ABSTRACT
Worldwide, hypertension remains one of the most significant causes of morbidity and mortality. Despite the substantial public burden of hypertension coupled with the sustained government efforts in controlling the disease among hypertensive patients, there is still slow progress in the prevention and control of the ailment. The majority of patients still have uncontrolled blood pressure levels, with a significant number having life-threatening complications. The malady continuously subjects patients to immense suffering as it affects their health, predisposing them to life-threatening complications such as heart failure and even stroke in their 50s. Most countries, especially in the global south, have reported uncontrolled blood pressure levels among hypertensive patients despite anti-hypertensive drugs. This study, therefore, aims to investigate the clinical management of hypertension in adult patients by healthcare providers in Kakamega County, Kenya. The Specific objectives will be threefold: To assess patients' factors that influence the clinical management of hypertension in Kakamega County. The second one will examine the health care provider's factors that influence the clinical management of hypertension in Kakamega county. The third specific objective is to determine health system factors influencing clinical management of hypertension in Kakamega county based on clinical guidelines of 2018. The researcher will employ a cross-sectional analytical study design in multiple study sites. The pilot study will be carried out in the Vihiga county referral hospital. The primary study will be carried out in both tier 2 and tier 3 public, together with private hospitals in Kakamega County. Data will be collected from both the patients and the health care providers. The study will employ the use of a questionnaire and an observation checklist. Analysis of the collected data will be by the Statistical Package for Social Science (SPSS) version 28. Logistic regression will be used to identify factors associated with uncontrolled blood pressure and prognosis. Research participants will be required to sign a written consent.
Important thing to note is the polypharmacy needed in hypertensive patients.
Roughly about 0ne third of the patient presenting to hospitals need one drug, one third need 2 drugs, while one third need 3 or more drugs to control the BP to target.
Another reason for poor control are the myths and misconception: people tend to stop medications when it is controlled, or take medications only when they have symptoms. Of course, affordability is one of the issue (1).
1. Article Compliance of drug thrapy and reasons for non-compliance amo...
Treatment of hypertension is a stepwise approach. We have to follow what guidelines (AHA) states. Race states are also important as the African population > 55 yrs of age we have start with Calcium channel blocker if the patient doesn't have any comorbidity. It's the stepwise approach. This is the first step. In step 2 if HTN was not controlled start with CCB+ ACEI/ARB or thiazide-like diuretics. In step 3 CCB+ ACEI/ARB + thiazide-like diuretics. Step 4 will be resident HTN.
Although this may be more true in the western world, the risk of atherothrombotic disease (ATD) in people with hypertension depends on it associated ATD risk factors: cigarette smo0king and dyslipidemia, with some contribution from the very high blood glucose levels of uncontrolled diabetes. Please see my paper in EC Cardiology 7.3 (2020):1-19.
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