ABSTRACT
Introduction: Despite the availability of multiple effective antihypertensive drugs; hypertension control rates remain poor. The reasons for this are complex; but increasingly; physician inertia has been identified as a crucial factor. In this study we attempted to define the level of blood pressure (BP) control and reasons for not achieving control in a survey of selected general practices within South Africa. Methods: This was a multi-centre; cross-sectional disease study involving 15 selected general practices throughout South Africa. Treated hypertensive patients over 18 years old were eligible for inclusion. The study was approved by Pharma Ethics; and after informed consent; consecutive hypertensive patients at the participating general practice centres were included; with each centre enrolling 30 patients. Results: A total of 451 patients; from 15 sites in South Africa; were entered in the study. The mean age of the patients was 60.7 years; 56.3were female and 15.7were current smokers. The BP was reduced by 26.4/17.6 mmHg (p 0.001) in 220 patients with a documented initial BP. Co-morbidities were present in 322 (71.4) patients and overall; 37.9had more than one co-morbidity. Lifestyle modification was not uniformly applied; with only 46.1; 59.6 and 56.8receiving advice about weight loss; exercise and diet; respectively. Less than a third (30.7) of patients were on monotherapy; 42.8were on two drugs (25.9on fixed-drug combination and 16.9on free combination) and 26.5were on more than two agents. Most (86.9) practitioners used either international or local guidelines to determine target BP. Overall; 61.2of patients were at goal (BP 140/90 mmHg). If a stricter target BP (BP ? 130/80 mmHg) is applied to patients with co-morbidities; as recommended by the guidelines; 60.6of patients did not reach goal. Of the 175 patients not at target BP; there was no action plan in 22.9; while 39.4were advised to undertake lifestyle changes only. Conclusions: Control rates were quite good in comparison with other surveys within and outside South Africa. However we were able to define several important deficiencies: there was evidence of physician inertia and also practitioners need to be more cognisant of local and international guidelines to optimise treatment