Awareness and Utilization of Guidelines in the Management of Hypertension among Medical Practitioners in a Tertiary Hospital in Nigeria

Background: Hypertension is a public health problem in Sub-Saharan Africa, as it is responsible for increased cardiovascular morbidity and mortality. The need to improve the global control of high blood pressure and mitigate its complications has necessitated the stipulation of various treatment guidelines. In recent times, it includes those of European Society of Hypertension (ESH), the Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of Hypertension (JNC VII), and the National Institute for Health and Care Excellence (NICE) guidelines. The aim of this study is to determine the level of awareness and utilization of management guidelines in the treatment of hypertension among medical practitioners in a tertiary hospital.

Methodology: A cross sectional descriptive study design was chosen and a structured questionnaire was developed and administered. A total of seventy medical practitioners had analyzable data.

Results: Most of the respondents (87.0%) were aware of the existence of treatment guidelines in the management of hypertension, but only 68.1% routinely use any of the available guidelines in their practice. The most frequently used guideline was the JNC VII treatment guideline (64.7%) followed by NICE guideline (25%), and ESH guideline (17.6%). Among the medical practitioners, the utilization of guidelines was mostly for the management of hypertensive-diabetics (63.8%), followed by their use in the management of hypertensive-chronic kidney disease patients (34.8%), and then in essential hypertensive patients (39.1%). Most of the practitioners however, combined the use of therapeutics and life style modification (75.4%).

It was observed that with increase in level of education, awareness also increased, with the senior registrars been most aware (94.1%), and the least aware been the interns (78.1%). The interns however, routinely utilized the guidelines more than the registrars (65.6% versus 64.3%) although this was not statistically significant (p=0.231). Although most of the participants considered the guidelines appropriate for the management of hypertension in our environment (73.1%) they however feel the training they have received in the course of their training was not adequate (81.2%).

Conclusion: Medical practitioners in this hospital fairly complied with stated guidelines especially when there is co-morbidity, but feel they may require more formal training in the use of these guidelines in order to better manage their hypertensive patients. The findings should serve as a starting point to design new teaching paradigms to increase physician awareness of hypertension treatment guidelines in Nigeria in particular, and in Africa and the developing world, in general.