CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 5, November/December 2023 AFRICA 311 (two articles), two-drug strategies (three articles) and threedrug strategies (seven articles). However, 10 articles described antihypertensive drug strategies beyond three-drug strategies. Overall, 21% (IQR: 12.9–39.5%) of patients received monotherapy, 42.6% (IQR: 35.8–49%) a two-drug combination and 26.6% (IQR: 8.7–36.5%) a three-drug combination (Fig 4A). Prescription of a single-pill combination was described in six articles (20%). According to these studies, one to 51.8% of patients received single-pill combination therapy. Among all the treatment strategies, antihypertensive medication classes prescribed were not systematically described (21 articles; 70%). Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) were not systematically differentiated and were combined under the common class of renin–angiotensin system (RAS) blockers in three articles.25,28,38 RAS blockers were the most commonly prescribed BP-lowering drugs [total RAS blockers: 67% (IQR: 64–69%); ACEI only: 48% (IQR: 22.4–53.5%); ARB only: 13.8% (IQR: 4.9–23%)], followed by diuretics (median: 59.7%; IQR: 48–76%) (Fig 4B). Calcium-channel blockers (CCB) were the third antihypertensive drug class mostly prescribed, with a median of prescription of 34.5% (IQR: 24–58%). RAS blockers were the most widely cited drugs in monotherapy, followed by CCB (Fig. 5). Diuretics were the most common drugs cited in two-drug combinations, followed by RAS blockers and CCB. Beta-blockers were most frequently cited as part of a threedrug antihypertensive medication strategy, followed by RAS blockers. Antihypertensive medications by drug strategies were not itemised by quantitative data. Of the 30 articles, nine described adherence to medication.17,18,24,27,28,31,37,40,43 Methods to assess adherence were described in three articles and based on questionnaires filled in by patients.24,40,43 For the other six studies, the physicians assessed adherence without clear methodology. A total of eight articles (26%) described combination of lifestyle measures and antihypertensive medications. Of the 30 articles, six (20 %) did not report the proportion of patients with BP control or average office BP measurements before and after treatment. Hypertension was often defined (27 studies) but guidelines used to define hypertension and threshold of BP control were not systematically described (19 studies). Different guidelines were used across the studies (US Joint National Committee,44–46 European Society of Cardiology47,48 or WHO).49 Proportions of studies describing BP control, BP office measurements or both were 50% (n = 15); 6.6% (n = 2) and Table 3. Patients’ characteristics First author No. of patients Average age M/F ratio Diabetes mellitus (%) Cardiovascular disease history (%) Obesity (%) Dyslipidaemia (%) Renal failure (%) Tobacco use (%) Hypercholesterolaemia (%) Cardiovascular family history (%) Sedentary lifestyle (%) Metabolic syndrome (%) Hypertriglyceridaemia (%) Adigun et al. 150 61 0.9 21 – – – – – – – – – – Hesse et al. 155 55 0.3 – – – – – – – – – – – Yusuff et al. 189 – – 39.6 – – – 6.3 – – – – – – Yusuff et al. 189 – – 32.7 9.1 – – 7.3 – – – – – – Etuk et al. 145 52.3 0.9 – – – – – – – – – – – Pillay et al. – – – – – – – – – – – – – – Rayner et al. 451 60.7 0.8 18.6 – 36.4 – – 15.7 44.3 – – 17.1 – Olanrewaju et al. 787 57.8 0.6 – – – – – – – – – – – Ganiyu et al. 208 – 1.5 13.9 21.2 – 5.3 – – – – – – – Ilesanmi et al. 250 61 0.7 – – – – – – – – – – – Konin et al. 144 43.8 0.7 3.47 – 20.8 – – 6.25 13.2 – – – – Kramoh et al. 854 73.1 0.7 11.5 – 33.80 56 – 23.70 – – – – – Omole et al. 230 51 1.4 7 4.4 – – 29.6 – – – – – – Tamuno et al. 200 50.7 0.7 13 3.50 6.50 7.50 6.5 – – – – – – Ukwe et al. 376 61 1.0 19.7 71 4.87 1.54 – – – – – – – Ojji et al. 590 49.7 1.0 – – – – – – – – – – – Shoba– et al. 111 58.3 1.7 – 100 – – – – – – – – – Yaméogo et al. 456 – 0.8 24.5 – 21 30 – 7 – – 11 – – Mutua et al. 452 63 0.4 41.8 4 – – – – – – – – – Ikama et al. 620 53.8 1.3 14.5 – 21.6 19.5 – 4 – 28 44.4 – – Shukrala et al. 400 – 0.6 64.3 17.4 – – – – – – – – – Bakare et al. 200 58.4 0.5 11 41 5 7.5 – – – – – – – Busser et al. 486 – 0.8 – – – – – – – – – – – Kika et al. 298 64 0.4 37 – 17 – 30 3 17 50 – 10 18 Ssianulya et al. 741 – 0.2 1.5 1.9 – 0.5 – – – – – – – Adejumo et al. 224 59.6 0.5 10.7 – – – – – – – – – – Berhe et al. 897 57 0.6 25 7 – 5 3 6 – – – – – Mbui et al. 247 55.8 0.1 36.8 2 – – – – – – – – – Olowofela et al. 514 57.9 0.5 25.5% – 3.1 – – 3.1 – – – – – Teshome et al. 392 58 0.9 18.4 17.3 – – 6.6 1.3 – 20.7 – – – Median 274 58 0.7 18.6 9.1 17 6.4 6.6 6 17 28 27.7 13.5 18 IQR1–IQR3 192–478 54–61 0.5–0.9 11.2–29.1 4–21.2 5–21 4.1–13.1 6.4–18.4 3.1–7 15.1–30.6 24.3–39 19.3–36 11.7–15.3 Min–max 111–897 43.8–6] 0.3–1.7 3.47–64.3 2–100 3.1–36.4 0.5–56 3–30 1.3–23.7 13.2–44.3 20.7–50 11–44.4 10–17.1
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