CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 4, July/August 2011
AFRICA
187
was obtained from the University of Cape Town Health Sciences
Faculty Research Ethics Committee. Relevant statistical analysis
using Microsoft Excel, SPSS and STATISTICA was performed.
Normally distributed data were analysed using the Student’s
t
-test, and non-parametric data were analysed using either the
Fisher’s exact test or Pearson chi-square test. All
p
-values were
two-sided, and
p
<
0.05 were taken to indicate statistical signifi-
cance.
Results
There were 16 doctors employed at the two CHCs, all of whom
were voluntarily enrolled into this study. Seven (43.7%) of the
doctors were female, 14 (87.5%) were aged between 26 and 40
years, and 81.25% of the doctors surveyed had been practicing
medicine for less than 10 years (Table 1).
Management of hypertension in general
All the doctors (100%) felt that the management of hypertension
was a significant part of their daily practice. Ten (62.5%) stated
that they attempted to treat hypertension to target. All doctors
thought that lifestyle modification was an important adjunct to
the treatment of hypertension, yet recommendations on lifestyle
modifications to patients were reportedly poorly done by all the
doctors. Only 50% of doctors indicated that they even mentioned
lifestyle modifications to some of their patients (Table 2).
Awareness of the South African hypertension
guidelines
Eleven (68.8%) of the doctors were aware of the recent South
African hypertension guidelines. Of these 11, nine (81.8%)
stated that they were not conversant with the content of the
guidelines (this was reported in spite of the guidelines being
prominently displayed in the corridors and some of the consult-
ing rooms of both CHCs). Knowledge of the compelling indica-
tions for treatment of hypertension, as stated in the hypertension
guidelines, was poor, with the majority of doctors not knowing
what these conditions are (Fig. 1).
Estimation of effective blood pressure control
Overall, the doctors estimated that 35% (range 5–60%) of their
hypertensive patients were controlled on the antihypertensive
treatment prescribed.
Preferred management approach to hypertension
Doctors were asked to list their preferred treatment for hyperten-
sion. Eleven (68.8%) of the doctors stated that hydrochlorothi-
azide was their preferred first-line antihypertensive agent, in the
absence of compelling indications; with 11 (68.8%) indicating
that enalapril was their preferred second-line agent. Ten (62.5)
selected amlodipine as a preferred third-line agent. Four (25%)
of the participants in the study indicated that
b
-blockers were
their preferred fourth-line antihypertensive, with various other
drugs listed as fourth-line options, in the absence of compelling
indications (Table 2).
Doctors were also asked to choose from a list of four drugs
(angiotensin converting enzyme inhibitor or angiotensin recep-
tor blocker, calcium channel blocker,
b
-blocker or diuretic) and
indicate their preferred choice of antihypertensive agent, when
TABLE 2. KNOWLEDGEABOUT HYPERTENSION
AND PREFERENCE FOR MANAGEMENT OF
HYPERTENSIONAMONG DOCTORS SURVEYED
Proportion who felt that hypertension is an important
aspect of their daily practice (%)
16 (100.0)
Proportion who attempt to treat hypertension to target (%) 10 (62.5)
Proportion who feel that lifestyle modification is an
important aspect of management of hypertension (%)
16 (100.0)
Proportion who recommend lifestyle modification to their
patients (%)
8 (50.0)
Proportion who are aware of the existence of the
hypertension guidelines (%)
11 (68.8)
Proportion who are conversant with the contents of the
hypertension guidelines (%)
2 (12.5)
Choice of drugs to treat hypertension, in the absence of
compelling indications
11 (68.8)
First line: hydrochlorothiazide
11 (68.8)
Second line: enalapril
10 (62.5)
Third line: amlodipine
5 (31.25)
Fourth line: beta-blocker, hydralazine or other agent
TABLE 1. DEMOGRAPHIC DETAILS OF
DOCTORS SURVEYED
Demographic details
Doctors surveyed (
n
=
16)
Gender
male (%)
9 (56.3)
female (%)
7 (43.7)
Age (years)
<
25 (%)
1 (6.25)
26–30 (%)
7 (43.75)
31–40 (%)
7 (43.75)
over 60 (%)
1 (6.25)
Duration of practice (years)
0–5 (%)
8 (50.0)
6–10 (%)
5 (31.25)
11–15 (%)
1 (6.25)
16–20 (%)
1 (6.25)
>
35 (%)
1 (6.25)
Fig. 1. Compelling indications for the treatment of hyper-
tension as given by the doctors surveyed. DM
=
diabetes
mellitus, IHD
=
ischaemic heart disease; PVD
=
periph-
eral vascular disease, HC
=
hypercholesterolaemia, HF
=
heart failure, PMI
=
previous myocardial infarction, RD
=
renal disease, HIV
=
human immunodeficiency virus
infection, CVA
=
cerebrovascular accident.
14
12
10
8
6
4
2
0
DM IHD PVD HC HF Age Preg-
nan-
cy
PMI RD HIV CVA
Doctors (
n
)
Indications for treatment of hypertension
