A retrospective study of physician-managed hypertension in a tertiary hospital in Southwestern Nigeria
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Abstract
Background: Hypertension is a cardiovascular disease of public health concern that has caused severe mortality and morbidity. Information on costs of managing hypertension is very essential. Data on factors that influence physicians' choice of antihypertensive drugs are scarce.
Objectives: To determine costs and classes of antihypertensive drugs used by physicians and assess factors that influence physicians' choice of such drugs in a tertiary hospital in Southwestern Nigeria.
Methods: Six hundred and eighty-four case notes of hypertensive patients were retrospectively reviewed within a three-month period. A prospective interaction with 85 randomly selected physicians was undertaken using a pretested questionnaire to obtain their demographic characteristics and their views on the class of drugs used in managing hypertension. Data were summarized using descriptive statistics. Inferential statistics was used to determine the associations between variables.
Results: Physicians and patients mean ages were 45.74±10.63 and 65±11.12 years respectively. Average monthly costs of antihypertensive drugs in patients without and with comorbidities were $9.11±0.15 USD and $12.56±0.06 USD, respectively. These different costs were significant at p=0.001. Classes of antihypertensive drug used were thiazides (60.8%), calcium channel blockers (57.6%), angiotensin converting enzymes inhibitors (50.7%), α-blockers 15.2%), and β-blockers ( (6.1%). Physicians' choice of anti-hypertensive medications was significantly influenced by cost of medication (p=0.003), patients' economic status (p=0.004), presence of comorbidities (p=0.026), among others.
Conclusion: Cost of managing hypertension was high compared to average monthly income of patients. Classes of drugs used were in line with JNC 7 guidelines. Physicians' choice of medications was mostly influenced by costs of medication, patients' physical and economic status. The implications of these findings in clinical practice are that physicians should continue to focus more on generic prescribing and substitution as cost-reduction strategies.
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