
SBP and DBP was significantly higher in patients with renal
failure (p = 0.01) and those with high (p = 0.03) to very high ( p
= 0.02) absolute cardiovascular risk. The metabolic syndrome
(OR 2.40; 95% CI 1.01–5.74; p = 0.04) emerged as the main risk
factor associated with uncontrolled hypertension.
Conclusion: Uncontrolled hypertension was common in this
case series and was associated with factors related to lifestyle
and diet, which interact with blood pressure control.
Keywords: uncontrolled hypertension, risk factors, primary care,
black Africans
Submitted 9/8/14, accepted 22/3/16
Cardiovasc J Afr 2016; 27: 361–366
DOI: 10.5830/CVJA-2016-036
Hypertension is the most prevalent treatable cause of
cardiovascular (CVD) and chronic kidney disease (CKD).1
Controlling hypertension leads to significant reduction in the
prevalence and incidence of target-organ damage (TOD) and
mortality from CVD.1 Despite the availability of effective
antihypertensive treatments and guideline recommendations on
the management of high blood pressure, hypertension remains
one of the most poorly controlled risk factors in patients with
and without CVD. 1 This highlights the need to consider lifestyle
and diet as well as tolerance and adherence to treatment with
several antihypertensive drugs.1 Controlling hypertension often
requires the use of several antihypertensive agents, especially in
elderly patients or those with stroke or diabetes.1
Patients with hypertension and one or more co-morbidities
increasingly form a significant part of the primary care
practitioner’s case load.2 Insufficient blood pressure control
remains an important issue in daily clinical practice worldwide.3
However, most of the international data on blood pressure-
control studies originate from national surveys, population-
based studies or secondary healthcare, despite the fact that the
majority of patients are treated in a primary care (PC) setting.3
Therefore, data on hypertension treatment and control from PC
are awaited.
In Democratic Republic of the Congo (DRC), despite the
ever-growing prevalence of hypertension, data on uncontrolled
hypertension are scarce and rely upon few population-based
studies.4-6 Therefore, the objective of this study was to evaluate
the frequency of uncontrolled hypertension and associated
risk factors among hypertensive patients followed at primary
care facilities in Kinshasa, the capital city, with an estimated
population of 10 million.
Methods
From 30 April to 24 August 2012, all consecutively appearing
patients with known hypertension and regularly followed at
healthcare centres of the Roman Catholic Church Network
(BDOM) were asked to participate in this cross-sectional study.
Inclusion criteria were: age ≥ 18 years, being on antihypertensive
treatment for at least three months, and giving a written
informed consent to participate in the study.
Division of Cardiology, University of Kinshasa Hospital,
Kinshasa, Democratic Republic of the Congo
TM Kika, MD
EV Kintoki, MD
JR M’Buyamba-Kabangu, MD
Division of Nephrology and Hypertension, Kinshasa School
of Public Health, Kinshasa, Democratic Republic of the Congo
FB Lepira, MD, PhD,
JR Makulo, MD
EK Sumaili, MD
Department of Internal Medicine, University of Kinshasa,
Kinshasa, Democratic Republic of the Congo
PK Kayembe, MD