Patterns and characteristics of hypertension pharmacotherapy in Zimbabwe
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Background: Hypertension is a non-communicable chronic disease that has been increasing in prevalence in developing countries in the last decade. On a global scale, mortality attributed to hypertension remains high (14%) affecting at least one billion people in the world; and approximately 80 million people in Africa. In Zimbabwe the prevalence of hypertension is currently estimated to be 27% of the total population; which is higher than HIV and Tuberculosis. As such successful management of hypertension is essential to reduce mortality from hypertension and associated complications. Systematic collection of information about hypertension pharmacotherapy is paramount to optimising patient care. Objectives: The aim of this research was to investigate the patterns and characteristics of hypertension pharmacotherapy.The specific objectives were:(i) to determine the patterns of use of anti-hypertensive drugs, (ii) to determine the commonly experienced adverse effects, (iii) to assess the extent to which patients are compliant with drug therapy, (iv) to ascertain knowledge, attitude and practice about hypertension and drug therapy and (v) to assess drug accessibility. Methodology: A purposive sampling technique was used to recruit a sample of 400 patients with hypertension aged 18 years and above. The participants were from twenty randomly selected private pharmacies, Harare Central Hospital outpatients’ pharmacy and Parirenyatwa Group of Hospitals outpatients’ pharmacy. A structured questionnaire was used which was administered through interviews by the chief investigator and four trained research assistances. Data was analysed using SPSS- frequencies, descriptive statistics, cross tabulations, hypothesis testing and regression analysis. Results: Systolic blood pressure of 57% of the participants was not under control. Age, body-mass index, waist size, alcohol taking, smoking, diabetes were some of the key individual characteristics that were found to explain hypertension. Hydrochlorthiazide, Nifedipine, Enalapril, Furosemide, Atenolol, Losartan, Amilodipine and Spinorolactone were the commonly used drugs. The commonly experienced adverse effects included headaches, dizziness, oedema and sexual dysfunction.Although Patients were taking drugs accordingly in terms of dosing and frequency 41% were not persistent. Lack of money and side effects were the main reasons for stopping drugs. Nineteen percent stopped taking medicines when they feel their blood pressure was under control. On assessing knowledge, 34% of the participants did not know that hypertension is not curable. Sixty percent of the patients were not able to mention a single risk factor, complication or preventive measure and 47% did not know the normal range of blood pressure. Only 11% had home BP machines. Thirty-seven percent indicated that they use drugs only for the management of hypertension. Lifestyle modification like diet, exercise, and weight control were being practised by a few people. Herbs were also being used to control HBP. Although drugs were readily available in the private sector, participants cited affordability problems. Conclusion: The study has shown that current treatment practices to manage hypertension are not adequately controlling the condition in those affected. Intervention programmes which encourage healthy life- style, provision and supply of various drugs, patient education, counselling services and a national chronic diseases management policy are required to improve hypertension pharmacotherapy.