Hypertension; ecological factors, control and complication in Urban Sohag, Upper Egypt

ABSTRACT

Because of the associated morbidity, mortality and the cost to societies, hypertension is an important public health challenge being the most common worldwide disease-affecting human. To study the clinical characteristics, therapeutic regimens, compliance with treatment, risk factors and target organ damage of hypertensive patients among people > 35 years old. A cross sectional study; conducted in Sohag city; it involved 520 patients; males [45.7%] and females [54.3%]. Their ages were 35 to 85 years. Hypertension presented more between non-smokers [72.55%], females [54.3%], educated patients [50.99%] and patients with low SES [54.9%]. ECG of hypertensive patients showed that ischemia presented in [51.63%] of patients, while their laboratory investigations showed that hyperglycemia presented in [28.7%], anemia in [18.3%], high serum creatinine level presented in [8.49%] and proteinuria in [10.45%] of patient. Adequate BP control was found to be achieved in [49.67%]; older patients had lower adequacy of BP control in spite of the extensive use of multiple-drug therapy and of appropriate drug choice. This is probably due to high prevalence of a difficult to control form of hypertension and poor compliance with the multiple-drug regimen. Most hypertensive patients had more than one coexistent CV risk factor. Aging, being a female [54.3%], diabetes, family history of hypertension [28.7%], smoking [27.45%], family history of coronary heart disease [25.4%], and obesity [10%] were of the contributing risk factors .About 72% had target organ damage. Heart involvement was the most frequent finding [63.39%]; coronary heart disease was the most common heart damage [51.63%]. ACE-inhibitors were prescribed in [58.16%]; mostly capotril and zestril. Beta-blockers were used in [34.64%] of the patients, Ateno is the drug mostly used in this group. Monotherapy was prescribed for [41.17%] only of the patients. Fortunately [75.81%] of patients showed regular use of their drug regimens. It was observed that [49.67%] only of patients had their condition under control, the number of drugs was inversely related to BP control. Hypertensive patients in Sohag city had a profile of high CV risks, target organs damage and poor blood pressure control particularly in the elderly. Great efforts towards improving the compliance of both service providers with guidelines and patients with treatment must be done. A multidisciplinary approach for routine clinical check up, follow-up, training, prescribing simple once-daily regimens and encourage life style modifications; all to optimize patient outcomes and prevent disease