A. Olowofela and A. O. Isah
Clinical Pharmacology and Therapeutics Unit,
Department of Medicine
University of Benin Teaching Hospital.
Benin-City.
Nigeria.
Introduction
 The Nigerian Hypertension Society guidelines
(2005) was based on that of 1999 ISH/WHO and
the 2003 sub-Saharan Africa hypertension
guidelines.
 It was introduced with the intention of promoting
proper management of hypertension by
physicians.
 Of interest is the lack of characterization of the
prescribing pattern of physicians following the
introduction of these guidelines in Southern
Nigeria.
ICIUM 2011 Antalya Turkey
Objectives
 To assess changes in prescribing of
antihypertensives prior to and after the 2005
guidelines.
 To further assess physicians’ awareness of the
guidelines.
ICIUM 2011 Antalya Turkey
Methodology
 Design: A policy evaluation and descriptive
study and a cross-sectional study of the
physicians’ awareness of the guidelines
 Location: Medical Outpatient Clinic and
Department of Internal Medicine, University of
Benin Teaching Hospital, (UBTH) Benin-City,
Nigeria. A 620-bedded tertiary hospital.
 Study Population: The study evaluated the
case records of 3,379 hypertensive patients who
had attended the medical outpatient clinic(1999–
2008) and 48 post registration doctors working in
the department of Medicine, UBTH.
Methodology
• All cases were selected using a convenience
sampling method. A self-administered semistructured questionnaire was administered to the
doctors to assess awareness.
• Policies: The Nigerian hypertension guidelines
(2005) recommended the use of diuretics as
first-choice antihypertensives in uncomplicated
hypertension.
• Outcome Measures: The study’s primary
outcome was to determine if diuretics were the
most prescribed group of antihypertensives since
the release of the guideline; also to determine if
diuretics would be the most preferred
antihypertensives by doctors
ICIUM 2011 Antalya Turkey
Results
• Annual prescriptions of diuretics increased
steadily from 38% in 1999 to a peak of 58% in
2005. The values were sustained in 2006 (57%),
2007 (55%), and 2008 (55%). (Figure 1).
• A total of 37/48 doctors returned the filled
questionnaire (response rate 77.1%).
• A high proportion (32/37; 86.5%) of the doctors
were aware of the national guidelines but only
13/37 (35.1%) were satisfied with the
recommendations. (Table 1).
• Diuretics were stated as the most preferred class
of antihypertensive medicines by 26/37 (70.3%)
of respondents.(Table 2).
ICIUM 2011 Antalya Turkey
% of patients prescribed
antihypertensive medcines
80
70
60
ACEI
ARB
BB
CCB
DIUR
AMD
ALPHB
OTHERS
50
40
30
20
10
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
YEARS
Figure 1: Trends of classes of antihypertensives
prescribed during the period 1999-2008.
AMD: METHYDOPA, DIUR-DIURETICS, ALPHB- ALPHABLOCKERS, BB-BETA
BLOCKERS, OTHERS- RESERPINE, BASED PREPARATIONS.
ICIUM 2011 Antalya Turkey
Demographics of participating doctors
Frequency
of all
doctors
37.60±9.1
Registrars
Senior
registrars
Consultants
32.10±4.1
34.8±3.0
48.8±10.2
Gender (M/F)
Duration of clinical
practice (years)
23/14
12.0±8.5
6/7
6.8±2.4
12/3
9.6±3.0
5/4
24.5±9.1
Reported awareness of
provisions in any HTN
guidelines (%)
33(91.9)
10(30.3)
15(45.5)
Reported awareness of
11(29.7)
provisions in 1999
WHO/ISH guidelines (%)
3(27.3)
Reported awareness of
provisions in JNC VII
2003 (%)
15(40.5)
Reported awareness of
provisions in national
guidelines (%)
32(86.5)
Characteristics
Age (years) Mean(SD)
Chi
square
pvalue
8(24.2)
3.848
0.15
5(45.4)
3(27.3)
0.425
0.81
4(26.7)
7(46.7)
4(26.7)
0.805
0.67
9(28.1)
15(46.9)
8(25.0)
5.70
0.06
ICIUM 2011 Antalya Turkey
Table 2:Distribution among the cadres of doctors
in their choice of first preference
antihypertensive medicine
Medicine class
Registrars
n(%)
Senior registrars
n(%)
Consultants
n(%)
ACEI
First preference
antihypertensive
medicine
n(%)
2(5.4)
0
1(50.0)
1(50.0)
ARB
0
0
0
0
BB
0
0
0
0
CCB
9(24.3)
3(33.3)
4(44.4)
Diuretic
26(70.3)
11(42.3)
11(42.3)
4(15.4)
Centrally
Acting
No response
0
0
0
0
0
0
0
0
2(22.2)
Conclusion
• The findings suggest a less than optimal
compliance with the guidelines with growing
preference for newer medicines.
• There was a disconnect in the prescribers’
knowledge of recommendations in the
guidelines, their stated preferences for
medicines, and the observed findings in the
case records.
• This may be due in part, to the observed
dissatisfaction of doctors with the guidelines.
ICIUM 2011 Antalya Turkey