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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 2, March/April 2017
72
AFRICA
Cardiovascular Topics
Awareness of hypertension guidelines and the diagnosis
and evaluation of hypertension by primary care
physicians in Nigeria
OK Ale, RW Braimoh
Abstract
Background:
The availability of numerous hypertension guide-
lines seems not to have impacted significantly on the burden
of hypertension. We evaluated awareness of hypertension
guidelines among primary-care physicians (PCPs) in Nigeria
and its relationship to hypertension diagnosis and work up.
Methods:
Anonymous self-administered questionnaires were
filled in by PCPs categorised into two groups: hypertension
guideline aware (GA) and unaware (GU).
Results:
The 403 participating PCPs had a mean age and
experience of 40
±
11.34 and 14
±
11.10 years, respectively,
with 46.7% (
n
=
188) of them being GA. Out of the 19 ques-
tions assessed, GA and GU PCPs performed better in seven
and two questions, respectively, while the two subgroups had
a similar performance in 10 questions. The performance of
the PCPs in government and private practice was similar.
Conclusions:
There is a gap between guideline recommenda-
tions and hypertension care in Nigeria that is further widened
by PCPs’ unawareness of the guidelines. Popularising hyper-
tension guidelines among PCPs may significantly improve
hypertension care and reduce the burden of disease.
Keywords:
hypertension, guidelines, diagnosis, work up, primary-
care physicians, Nigeria
Submitted 26/6/15, accepted 5/4/16
Cardiovasc J Afr
2017;
28
: 72–76
www.cvja.co.zaDOI: 10.5830/CVJA-2016-048
Hypertension is a major public health challenge, with increasing
prevalence worldwide.
1
It is the leading cardiovascular (CV) risk
factor for morbidity and mortality and the largest contributor
to the global burden of disease.
2,3
Approximately 40% of adults
aged 25 years and older worldwide had hypertension in 2008,
with Africa and the Americas having the highest (46%) and
lowest (35%) prevalence, respectively.
4
The estimated prevalence
of hypertension in Nigeria is 29.5%.
5
Undiagnosed, uncontrolled and inappropriately managed
hypertension is associated with a high risk for morbidity and
mortality from potentially preventable complications such as
stroke, and kidney and heart diseases.
2,3,6
However, evidence
from clinical and epidemiological research has provided huge
capabilities for lowering blood pressure in almost every person
with hypertension.
1
This evidence has been collated, evaluated
and summarised into hypertension guidelines to assist physicians
in selecting the best hypertension-management strategies, taking
into account the impact on outcome, as well as the risk–benefit
ratio of particular diagnostic or therapeutic means. Few of these
guidelines are indigenous to sub-Saharan Africa (SSA) despite
the huge burden of hypertension in this region, and many of the
available guidelines do not factor the peculiarities of SSA into
their recommendations.
Although it is important to consider the science of medicine
for the treatment of hypertension, particular consideration
should be given to cost-effectiveness and affordability because
many countries in SSA have severe resource constraints.
7
A good
combination of science, cost-effectiveness and affordability is
provided by the International Forum for Hypertension control
and prevention in Africa (IFHA) recommendations for the
prevention, diagnosis and management of hypertension and
cardiovascular risk factors in sub-Saharan Africa.
7
The presence of hypertension guidelines seems not to have
significantly impacted on hypertension control in SSA, with the
burden of hypertension increasing. Its epidemiology is generally
characterised by low levels of awareness, poor treatment, poor
blood pressure control and a high burden of hypertension-
related complications.
2,3,8
Hypertension is the commonest condition in the primary-care
setting, and in many countries it is almost entirely managed by
primary-care physicians (PCPs).
5,9
It has been suggested that
the detection and treatment of hypertension in the primary
healthcare setting in SSA is poor.
7
This is similar to the
unsatisfactory management of hypertension and cardiovascular
risk factors reported in various parts of the world.
10-12
Limited knowledge of hypertension by healthcare professionals,
among other factors, has been identified as being responsible for
poor hypertension control in SSA.
3
This makes it worthwhile to
investigate the contribution of PCPs to the burden of undiagnosed
and inadequately/inappropriately managed hypertension in
Nigeria. Our aim was to evaluate awareness of hypertension
Department of Medicine, Faculty of Clinical Sciences,
University of Lagos/Lagos University Teaching Hospital,
Lagos, Nigeria
OK Ale, MB BS, MPH, FMCP,
gokeale@yahoo.comRW Braimoh, MB BS, FWACP