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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 2, March/April 2017
74
AFRICA
Table 4 shows hypertension knowledge, diagnosis and work
up by the PCPs according to the type of practice. One-third (
n
=
134) of respondents were in government practice. PCPs in private
practice were older, more likely to be male, had more years of
experience, saw fewer patients, and had a higher prevalence
of hypertension guideline awareness (
p
<
0.05). Out of the 19
questions asked, physicians in private practice performed better
in three, those in government practice also performed better in
three, and the performance of the two groups in the remaining
13 questions was similar.
Discussion
Identification of deficiencies in the approach of physicians to
the prevention, diagnosis and management of hypertension
is a prerequisite for planning interventions targeted towards
hypertension control. Hypertension guidelines summarise
evidence-based best practices aimed at improving hypertension
diagnosis, evaluation, treatment and control. Knowledge of and
adherence to guidelines by care givers is imperative for effective
hypertension control. This will also help reduce the high risk
of cardiovascular morbidity and mortality from the potentially
preventable complications of hypertension, such as heart failure,
kidney disease and stroke.
13
Less than half of the respondents in this study (46.7%)
were aware of the hypertension guidelines. This proportion is
unsatisfactory but smaller than the 68.8% recorded for PCPs in
South Africa.
13
This suggests that hypertension management by
most of the PCPs in our study may not be evidence based. This
is disquieting as it suggests that most hypertensive patients in
Nigeria may not be benefiting from diagnostic and therapeutic
advances in hypertension management since most individuals
with hypertension are managed by PCPs.
9
This survey finding
represents a potential cause for concern as it may be responsible
for the high burden of hypertension-related complications in
Nigeria.
2,8
However, the paucity of hypertension guidelines
indigenous to SSA may be a reason for the above findings.
Hypertension rarely causes symptoms in the early stages
and in many people it goes undiagnosed.
4
The fact that over
two-thirds of hypertensive individuals in Nigeria are unaware
of their hypertensive status makes proper surveillance for
the detection of hypertensive individuals imperative for good
hypertension control.
2
This underlies the IFHA recommendation
of blood pressure checks on all adult healthcare seekers at every
encounter with healthcare providers.
7
Two-thirds (69.9%) of the PCPs in this study routinely
checked the blood pressure of patients in consultation. A
similar proportion of the PCPs in this study (69.7%) also agreed
that uncomplicated hypertension is usually asymptomatic. This
however contrasts sharply with the high proportion (95.1%)
of physicians who considered hypertension a major public
health challenge. These findings suggest that the knowledge
of the enormity of the challenge posed by hypertension may
have been overridden by their inadequate knowledge of the
symptomatology of hypertension. The effect of this is reflected
in the lower proportion of PCPs who routinely checked the
blood pressure of their adult clients in consultation.
