Prevalence of Uncontrolled Blood Pressure and Drug Related Problems in Adult Hypertensive Patients: A Comparative Study and Drug A

Background: DRPs are one of the major challenges to health care providers as this may affect morbidity, mortality and patients’ quality of life. Objective: This study aimed to compare the prevalence of uncontrolled blood pressure and drug therapy problems in two Nigerian tertiary institutions. Methods: This was a retrospective cross sectional study carried out in the Department of Internal Medicine, University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu state and Federal Medical Centre Lokoja (FMCL), Kogi State, over a period of two months (June1, 2019- July 31, 2019). Ethical clearance for the study was obtained from the Health and Research ethics committee of both hospital. A well designed proforma adopted from similar studies was used to collect patients’ socio-demographic and clinical variables from their folders. Pharmaceutical Care Network Europe (PCNE) Classification tool Version8.02 (PCNE, 2010) was used to document the types and causes of Drug therapy problems. The data cleaning was conducted in Microsoft excel after which information were exported and analysed using the Statistical Package for Social Sciences (SPSS for windows, Version 16.0. SPSS Inc. 2007.Chicago, USA) software. Continuous data were presented as mean ± standard deviation while categorical data were presented as percentages and frequencies. uncontrolled blood pressure was 1:1.02 for UNTH and 1:0.601 for FMCL. FMCL recorded a percentage of patients with uncontrolled blood pressure. Older patients had more DTPs than the younger ones and this was statistically significant. Blood pressure control was associated with age in both study centres as increase in age decreased blood pressure control and this was statistically significant. Conclusion: Blood pressure control in both centres were below average while prevalence of DRPs was high in both centres too. An educational interventional programmes is recommended to enlighten patients on the need adopt lifestyle modifications to control their blood pressure and the dangers of uncontrolled blood pressure. Comparative


Eligibility Criteria
The inclusion criteria were: a) Hypertensive patients who received care from January 1, Sample size and selection: The entire patient folders that met the eligibility criteria were included in the study.

Data Collection
A well designed proforma adopted from similar studies was used to collect patients' socio-demographic and clinical variables from their folders. Pharmaceutical Care Network Europe (PCNE) Classification tool Version8.02 (PCNE, 2010) was used to document the types and causes of Drug therapy problems.

Data Analysis
The data cleaning was conducted in Microsoft excel after which information were exported and analysed using the Statistical

Results
From Also, a majority of the patients at both study centres were married and had a source of income (Table 1). From Figure 1, UNTH had an almost equal distribution of patients with controlled and uncontrolled blood pressure, while FMCL had a majority of patients with uncontrolled blood pressure ( Figure 1).

Figure 1:
Distribution of blood pressure control between the two centres.
From Table 2, A majority of the patients who were aged 56-65 years had their blood pressure uncontrolled in b UNTH and FMCL and this was statistically significant (p= 0.018 and 0.012 respectively). Also, singles and widowed who had uncontrolled blood pressure were more than those that had controlled blood pressure in both UNTH and FMCL and this was statistically significant (p= 0.010 and 0.048 respectively) ( Table 2). From Figure 2, the most common type of drug related problem encountered in UNTH was untreated indication while the least type of DRP was adverse drug event. Whereas the most common type of DRP encountered in FMCL was effect of drug not optimal while the least type of DRP was untreated indication (Figure 2).

Figure 2:
Types of Drug therapy problems encountered in UNTH and FMCL.
From  (Table 3). were found among those who were married and this was also statistically significant. Also increase in DRP was seen in increased number of co-morbid states and in patients receiving more than one antihypertensive medication (P <0.001) ( Table 4). wall stiffness, decreased baroreceptor sensitivity, increased responsiveness to sympathetic nervous stimuli, altered renal and sodium metabolism which are associated with aging could be a reason why hypertension is more prevalent in older adults [12].
Also, the ratio of controlled blood pressure to uncontrolled blood pressure The most common type of DTP found in UNTH was untreated indication while the most common type of DTPs found in FMCL was drug treatment not optimal. This could be the reason why FMCL reported a higher proportion of patients with uncontrolled BP than UNTH. Older patients had more DTPs than the younger ones and this was statistically significant. This could be because older patients have a likelihood of having more co-morbid conditions and this will invariably expose them to more number of drugs. Increase in the number of drugs has been found to lead to an increase in DTPs. Although the female patients had more DTPs than the male, it was not statistically significant. Unsurprisingly, smokers had more DTPs than non-smokers. This could be explained by the fact than smoking could predispose one to more ailments which can lead to increased number of medications. Also, patients who were on more than one antihypertensive medication encountered more DTPs.
This is because increased number of drugs can lead to an increase in drug-drug interactions.