dc.contributor.author | Mwangi, K Robert | |
dc.date.accessioned | 2013-05-25T06:27:01Z | |
dc.date.available | 2013-05-25T06:27:01Z | |
dc.date.issued | 2006 | |
dc.identifier.citation | Master of Pharmacy Degree in Clinical Pharmacy | en |
dc.identifier.uri | http://erepository.uonbi.ac.ke:8080/xmlui/handle/11295/25527 | |
dc.description | A dissertation submitted in part fulfilment of the requirements for award
of a Master of Pharmacy Degree in Clinical Pharmacy of the University of
Nairobi. | en |
dc.description.abstract | Background to the study
Hypertension is an important public health challenge in both economically
developing and developed countries. Significant numbers of individuals with
hypertension are unaware of their condition and, among those with
diagnosed hypertension, treatment is frequently inadequate.
This global pandemic is of great public health concern because hypertension
is the single most important cause of attributable mortality. It is a key
contributory factor in the development of cardiovascular and
cerebrovascular disease, and a major cause of stroke, myocardial infarction,
heart failure and kidney disease.
Results from a large number of randomized clinical trials document
conclusively that treatment of elevated systolic and/or diastolic blood
pressure markedly reduces the risk of cardiovascular complications . Several internationally recognized guidelines for management of
hypertension exist, each aimed at giving information obtained from the latest
research to ensure proper management of patients. The purpose of this study
therefore is to find out the extent these guidelines are adhered to in the
management of high blood pressure at KNH's out patient department.
Objectives of the study
1. To document the, drugs commonly used in the treatment of
hypertension.
2. To determine whether these drugs are rationally prescribed.
3. To compare management of hypertension at KNH with
recommendations from international guidelines.
Methodology
The study was a retrospective description of 288 patients treated for
hypertension at the medical out-patient clinic in KNH in the year 2007
The outpatient booking list for January to December 2007 was used to get
file numbers for patients who attended the MOpe in 2007. The list of file
numbers was used to retrieve a total of 2144 files.
Sequential sampling was applied to obtain a total of 288 files for patients
with hypertension fitting the inclusion criteria.
Data from patient records were entered into data collection forms and keyed
into a computer database using MS Access for analysis with SPSS 16.0.
Results
73.7% of patients were female and a majority were in the middle age and
elderly populations. 55 % of patients were aged between 46-65 years, and
27% above 65 years. Most patients did not have any co morbidities, but
hypertensive heart disease was leading among co morbidities affecting 20%
of the patients.
Various drug classes of antihypertensive drugs were used during the study
period. Diuretics were the most frequently prescribed drugs accounting for
32.3% of all prescribed drugs not in combination. The next category was
Beta blockers, 20.7% of all prescriptions; followed by CCB at 19.6% of
prescribed drugs. Fixed Dose Combinations were 15.3 % of prescribed
drugs.
Prescription of the above drugs was rational in 78% of the 1140
hypertensive visits considered for the 288 patients from January to
December 2007.
Lower blood pressures were attained in those with mild hypertension at first
presentation (mean pressure 138/87 mmHg) compared with moderate
(144/90) and severe (149/93) mmHg.
Conclusion
In this study prescribing practice was consistent with local (MOR) and
international guidelines (JNC and ESCIESR) in choice of drugs, where the
recommended diuretics and Beta blockers were prescribed at a much higher
frequency than newer agents (ACEI and ARB's).
79% of drugs were prescribed rationally for patients. 120/0 of the
prescriptions were irrational on basis of factors related to BP of patients.
Recommendations
A study is needed on management of hypertensive patients with comorbidities
that constitute compelling indications for use of particular drug
classes.
Prospective studies on prescription patterns may help get over the hurdles
limiting the retrospective study, including inconsistencies in the data
recorded in patient treatment records. | en |
dc.language.iso | en | en |
dc.publisher | University of Nairobi | en |
dc.title | Prescription patterns in management of hypertension at Kenyatta National Hospital's medical out patient clinic. | en |
dc.type | Thesis | en |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
local.publisher | School of Pharmacy | en |