Epidemiology of Hypertension Mutare City Clinics_Research

Background: Poor control of BP can lead to increased incidence of cardiovascular conditions and their complications. The study aimed to determine the level of control of hypertension among clients accessing care at Mutare City Clinics, Zimbabwe. We also sought to ascertain the demographic and clinical factors associated with achievement of BP control among hypertension clients seen in the urban public sector clinics in Mutare.

Methods: An analytical retrospective survey utilizing secondary data analysis was carried out employing a census of all data derived for the period 1 January to 31 December 2016 from the Out-Patients Department (OPD) registers in 5 of the 7 council owned clinics in Mutare City. Data from the remaining two clinics were excluded from the analysis because they were incomplete. Data was obtained for a total of 905 records, however final analysis was limited to a sample size (n) of 456 after excluding records that were incomplete. The outcome variable was ‘achievement of BP Control’ (as informed by the JNC 8 Treatment Algorithm for adults aged >18 (James, Ortiz, et al. 2014)]. The independent variables used in this study were categorized into two groups: demographic and clinical factors. The first part of the analysis was primarily descriptive, where prevalence of BP control was calculated and trends of demographic and clinical features of hypertension patients were described.  In the second part, binary logistic regression models were fitted to examine the associations between the independent variables and the outcome variable. Prevalence and odds ratios with 95% confidence intervals (95% CI) were calculated using Epi Info Version 7.

Results: A total of 456 records were reviewed in this study [males=121 (27%); females=335 (73%)]. Fifty-six percent (56%) of patients exhibited adequate BP control as defined by the JNC 8 Guidelines. The mean systolic blood pressure (SBP) was 130±14 mmHg in those who had controlled BP and 164±20 mmHg in patients whose BP ‘was uncontrolled’. Participants with controlled BP had a mean diastolic blood pressure (DBP) of 79±10 mmHg whilst their counterparts who had uncontrolled BP had a mean DBP of 96±16 mmHg.

In terms of demographic factors, no significant difference in BP control was demonstrated with respect to gender, type of residential area and individual facilities visited. However, patients who were older than 60 years had higher odds of controlled BP readings when compared to those below the age of 60 (OR: 1.91; 95%CI: 1.29-2.83; p-value: 0.001).

The majority of records of antihypertensive medication resupply visits indicated that the patients were asymptomatic at the time of the visits (n=294, 65%). Most of the 162 records of hypertensive patients who visited the clinic with symptoms revealed that they presented with headache (n=72; 44%) followed by general body malaise (n=29; 18%).  The patients who presented for resupply with symptoms were less likely to have controlled BP when compared to their asymptomatic counterparts (OR: 0.58; 95%CI: 0.39-0.87; p=0.008).

Majority (89%) of patients who had been initiated on medication were on Hydrochlorothiazide (HCT) in accordance with the EDLIZ guidelines for 1^st-line treatment. Sixty-nine percent (n=244) of participants on medication were on monotherapy. No statistical significance was elicited in the relationship between number of medications prescribed and achievement of BP control.

Conclusions: Given the relatively low BP control rates in Mutare City Clinics, there is urgent need for a plan to control BP to at least above the targeted rate of 61.2% by 2020 in accordance to the Healthy People 2020 Leading Health Indicators target (ODPHP, 2014). Our findings show less likelihood of control in younger patients aged less than 60 years suggesting that more interventions aimed at controlling BP  should target younger hypertensive patients and there is need to educate clients on the importance of regular monthly check-up clinic visits. Completeness of data was a major barrier in data collection and analysis for this study. The high number of incomplete data in registers at clinic level in Mutare is of major concern. Health providers must be encouraged to record all BP measurements in relevant registers to help in evaluation of interventions as well as monitoring hypertension outcomes. Lastly, health managers must provide clinics with adequate material and human resources to promote completeness of data and improve client loyalty.