Table 3. Hypertension knowledge, diagnosis and work up by 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
(%)
n
(%)
n
(%)
Correct BP threshold for
hypertension diagnosis (403) 301 (74.7)
158 (84)
143 (66.5)
76.3/
<
0.001
Routinely checked BP in
practice (392)
273 (69.6) 144 (80.9) 129 (60.3)
19.5/
<
0.001
Allows short rest before
measuring BP (390)
103 (26.4) 51 (28.3)
52 (24.8) 0.64/0.425
Take ≥ two BP readings
before diagnosing hyperten-
sion (403)
398 (98.8) 188 (100) 210 (97.7)
0.064*
Measures BP in both arms
during first visit (390)
63 (16.2)
36 (20)
27 (12.9) 3.65/0.056
Agreed uncomplicated
hypertension is asymptom-
atic (403)
281 (69.7)
111 (59)
170 (79)
<
0.001*
FH of hypertension (398)
349 (87.7)
173 (92)
176 (83.8) 6.2/0.014
FH of DM ( 403)
305 (75.7) 163 (86.7) 142 (66.6)
<
0.001*
PH of DM ( 400)
312 (78)
161 (87)
151 (70)
<
0.001*
Obesity evaluation ( 400)
183 (45.8) 93 (50.3)
90 (41.9) 2.8/0.092
Alcohol history (403)
297 (73.7) 137 (72.9) 160 (74.4) 0.12/0.73
Tobacco history (398)
297(74.6) 142 (75.5) 155 (73.8) 0.16/0.69
Physical activity evaluation
(383)
251 (65.5) 128 (71.9)
123 (60)
6.0/0.014
Urinalysis (403)
324 (80.4) 163 (86.7) 161 (74.9) 3.9/0.003
Blood glucose (398)
248 (62.3)
124 (66)
124 (59)
0.18*
EUCr (399)
245 (61.4) 120 (65.2) 125 (58.1) 2.1/0.15
Lipogram (403)
166 (41.2) 73 (38.8)
93 (43.3)
0.8/0.37
Fundoscopy (400)
21 (5.3)
0 (0)
21 (9.8)
<
0.001*
Electrocardiography (398)
204 (51.3) 101 (53.7)
103 (49)
0.87/0.35
GA, guideline aware; GU, guideline unaware; BP, blood pressure; FH, family
history; PH, personal history; DM, diabetes mellitus; EUCr, serum electrolytes
and creatinine; *Fishers exact test.
Table 4. Hypertension knowledge, diagnosis and work up by the
respondents according to their type of practice
Variable (
n
)
Type of practice
Private vs
government
χ
2
/
p
-value
All
n
(%)
Private
n
(%)
Government
n
(%)
Correct BP threshold for
hypertension diagnosis (403)
301 (74.7) 208 (77.3) 93 (69.4) 2.97/0.085
Routinely check BP in prac-
tice (392)
273 (69.6) 201 (76.4) 72 (55.8)
17.39/
<
0.001
Allows short rest before
measuring BP (390)
103 (26.4) 74 (28.4)
29 (22.5)
1.53/0.22
Take ≥ two BP readings
before diagnosing hyperten-
sion (403)
398 (98.8) 264 (98.1) 134 (100)
0.175*
Measures BP in both arms
during first visit (390)
63 (16.2)
44 (16.7)
19 (15.1)
0.16/0.69
Agrees uncomplicated
hypertension is asymptom-
atic (403)
281 (69.7) 177 (65.8) 104 (77.6) 5.9/0.015
FH of hypertension (398)
349 (87.7) 229 (86.7) 120 (89.6) 0.65/0.42
FH of DM ( 403)
305 (75.7) 212 (78.8) 93 (69.4)
4.30/0.04
PH of DM ( 400)
312 (78)
201 (75.6) 111 (82.8)
2.75/0.1
Obesity evaluation ( 400)
183 (45.8) 122 (45.4) 61 (45.5) 0.052/0.82
Alcohol history (403)
297 (73.7) 201 (74.7) 96 (71.6)
0.44/0.51
Tobacco history (398)
297 (74.6) 211 (79.9) 86 (64.2) 11.64/0.001
Physical activity (383)
251 (65.5) 180 (70.9)
71 (53)
9.49/0.002
Urinalysis (403)
324 (80.4)
242 (90)
82 (61.2) 47/
<
0.001
Blood glucose (398)
248 (62.3) 164 (62.1) 84 (62.7)
0.01/0.91
EUCr (399)
245 (61.4) 153 (57.7) 92 (68.7)
4.48/0.03
Lipogram (403)
166 (41.2) 104 (38.7) 62 (46.3)
2.14/0.14
Fundoscopy (400)
21 95.3)
17(6.3)
4 (3.1)
1.89/0.17
Electrocardiography (398)
204 (51.3) 136 (51.5) 68 (50.7)
0.02/0.89
BP, blood pressure; FH, family history; PH, personal history; DM, diabetes
mellitus; EUCr, serum electrolytes and creatinine; *Fisher’s exact test.