Compliance to hypertensive prescribing guidelines and blood pressure control in elderly patients in Namibia: findings and implications

Shylet Mashozhera, Samuel Bamitale Kayode, Brian Godman, Dan Kibuule

Research output: Contribution to journalArticle

Abstract

Objective: Resources-limited countries in sub-Saharan Africa are facing a crisis of hypertensive-related morbidity, mainly due to poor blood pressure (BP) control. The study aimed to evaluate BP control and hypertensive prescribing for elderly patients in a resource-limited setting. Methods: Hospital-based survey assessing hypertensive prescribing practices among elderly patients (age, ≥60years) at a leading ambulatory care clinic in Namibia. The primary and secondary outcomes were compliance with prescribing guidelines, prescribing patterns and BP control respectively. Data were collected using patient exit interviews and a review of their prescription records. Data were analyzed using descriptive statistics using SPSS v25. Key findings: Of the 189 elderly patients recruited, 69.3% were females, mean age was 70.3±8.5 years and 2.6% had HIV. 61.4% of the prescriptions complied with the prescribing guidelines in terms of treatment choice and 78.3% (n=148) had a poor BP control. 61.4% had at least one comorbidity, mainly diabetes mellitus (32.2%) or cardiac disease (20%). On average, 4.5 medicines were prescribed per patient and 4.8% were out of stock. Prevalence of non-INN prescribing was 64%. Diuretics, renin-angiotensin inhibitors were the most prescribed antihypertensive, 73.9% (n=138/189) and 51.9% (n=98/189) respectively. 90% of patients with good BP control were on ≥3 medicines compared to 77% for patients with poor BP controlled. Conclusion: Whilst compliance with prescribing guidelines is modest, the sub-optimal BP control, high prevalence of co-morbidities and over prescribing with non-INN products is discouraging. Pharmacist-led medication audits could improve hypertensive prescribing and BP control among elderly patients, and we will be following this up
Original languageEnglish
Number of pages13
JournalJournal of Pharmaceutical Health Services Research
Publication statusAccepted/In press - 9 Oct 2020

Keywords

  • elderly
  • hypertension
  • prescribing
  • treatment guidelines
  • Namibia

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