Management of hypertension in Swedru District Hospital in the Central Region of Ghana

Controlling high blood pressure is of paramount importance for preventing cardiovascular disease which develops into complications leading to the loss of life. The Swedru District Hospital recorded a relatively high prevalence rate of hypertension coupled with a high mortality from cardiovascular disease e.g. heart failure ,stroke and ischemic heart disease. The above observation informed the need to investigate the management of hypertension in the district hospital and make the necessary recommendations to improve or control the health problem. Objectives The objective of the study was to look for the factors that contributed to improper management of hypertension in the facility. These factors, if addressed, therapeutic outcome and patient well-being are likely to be improved. Design This is a cross-sectional study of 200 hypertensive patients that visited the hospital from 8thJuly 2005 to 16thSeptember 2005. Both retrospective and interview methods were employed. The inclusion criteria were all hypertensive patients with BP of less than 250 /100mm Hg and greater than120/80mmHg that attended the hospital from 8th July 2005 to 16th Sept 2005. Those patients with high BP greater than 250/100mmHg were excluded. Findings The survey revealed that 46% had their BP controlled to 140/90, 25% fairly controlled to 150/90 and 29% not controlled. Management of hypertension in the hospital needs to be improved according to WHO-ISH to reduce percentage of uncontrolled blood pressure. There was no classification into grades e.g. .grade 1,2 and 3. No stratification into low, moderate and high risk on the medication card. Complaints from patients about side effects were not adequately addressed. Non adherence was exhibited by some patients on the account of adverse effect of drug, quantity of pills per day to be taken, cost of medicine and inadequate drug information. Review and monitoring were not regularly performed. Medicines were not rationally prescribed all the time. The study identified the factors that contributed to the inappropriate management of hypertension and made recommendations. Conclusion The management of hypertension is a challenging medical practice in Swedru District Hospital. Factors contributing to inappropriate management of hypertension include, lack of classification to grades and lack of stratification of risk. The others were inadequate education on the lifestyle modifications and on medicines ; no regular review and follow-up and finally irrational medicine prescription . Recommendations The following interventions were recommended. Routine classification of BP and stratification of risk factors should be written on the medication card of all hypertensive patients. Strict adherence to developed protocol on punctual appointment (review) and monitoring of laboratory investigations. Protocol on treatment targets and on non pharmacological advice for lifestyle modification. The others were routine measurement of BP of all patients to the hospital to increase detection and treatment of undiagnosed hypertension, and determination of BMI of all patients.

Source: KNUST