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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 2, March/April 2017
AFRICA
73
guidelines among PCPs in Lagos, Nigeria and its effect on their
diagnostic approach to hypertension. We also sought to determine
the relationship between the type of practice, namely private or
government, and hypertension diagnosis and work up.
Methods
Four hundred and three Lagos-basedPCPs (general practitioners)
attending continuing medical education programmes were
categorised into two groups: hypertension guideline aware and
guideline unaware. Hypertension guideline awareness status was
defined by a ‘yes’ or ‘no’ answer to the question: ‘are you aware
of hypertension guidelines?’ Physicians with speciality training in
internal medicine were excluded from the study.
Ethical clearance was obtained from the ethics and research
committee of the Lagos University Teaching Hospital. Consent
of each participant was obtained.
Anonymous self-administered questionnaires consisting of
19 open-ended and closed questions on hypertension diagnosis
and work up were used. The closed questions had either yes/
no or Likert-type scale responses. The study questionnaire
was in four main domains: (1) type of practice – private versus
government and number of patients seen; (2) hypertension
detection – frequency of blood pressure checks in patients,
resting before blood pressure measurement, number of blood
pressure readings, blood pressure threshold levels; (3) clinical
evaluation – personal history of diabetes mellitus, alcohol and
tobacco habits, family history of diabetes and hypertension,
evaluation for obesity, and blood pressure measurement; and (4)
laboratory/ancillary evaluation – urinalysis, serum electrolytes
and creatinine, blood glucose, lipogram, electrocardiogram and
fundoscopy. An additional question on hypertension being a
major public health problem was included.
Statistical analysis
Likert-type scale responses were transformed into dichotomous
responses of appropriate/yes (‘always done’ and ‘often or usually
done’) and inappropriate/no (‘sometimes done’, ‘occasionally
done’ and ‘rarely or never done’) practice/behaviour. Another
Likert-like scale (stronglyagree, agree, neutral/undecided, disagree
and strongly disagree) response to the statement ‘uncomplicated
hypertension is usually asymptomatic’ was transformed into
yes (strongly agree, agree) and no (neutral/undecided, disagree
and strongly disagree). Definitions were adopted for binary
outcomes based on the IFHA recommendations for prevention,
diagnosis and management of hypertension and cardiovascular
risk factors in sub-Saharan Africa.
7
All statistical data were analysed using the Statistical Package
for Social Sciences (SPSS, version 16.0). Descriptive statistics
were used to report the findings. Categorical and continuous
variables were expressed as proportions and means
±
SD
respectively. The statistical significance of variables was tested
using the chi-squared test for categorical variables and Student’s
t
-test for continuous variables. All tests were two-sided and
values were considered statistically significant if
p
<
0.05.
Results
Data from 413 PCPs with a mean age of 40
±
11.34 years and
a mean post-registration experience of 14.30
±
11.00 years were
analysed. Guideline awareness among the cohort was 46.7%
(
n
=
188). Tables 1 and 2 show the basic characteristics of the
PCPs according to their awareness of hypertension guidelines
and the type of practice, respectively. The guideline-aware (GA)
physicians were younger than the guideline-unaware (GU)
physicians (
p
<
0.05). The GA and GU physicians were similar
in terms of gender, experience and patient load (
p
<
0.05).
Hypertension was considered a major public health problem by
95.1% (
n
=
369) of the physicians.
Table 3 shows hypertension knowledge, diagnosis and work
up by the PCPs according to their awareness of hypertension
guidelines. Out of the 19 questions asked, the GA PCPs
performed better than the GU physicians in seven, the GU PCPs
performed better than the GA physicians in two, and the two
groups had a similar performance in the remaining 10 questions.
The practice of routinely checking blood pressure of all adult
patients in consultation was independent of whether or not
the physicians considered hypertension a major public health
challenge (
χ
2
=
0.07,
p
=
0.8).
Table 1. Basic characteristics of the respondents
according to their awareness of guidelines
Variable (
n
)
All
Awareness of guidelines
GA vs GU
χ
2
/
p
-value
Yes (GA) No (GU)
n
(%)
mean
±
SD
n
(%)
mean
±
SD
n
(%)
mean
±
SD
No of physicians
403 (100) 188 (46.7) 215 (53.3)
Age (397)
40.0
±
11.3 38.5
±
9.6 41.4
±
12.6 0.01
Gender (403)
0.99/0.32
Male
249 (61.8) 121 (64.4) 128 (59.5)
Female
154 (38.2) 67 (35.6)
87(40.3)
Years post registration (403) 14.3
±
11.1 13.4
±
9.9 15.1
±
12.0 0.12
No of patients seen per day
(403)
17.4
±
14.3 17.5
±
11.6 18.3
±
16.2 0.58
No of hypertensive patients
seen per day (396)
4.4
±
3.5 4.1
±
3.3 4.6
±
3.6
0.21
Type of practice (403)
5.95/0.015
Private (269)
269 (66.7) 137 (72.9) 132 (61.4)
Government (134)
134 (33.3) 51 (27.1)
83 (38.6)
Consider hypertension a
public health challenge (388) 369 (95.1) 164 (94.8) 205 (95.3) 0.06/0.80
GA, guideline aware; GU, guideline unaware.
Table 2. Basic characteristics of the respondents
according to the type of practice
Variable (
n
)
Type of practice
Private
vs
government
χ
2
/
p
-value
All
Private Government
n
(%)
mean
±
SD
n
(%)
mean
±
SD
n
(%)
mean
±
SD
No of physicians
403 (100) 269 (66.7) 134 (33.3)
Age (397)
40.0
±
11.3 42.6
±
11.9 35.0
±
7.9
<
0.001
Gender (403)
20.47/
<
0.001
Male
249 (61.8) 187(69.5)
62(46.3)
Female
154 (38.2)
82(30.5)
72(53.7)
Years post registration (403) 14.3
±
11.1 16.9
±
11.4 9.2
±
8.5
<
0.001
No of patients seen per day
(403)
17.4
±
14.3 15.8
±
10.8 22.2
±
18.7
<
0.001
No of hypertensive patients
seen per day (396)
4.4
±
3.5 3.3
±
2.3 6.5
±
4.3
<
0.001
Awareness of guidelines
(403)
188 (46.7) 137 (50.9)
51 (38.1) 5.95/0.015