Drug therapy, lifestyle modification and blood pressure control in a primary care facility, south of Johannesburg, South Africa: an audit of hypertension management

Abstract

Background: Hypertension management is suboptimal in many settings. We assessed blood pressure (BP) control according to target, the appropriateness of antihypertensive therapy and the extent of implementing lifestyle modification among hypertensive patients. Method: This study was an audit involving a retrospective review of medical records of hypertensive patients who were 18 years of age and older (n = 300), attended to by doctors or primary health care nurses at a large community health centre, south of Johannesburg, South Africa. Demographic, anthropometric, clinical and management data were extracted from the files of hypertensive patients who met the inclusion criteria. Data analysis included the use of descriptive statistics, the chi-square test and Fisher’s exact test. The main outcome measures were the proportions of patients with controlled BP, who used appropriate antihypertensive drugs and who had documented lifestyle modifications. Results: Most patients were black (75.7%) and female (68.3%). The mean age was 60 years. The majority of the patients (55.7%) were either overweight or obese. Fifty-seven per cent of the patients (n = 171) had BP control meeting the target. Appropriate choice of antihypertensive drugs was documented in 81.3% of patients (n = 244), while 56.3% had lifestyle modification documented in their records. Significantly more women had their BP controlled to target compared to men (P = 0.0028). Factors significantly associated with good BP control were white race (P = 0.0001) and documentation of adherence to therapy (P = 0.000). Conclusion: BP control was achieved in the majority of patients and the vast majority was on appropriate drug therapy. White race, female sex and adherence to treatment documented in the medical record were significantly associated with BP controlled to target.